Parasomnia

Different parasomnias come from different stages of sleep and have different risks and treatments. The Sleep & Attention Disorders Institute diagnoses and treats a full range of parasomnias in adults and children from across Macomb and Oakland counties.

Non‑REM (NREM) Parasomnias

NREM parasomnias arise out of deep sleep and are more common in children, though they can occur in adults as well. During episodes, the person is partially awake but not fully aware and is often very difficult to arouse. Common NREM parasomnias include:

• Sleepwalking: The sleeper gets out of bed and walks around with a blank look; if awakened, they are often confused and disoriented.
• Sleep terrors (night terrors): The sleeper may sit up, scream, or appear terrified and inconsolable shortly after falling asleep; they usually do not remember the event.
• Confusional arousals: The sleeper wakes up partially, seems confused or slow, and may exhibit odd behaviors before fully waking.

Children often outgrow NREM parasomnias, but episodes can be distressing and sometimes lead to injury if the child leaves the bedroom or home. When events are frequent, violent, or associated with potential harm, professional evaluation is strongly recommended.

REM Sleep Behavior Disorder (RBD)

REM sleep behavior disorder is a parasomnia where the normal paralysis of muscles during REM (dream) sleep is lost, allowing people to act out their dreams. The dreams are often vivid and may involve being chased or attacked, and the sleeper may shout, punch, kick, or leap out of bed.

RBD is more common in older adults and can be associated with neurologic conditions, certain medications, and other sleep disorders. Because injuries to the sleeper or bed partner are common, REM sleep behavior disorder should always be taken seriously and evaluated at a specialized sleep clinic.

Other Sleep‑Related Behaviors

We also evaluate and manage other abnormal sleep behaviors, including:

• Sleep‑related eating
• Sleep‑related sexual behaviors (sexsomnia)
• Nightmares
• Rhythmic movement disorders (such as head‑banging or body rocking in sleep)

Seizures and other medical or neurologic conditions can mimic parasomnias, which is why an accurate diagnosis is essential before deciding on a treatment plan.

Some parasomnias are mostly disruptive and frightening, while others can be physically dangerous. Sleepwalking, REM sleep behavior disorder, and other complex behaviors in sleep can lead to falls, injuries, leaving the house, or striking a bed partner. Even when no injury occurs, parasomnias can:

• Disturb the sleep of the entire household
• Increase anxiety and stress for family members
• Make people fearful of going to sleep
• Interfere with relationships and daily life

Because seizures and other serious conditions can look similar to parasomnias, and because safety is a real concern, persistent or violent sleep behaviors should be evaluated by a sleep specialist in a fully accredited sleep clinic.

Parasomnias often result from a combination of brain, sleep, and environmental factors. At the Sleep & Attention Disorders Institute in Sterling Heights, we look for underlying causes so we can treat more than just the visible behavior. Factors that can trigger or worsen parasomnias include:

• Sleep deprivation and irregular schedules
• Other sleep disorders, such as sleep apnea
• Fevers or illness, especially in children
• Stress and anxiety
• Certain medications, alcohol, or substances
• Neurologic conditions (particularly with REM sleep behavior disorder)

Because sleep apnea is common and can coexist with parasomnias, we frequently screen for and treat sleep apnea in patients who present with abnormal nocturnal behaviors. Treating sleep apnea sometimes reduces or resolves related parasomnia events.

A careful history is the first step, including detailed descriptions from the person who experiences the episodes and from family members or bed partners who witness them. We ask about timing, frequency, specific behaviors, potential triggers, and any history of injury or dangerous situations.

When needed, we recommend an overnight sleep study (polysomnography) with video monitoring at our Sterling Heights sleep clinic. During this test, we can:

• Record brain waves to determine sleep stages
• Monitor breathing and oxygen levels to check for sleep apnea
• Track heart rhythm and leg movements
• Capture video of behaviors during the night

Video‑EEG monitoring helps distinguish parasomnias from nocturnal seizures and other neurologic events. Once we understand exactly what is happening and which sleep stage the events occur in, we can recommend the safest and most effective treatment.

Parasomnia treatment at the Sleep & Attention Disorders Institute focuses on safety, treating underlying causes, and reducing the frequency and severity of episodes. Depending on your specific condition and medical history, your treatment plan may include:

Safety and Sleep Environment

• Making the bedroom safer (removing sharp objects, securing windows and doors, using low beds or placing a mattress on the floor)
• Ensuring bed partners have enough space and protection in cases of REM sleep behavior disorder
• Addressing sleep deprivation and maintaining a regular sleep schedule

Treating Underlying Conditions

• Treating sleep apnea with CPAP or other appropriate therapy when present
• Reviewing and adjusting medications that may trigger or worsen parasomnias
• Managing stress, anxiety, or mood disorders that fuel nighttime.

Medications When Needed

When events are frequent, severe, or associated with risk of injury, medications may be recommended. Options vary depending on the type of parasomnia and may include medicines that:

• Reduce dream enactment behaviors in REM sleep behavior disorder
• Stabilize sleep–wake transitions in NREM parasomnias
• Treat underlying conditions such as anxiety or neurologic

Medication is typically used alongside safety measures and sleep‑behavior strategies, not as a stand‑alone treatment. Our goal is always to use the lowest effective dose and to monitor patients closely over time.

The Sleep & Attention Disorders Institute is a fully accredited sleep clinic with decades of experience diagnosing and treating complex sleep disorders, including parasomnias. We are uniquely positioned in Michigan to evaluate both sleep disorders and attention‑related problems that can coexist with nighttime behaviors.

From our location at the corner of Sterling Heights, Troy, Rochester Hills, and Shelby Township, we serve patients from communities across Macomb and Oakland counties, including Warren, Clinton Township, Macomb Township, Bloomfield Township, Royal Oak, Pontiac, and the Greater Detroit area. We offer:

• Expert evaluation and diagnosis of parasomnias in adults and children
• In‑lab sleep studies with video monitoring in private, comfortable bedrooms
• Comprehensive treatment plans focused on safety, underlying causes, and effective symptom control
• A reputation as a trusted sleep clinic in Sterling Heights, Michigan, for more than 25 years