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Narcolepsy and Parasomnias

Posted on June 07, 2021
Medically reviewed by
Allen J. Blaivas, D.O.
Article written by
Brooke Dulka, Ph.D.

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, dysregulated sleep cycles, and, in some cases, cataplexy (sudden muscle weakness). Another group of sleep disorders, known as parasomnias, are characterized by sleep disturbances such as sleepwalking, sleep terrors, or sleep-related eating disorders. Although narcolepsy and parasomnias have their differences, they can overlap and occur alongside each other.

What Are Parasomnias?

Parasomnias are disruptive sleep-related disorders. They involve abnormal talking, moving, or other actions carried out before falling asleep, during sleep, or upon waking, such as:

  • Sleepwalking
  • Sleep talking
  • Sleep terrors
  • Nightmare disorder
  • Sleep-related eating disorders

Parasomnias are categorized by the stage of sleep they are associated with. They can occur during rapid eye movement (REM) sleep and non-REM (NREM) sleep.

Parasomnias and Non-REM Sleep

Parasomnias that occur during NREM sleep tend to involve physical actions and verbal behaviors. These types of parasomnias include the following.

Sleepwalking (Somnambulism)

Sleepwalking involves walking around, moving things, and performing other complex actions while actually asleep.

Sleep Terrors (Night Terrors)

Night terrors involve waking up suddenly in a state of great fear. Sleep terror episodes are brief (lasting about 30 seconds) and feature increased heart rate, dilated pupils, and rapid breathing.

Confusional Arousal

Confusional arousal is a dissociated state that features characteristics of both sleep and wakefulness — you may appear to be awake, but you’re disoriented and your behavior is strange. Later, you may not remember what happened during the arousal from sleep.

Sleep-Related Eating Disorder

A sleep-related eating disorder is marked by a compulsion to eat (usually high-calorie food) while in the midst of sleep. During a sleep-related eating disorder episode, you may have partial consciousness or complete unawareness of your behavior.

Parasomnias and REM Sleep

Parasomnias also occur during REM sleep cycles. The common parasomnias associated with REM sleep include the following.

Nightmare Disorder

Nightmare disorder involves intense dreams that cause terror and anxiety. Stress, extreme tiredness, and alcohol use tend to increase the frequency of nightmares in this disorder.

REM Sleep Behavior Disorder

REM sleep behavior disorder is characterized by acting out or vocalizing your dreams, sometimes violently.

Recurrent Isolated Sleep Paralysis

Sleep paralysis is when you cannot move or are temporarily paralyzed, either immediately before falling asleep or just before waking. Sleep paralysis can happen with or without narcolepsy — without narcolepsy, it’s called isolated sleep paralysis.

There are several sleep parasomnias not associated with specific stages of sleep. These include:

  • Sleep-related hallucinations
  • Bed-wetting (sleep enuresis)
  • Sleep-related groaning (catathrenia)
  • Sexsomnia (in which you carry out sexual acts or vocalizations during sleep)
  • Exploding head syndrome (in which you hear a loud noise in your head at sleep onset or waking)

What Causes Parasomnias?

Parasomnias commonly affect children, but sometimes these disorders persist into adulthood. The causes of parasomnias have been linked to mental health or psychiatric conditions, such as epilepsy or attention deficit hyperactivity disorder. Medications that disrupt sleep — such as antidepressants — can also cause some parasomnias. Research even indicates that parasomnias have a genetic component. Importantly, other sleep disorders — including narcolepsy — can cause some parasomnias.

Can Someone Have Narcolepsy and Parasomnias?

Narcolepsy can cause symptoms associated with several parasomnias. Some researchers have also hypothesized that parasomnias are an early stage of narcolepsy type 2 (narcolepsy without cataplexy). The parasomnias most commonly associated with narcolepsy are sleep paralysis, REM sleep behavior disorder, and sleep-related hallucinations. Narcolepsy and parasomnias can be comorbid, meaning a person can experience both conditions simultaneously.

Treating Parasomnias in Narcolepsy

Like narcolepsy, parasomnias have no cure, but you can manage their symptoms with medications. Benzodiazepine drugs, such as Klonopin (clonazepam) or Xanax (alprazolam), are often first-line treatments for many parasomnias. In general, the following recommendations may help reduce the effects of parasomnias:

  • Maintain good sleep hygiene habits, including following a regular sleep-wake schedule.
  • Avoid recreational drugs and alcohol.
  • Take all medications exactly as prescribed.

A doctor might also recommend psychological therapy or counseling, including cognitive behavioral therapy, to help address symptoms.

Building a Community

MyNarcolepsyTeam is the social network for people with narcolepsy and their loved ones. On MyNarcolepsyTeam, members come together to ask questions, give advice, and share their stories with others who understand life with narcolepsy.

Are you living with narcolepsy or parasomnias? Share your experience in the comments below, or start a conversation by posting on MyNarcolepsyTeam.

References
  1. Narcolepsy Fact Sheet — National Institute of Neurological Disorders and Stroke
  2. Parasomnias and Disruptive Sleep Disorders — Cleveland Clinic
  3. Insomnia, Parasomnias, and Narcolepsy in Children: Clinical Features, Diagnosis, and Management — The Lancet Neurology
  4. NonREM Disorders of Arousal and Related Parasomnias: An Updated Review — Neurotherapeutics
  5. Parasomnias — CNS Drugs
  6. Sleepwalking, a Disorder of NREM Sleep Instability — Sleep Medicine
  7. NREM Sleep Instability in Children With Sleep Terrors: The Role of Slow Wave Activity Interruptions — Clinical Neurophysiology
  8. Confusional Arousals During Non-Rapid Eye Movement Sleep: Evidence From Intracerebral Recordings — Sleep
  9. Sleep‐Related Eating Disorder and Its Associated Conditions — Psychiatry and Clinical Neurosciences
  10. REM Sleep Parasomnias — Principles and Practice of Sleep Medicine: Fifth Edition
  11. Aetiology and Treatment of Nightmare Disorder: State of the Art and Future Perspectives — Journal of Sleep Research
  12. REM Sleep Behavior Disorder: Clinical and Physiopathological Findings — Sleep Medicine Reviews
  13. Lifetime Prevalence Rates of Sleep Paralysis: A Systematic Review — Sleep Medicine Reviews
  14. Parasomnias: Co-occurrence and Genetics — Psychiatric Genetics
  15. Parasomnia as an Initial Presentation of Narcolepsy — Journal of Sleep Medicine
  16. Long-Term, Nightly Benzodiazepine Treatment of Injurious Parasomnias and Other Disorders of Disrupted Nocturnal Sleep in 170 adults — The American Journal of Medicine
  17. Update on Nonpharmacological Interventions in Parasomnias — Postgraduate Medicine
  18. Confusional Arousals — Stanford Health Care
  19. Sleep Paralysis — Stanford Health Care
All updates must be accompanied by text or a picture.
Allen J. Blaivas, D.O. is certified by the American Board of Internal Medicine in Critical Care Medicine, Pulmonary Disease, and Sleep Medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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