Doing things in your sleep, especially if you can’t remember them later, is extremely disconcerting. But, there are a number of medically defined and clear reasons why some people move and talk while asleep.
These conditions are collectively known as ‘parasomnia’. These are problems that stop us from sleeping as we should, especially because of movement or talking. Depending on when during the sleep cycle they occur, the effects may vary.
In this guide, we explore exactly what parasomnia is and the symptoms that define it. These could be anything from waking up and not remembering where you are to becoming aggressive. The symptoms do vary, however, depending on the case.
So, if you’d like to know more about doing things involuntarily while you sleep, read on.
What is Parasomnia?
Table of Contents:
- 1 What is Parasomnia?
- 2 REM Sleep Behavior Disorder
- 3 NREM Sleep Disorders
Parasomnias are a group of sleep disorders. They occur during sleep and are characterized by movement and activity. This activity is unlike normal sleep activity like turning and rolling over.
The most recognizable symptoms include the following:
- Walking during sleep
- Repetitive actions
- Performing simple or complex tasks while asleep
- Being difficult to wake
- Appearing unresponsive to questions
- Becoming aggressive, irritated or annoyed when efforts are made to wake you
- Waking up and not remembering where you are
The most common parasomnia is sleepwalking. However, there are many variants which people aren’t aware of. Your problem could be any one of these. The section below explores a number of parasomnias and their causes.
REM Sleep Behavior Disorder
If you find yourself having conversations while sleeping and not remembering, it might be REM sleep behavior disorder. This results in similar, but subtly different symptoms to sleepwalking. It’s also physiologically different, meaning that it has different physical causes.
REM sleep is colloquially referred to as ‘light sleep’. This is the kind of sleep where you can dream. It’s easy to recognize when somebody is going through REM sleep. You can see their eyes moving around aimlessly in their sockets. They may also mumble and murmur, although usually not speak clearly. This is the stage during which REM sleep behavior disorder, or RBD, can happen.
During normal REM sleep, muscle atonia occurs. This is the medical way of saying that the muscles become slack and can’t move. However, in REM sleep behavior disorder, this doesn’t happen. The person with RBD can, therefore, effectively, act out their dream.
This can lead to a variety of interesting behaviors, including:
- Whispering, talking, shouting and even screaming in your sleep
- Thrashing aimlessly
- Co-ordinated movements
- Fighting, as if fighting somebody in a dream (as is often what people with RBD report)
Because the person is acting out their dream, they may be able to remember certain things. However, this isn’t always the case. Unlike sleepwalking, people with RBD are easy to wake. They may also wake themselves up once they try to stand up, for example. This usually occurs early in the morning, which is when people experience the majority of REM sleep.
What Are the Causes?
Recently, studies have begun to link RBD with various degenerative neurological diseases. These are chronic conditions where the brain very slowly deteriorates. They include problems like Parkinson’s disease and dementia. According to a discussion of the topic in Neuroethics, a particular study found that 2/3 of people who experienced RBD went on to be diagnosed with a degenerative condition.
Scientists think that this may be due to ‘Lewy bodies’, which are abnormal brain lesions. They are deposits of a particular kind of protein, which grow very slowly and destroy brain tissue. Over time, this leads to the serious deterioration seen in conditions like Alzheimer’s disease. At this point in time, scientists aren’t sure why they occur.
During RBD, your behavior is erratic and out of context for anybody who sees you. This is because you’re acting out a dream. The examples of what you do during RBD are therefore limited only by the creativity of your dreams.
If you exhibit any of the following behaviors, the problem may be RBD:
- A movement like kicking and punching, as if fighting somebody in a dream
- Flailing, moving your legs or jumping out of bed during a ‘chasing’ dream
- Making a variety of noises like laughing, crying, moaning, cursing or shouting
If somebody wakes you from your dream, you may be able to remember bits and pieces of the dream. These are normally snatches of the narrative—not full recollection. However, if you don’t fully awake, you won’t be able to remember the behavior in the morning.
Treatment for parasomnia usually is highly effective. The key is to identify which kind of parasomnia is affecting you before beginning treatment. For purposes of treatment, parasomnias are divided into two camps: REM sleep disorders and NREM (non-REM) sleep disorders. Any problem that occurs during deep sleep, or any stage of sleep other than REM, is considered NREM.
Nonpharmaceutical options for the treatment of parasomnia are limited. The normal method of treatment is with clonazepam. Clonazepam is sold under the brand name Klonopin among others. It’s usually used to prevent seizures and panic disorder. However, as a general tranquilizer, it is effective against parasomnias.
According to a study in the journal Psychiatry (Edgmont), clonazepam is effective in up to 90% of cases. Patients take doses of between 0.5 and 1mg just before bed. This is usually enough to prevent parasomnia completely. However, if symptoms persist, it is possible to up the dosage. Toleration does not occur through the use of clonazepam. It is, therefore, an excellent long-term solution.
Melatonin is a common sleep aid. It is a hormone produced by humans and other animals that helps to regulate sleep and wakefulness over the course of a day. Outside of parasomnia, melatonin supplements are used to aid sleep, with positive results. According to the study above, melatonin used at doses of 3 to 12mg can be effective. It’s especially effective when combined with clonazepam.
Specific other pharmaceutical aids may also help. The same study in Psychiatry (Edgmont) suggested that tricyclic antidepressants, levodopa and dopamine agonists may also be effective. You can talk to a doctor or pharmacist to find out more.
NREM Sleep Disorders
NREM sleep disorders occur while the body is in deep sleep, also known as slow wave sleep. Slow wave sleep, or SWS, is a period of low brain activity. SWS is measured in Hz (Hertz), a measure of frequency in cycles. Put simply, the brain is largely inactive: you’re not dreaming, thinking or moving during regular SWS. But when you’re awoken during this phase, you can act strangely.
Everybody’s familiar with sleepwalking. Most people have either walked in their sleep before or know somebody who has. Your first experience with sleepwalking might have been hearing a relative walking around downstairs, and perhaps talking to themselves. This can be scary for the people who hear it. But it’s not as upsetting as waking up somewhere unfamiliar.
Sleepwalking is referred to medically as somnambulism. The term comes straight from the Latin and means ‘sleepwalking’. According to a study in PLoS One, sleepwalking is reasonably uncommon. The lifetime prevalence of sleepwalking is 6.9%, although it is more frequent in children.
Contrary to popular belief, there are no health problems associated with sleepwalking. Waking a sleepwalker while they’re sleepwalking cannot cause health problems. However, they may become aggressive if you try to restrain them. Sleepwalking can be mild or severe. Normal cases involve walking around and performing actions.
However, severe/more dangerous cases can involve driving and even violence. The activity of the sleepwalker seems to be guided by their dream. According to a study in the journal Sleep, 71% of sleepwalkers can recall a dream which is associated with their actions. Of these, 24% involved aggression towards the sleepwalker, 54% involved “misfortune” and 84% involved “apprehension.”
That being said, not all sleepwalkers dream and not all sleepwalkers can recall episodes of activity in the morning. If awakened by somebody else, the sleepwalker often remains confused and disoriented for a time.
What Are the Causes?
Sleepwalking is caused by partial arousal (i.e., awakening) during slow wave sleep. During sleepwalking, the brain remains active in some ways but not in others. According to a discussion of the topic in Neuroethics, the body physically prepares itself to enter the deepest stage of sleep. This involves almost completely switching off sensory perception. That’s why it’s difficult to wake a sleepwalker—they can’t see, hear, smell or feel anywhere near as much as a person that’s awake.
However, other kinds of brain activity don’t switch off. In particular, motor activity continues. This means that a sleepwalker can still talk and move. Electroencephalograms—measurements of brain activity—show a mixture of sleep and wakefulness brain patterns. However, why this occurs is unclear and needs further research.
Sleepwalking isn’t just about walking around. There are a variety of movements and behaviors associated with sleepwalking. You might:
- Walk around in performance of a task, or as if searching for something
- Walk around before standing still and staring into the distance
- Perform simple or complex tasks
The majority of sleepwalkers simply walk around in a confused state. Most people grow out of sleepwalking once they reach adulthood.
2) Confusional Arousals
If you’re waking up confused and disoriented, the problem may be confusional arousals.
Confusional arousals are simple to understand. They’re occasions, over the course of a night, where a person wakes up—but not completely. During this time, they feel confused and disoriented. The feeling is similar to that which a sleepwalker feels when they wake up. However, they aren’t necessarily associated with as much activity as sleepwalking.
They result in the following:
- Slow and slurred speech for an extended period of time
- Muddled and confused thinking
- Poor memory—not being able to remember where you are or what you’re doing
That being said, confusional arousals do result in some activity. For example, they may perform small hand movements that wake up a sleeping partner. These include picking at bedding, poking or moving backward and forward.
The confusion begins when a person tries to wake up the sleeper. This could be for any reason: the sleeper may be thrashing, talking loudly or acting strangely. Upon ‘waking,’ the person goes through the confusional arousal described above. In rare cases, a person with confusional arousal may be aggressive and even try to fight the person waking them up.
People who experience confusional arousals won’t remember the episode by the morning. This may explain why you’re doing what you’re doing.
Confusional Arousal Causes
The cause of confusional arousal is unclear. However, what is clear is that it seems to be triggered by things which make deep sleep deeper than usual. According to a review in Neurotherapeutics, they can be triggered by ‘poly-neuropharmacy’: the use of many medications that alter brain function. If this is not the case for you, the problem could be caused by taking a sedative. These include both natural and pharmaceutical sedatives.
Confusional Arousal Examples
Confusional arousals are like a bridge between sleep and wakefulness. Examples are therefore strange and absurd and based on dreams. You may wake up thinking that:
- There are beetles, snakes or flies in the bed
- You think you’re somewhere that you’re not
- You think you’re fighting or arguing with somebody
The examples are limited by the strangeness of dreams.
Nocturnal Sleep-Related Eating Disorder (NS-RED)
A nocturnal sleep-related eating disorder isn’t just basic night-time snacking. It’s a variant of sleepwalking, but the behavior involved is specific: the person is driven to eat. During the night, the person will rouse, for whatever reason. But once roused, they will be unable to sleep properly until they eat.
The person will then automatically head to the kitchen in order to find food. This could be a snack and some soda. But it could also be a meal, in which case the person will cook. This is especially impressive considering that the person is barely aware, or not aware, of their actions.
3) NS-RED Causes
According to a review in Neurotherapeutics, NS-RED has two causes. First, since it’s an offshoot of sleepwalking and confusional arousals, it has the same causes as those two conditions. It’s essentially caused by competing brain functions, some ‘awake’, some ‘asleep’. However, there are also hormonal and biological causes at play.
In normal sleep, the body enters a prolonged fast. The body maintains energy homeostasis—using little energy during sleep. The metabolism slows down, and the appetite disappears. This state lasts until the morning when you get the desire to eat breakfast. This is in contrast to the body’s activity during the day. Your body demonstrates progressive hypoglycemia over the course of 12 hours fasting during the day.
In those with NS-RED, the body’s appetite continues to affect during the night, too. After a person is roused, they will experience a strong desire to eat. People with the condition describe their actions as involuntary and impulsive. In most cases, the person is aware, but not in control of their actions.
However, amnestic NS-RED involves eating without even being aware. The person cannot remember what happened during the night, in the morning. If you’re eating during the night, then, this is likely to be the problem.
Sexsomnia is a genuine condition, as defined by the International Classification of Sleep Disorders, Third Edition. According to a review in Neurotherapeutics, sexsomnia is a variant of sleepwalking and confusional arousals. However, the behavior exhibited by people with sexsomnia largely or solely sexual in nature. This could include attempting to have sex with a partner in bed, or masturbation.
Sexsomnia is a variant of confusional arousals and sleepwalking. It occurs during periods of slow wave sleep, rather than REM sleep. You would, therefore, have forgotten an episode of sexsomnia by morning. It is caused by the same mechanisms as sleepwalking and confusional arousals.
NREM Sleep Disorder Treatments
Conditions like confusional arousals don’t cause you to wake up by themselves. Something causes you to wake up, after which, confusional arousal occurs. The same applies to sexsomnia and NS-RED. By addressing the cause of arousals, you, therefore, prevent the condition from affecting you. There are many natural and non-natural ways to do this.
Masking or blocking noise will prevent you from waking up as often. To do so, you have many options. First, the most obvious is earplugs. But you can also choose from earmuffs, white noise machines and noise-blocking curtains and wall panels. Ask your partner or a family member if you often wake because of noises—if so, consider noise-blocking or masking.
There are many natural supplements available for you to try. Each of them helps you enjoy deeper sleep, which can help prevent arousal in some cases.
These supplements include:
- Valerian Root extract
These natural supplements are easily available and are relatively cheap. You may also want to try herbal teas like chamomile. Chamomile is famed for helping people sleep more deeply. However, it can also cause diuretic effects, which can paradoxically make you wake up more often.
Good sleep hygiene helps people resynchronize their “sleep clock.” This can be effective in preventing waking up during sleep. Good sleep hygiene practices include not using screens before bed, making your bedroom more comfortable and having a set routine. Doing things to make you relax before bed is also helpful.
Which Parasomnia Do I Have?
Identifying what exactly the problem is isn’t easy. That’s because these conditions are overlapping. Sexsomnia, for example, is a variant of sleepwalking or confusional arousals. For the person experiencing the issue, each condition feels similar, too. So how can you tell what the problem is?
Ask for Help
Since you’re asleep, it’s impossible to figure the problem out for yourself. If you have a partner, ask them more about what you tend to do and say while asleep. If you live at home, a family member may also be able to help, or a roommate or housemate. Whatever the case, you can ask them for valuable information to help guide your research.
Ask them the following questions:
- When the problem starts, are you clearly dreaming? Ask them whether your eyes are moving (characteristic of REM sleep).
- Do you talk, or do you talk and move? If you don’t or can’t move, normal muscle atonia during REM sleep may be occurring.
- Have you ever exhibited behaviors of sexsomnia or night time eating?
Their answers should help you narrow down the problem considerably.
Polysomnography is the medical study of sleep. It’s a test with multiple parameters (things that you measure) to identify problems with sleep. A PSG test takes place at a hospital or a clinic. It takes place overnight. During the test, you lie down in a bed, as usual, and fall asleep. However, your breathing, heart rate, muscle activation, eye movements and brain activity will all be monitored.
This will be able to tell the difference between the parasomnias above. REM sleep behavior disorder appears different on an electroencephalogram (EEG—brainwave monitor) to other parasomnias. This is because your body is in a different stage of sleep.
Your first step should be identifying what exactly the issue is. Ask family and friends, as well as your partner, to help you figure out what you do when you sleep. If you’re not sure, talk to a doctor.
Start by trying to prevent waking up during the night as much as possible. Use a combination of supplements and noise blocking/masking to see if it helps. If not, consult a doctor. They will be able to prescribe you clonazepam or other pharmaceutical aids that may dramatically cut down on the amount of parasomnia you experience.