What Are Parasomnias? Symptoms, Types, Causes, Treatment, and Sleep Safety
Updated: 1 day ago
Medically reviewed by *Dr. Baraa Alnahhal, MD* · Last reviewed: October 2026
Quick Answer: What are parasomnias?
Parasomnias are sleep disorders that cause unusual experiences or behaviors while falling asleep, sleeping or waking, such as sleepwalking, sleep talking, nightmares, sleep paralysis and movements during sleep. They can happen occasionally or often. A healthcare provider, often a sleep specialist, can help when disrupted sleep, confusion, injury risk or daytime problems become a concern. [1]
What the research says
Mental-health and neurodevelopmental issues are common in people with non-REM parasomnias. A systematic review of case-control studies found that psychopathological and neurodevelopmental problems were more prevalent in people with non-REM parasomnias (disorders of arousal such as sleepwalking, confusional arousals and night terrors) than in unaffected people, and that non-REM parasomnias were more common among patients with various mental disorders than in the general population. Medications did not significantly bias the results (Tomic et al., Sleep Med Rev, 2025). [2]
In isolated REM sleep behavior disorder, certain features predict later conversion to Parkinson’s disease. A meta-analysis of 123 studies found that hyposmia (HR 2.78; 95% CI 1.83–4.23), mild cognitive impairment (HR 2.27; 1.58–3.27), significant motor dysfunction (HR 1.83; 1.33–2.51), constipation (HR 1.52; 1.26–1.84) and abnormal putaminal dopamine transporter imaging (HR 2.60; 1.94–3.48) were associated with a higher risk of phenoconversion. This is why REM parasomnias deserve professional evaluation (Wang et al., J Neurol Neurosurg Psychiatry, 2022). [3]
Evidence for behavioral treatments is limited, but a few options stand out. A systematic review of behavioral and psychological treatments for NREM parasomnias included 72 publications, most of them case reports (68%) or case series (21%). Hypnosis (33 publications), psychotherapy (31) and sleep hygiene (19) were reported most often, and some evidence supports multicomponent cognitive behavioral therapy, sleep hygiene, scheduled awakenings and hypnosis (Mundt et al., Sleep Med, 2023). [4]
Medication choices depend on the type of parasomnia. An updated review reports that benzodiazepine therapy can be effective for sleepwalking, sleep terrors and sexsomnia but not for sleep-related eating disorder, which is often associated with sedative-hypnotic medications. It advises that initial management focus on reducing the risk of sleep-related injury, then treating coexisting sleep disorders and eliminating drugs that may be involved (Irfan et al., Neurotherapeutics, 2021). [5]
Sleep habits come first. A clinical review notes that parasomnias usually present in childhood and resolve spontaneously, and recommends sleep hygiene, avoiding sleep deprivation and regular bedtimes even on weekends as the first step, with referral to a sleep expert when indicated (Bruni et al., Psychiatr Clin North Am, 2024). [6]
What does parasomnia look like?
A person with a parasomnia may talk in their sleep, sleepwalk, have nightmares, wake confused, or fail to remember what happened during the night. Someone who shares the living space may notice the event first because the person experiencing it may remain asleep and have little or no memory the next morning. [1]
One study estimated that 4% to 67% of adults around the world have experienced a parasomnia in their lifetime. [1]
Symptoms vary by type. Some people make movements or sounds, while others experience fear, vivid dreams, temporary inability to move, or unusual behaviors such as eating during sleep. [1]
What are the main types of parasomnias?
The three broad groupings are based on the sleep stage affected. Non-REM sleep covers the first three stages of sleep and usually the first half of the night. REM sleep follows those stages and is associated with vivid dreaming; REM-related parasomnias tend to happen later in the night. Some conditions do not fit neatly into either phase. [1]
Group | Sleep-stage context | Examples |
Non-REM parasomnias | The first three sleep stages, from falling asleep through about the first half of the night. | Sleep terrors, sleepwalking, and confusional arousals. |
REM parasomnias | The later part of the night, during the sleep phase associated with vivid dreaming. | Nightmare disorder, recurrent isolated sleep paralysis, and REM sleep behavior disorder. |
Other parasomnias | Events that do not fit clearly into a non-REM or REM phase. | Bedwetting, sleep-related groaning, exploding head syndrome, sleep-related hallucinations, sleep-related eating disorder, and sexsomnia. |
Classification can differ between sources: some sleep medicine reviews group sleep-related eating disorder and sexsomnia with the non-REM parasomnias. [4]
What are non-REM parasomnias?
Non-REM parasomnias include sleep terrors, sleepwalking, and confusional arousals. Sleep terrors may involve suddenly waking scared, screaming or crying, a racing heart, fast breathing, sweating, and widened pupils. They are usually brief, although they can last a few minutes. [1]
Sleepwalking involves getting out of bed and moving while still asleep. A person may carry out complex activities or do things they would not normally do when awake. Confusional arousals can cause disorientation, slow speech, difficulty understanding others, crying, or sitting up with the eyes open. An episode may last from a few minutes to hours, and this pattern is common in childhood and tends to decrease with age. [1]
Sleep terrors usually last about 30 seconds. During sleepwalking the eyes are wide open, and complex activities can include driving or playing a musical instrument. [1]
What are REM parasomnias?
REM parasomnias include nightmare disorder, recurrent isolated sleep paralysis, and REM sleep behavior disorder. Nightmares are vivid dreams that cause fear, terror, or anxiety; when a person wakes during one, they may be able to describe the dream in detail and have trouble falling back asleep. [1]
Sleep paralysis causes a person to wake up unable to move. It usually occurs as muscles are relaxing before sleep or as a person wakes, and episodes may last seconds to a few minutes. REM sleep behavior disorder can involve acting out a violent dream through talking, swearing, laughing, shouting, punching, kicking, or grabbing. [1]
REM sleep behavior disorder is more common among adults and people with neurodegenerative diseases such as Parkinson’s disease, Lewy body dementia or multiple system atrophy. [1]
What other parasomnias can occur?
Other parasomnias include bedwetting during sleep, repeated groaning, hearing a loud or explosive sound while falling asleep or waking, and false perceptions while falling asleep or waking. Sleep-related eating disorder involves eating or drinking during sleep and can create risks such as choking, burns, cuts, or consuming inedible or toxic items. Sexsomnia involves sexual behaviors or vocalizations during sleep. [1]
What are the symptoms of parasomnia?
The exact symptoms depend on the type, but common patterns include the following.
Symptom pattern | What it may look like |
Nighttime disruption | Difficulty sleeping through the night or repeated disturbances. |
Unusual behavior | Walking, grabbing objects, eating, or other actions that would be unusual while awake. |
Sounds and movements | Talking, yelling, swearing, laughing, kicking, punching, or other vocalizations and movements. |
Emotional response | Fear, stress, anxiety, terror, or panic when waking. |
Morning or daytime effects | Confusion or disorientation on waking and tiredness during the day. |
Dream-related experiences | Bad dreams or vivid dreams that are remembered in detail after waking. |
What causes or triggers parasomnias?
Parasomnias have several possible causes. An irregular sleep-wake schedule, difficulty transitioning from wakefulness to sleep, genetic predisposition, an immature sleep-wake cycle in children, certain medications, and underlying health conditions can contribute.
Triggers vary from person to person. Possible triggers include certain medications, alcohol before bed, fever, specific noises, not getting enough sleep, physical touch, and stress.
Possible contributor or trigger | Examples |
Sleep pattern | Irregular schedules, jet lag, shift work, or sleep deprivation. |
Medication | Some antibiotics, antidepressants, antiseizure medicines, antipsychotics, asthma or allergy medicines, blood-pressure medicines, and sedatives. |
Health conditions | Chronic pain, circadian rhythm disorders, narcolepsy, obstructive sleep apnea, periodic limb movement disorder, and restless legs syndrome. |
Other conditions or events | Alcohol or substance abuse disorder, inflammatory disease, mental health conditions, neurological conditions, pregnancy, or traumatic brain injury. |
Immediate triggers | Fever, certain noises, physical touch, stress, alcohol before bed, and not enough sleep. |
Do not stop or change a prescribed medicine on your own. A healthcare provider can review current medicines and consider whether a change is appropriate.
Who is more likely to have a parasomnia?
Parasomnias can affect people at any age. Children and young adults ages 5 to 25 are more likely to develop non-REM parasomnias. In children, parasomnias usually occur alongside neurological or psychiatric health conditions such as epilepsy, attention-deficit/hyperactivity disorder, or developmental challenges. [1]
REM parasomnias most often affect adults and usually appear alongside an underlying neurological or degenerative brain condition. A person may also have a higher risk of non-REM parasomnias when someone in their biological family has one. [1]
What complications can parasomnias cause?
Possible complications include depression, physical injury to the person or others, poor performance at work or school, sleep anxiety, and stress. Fatal physical injuries are very rare, but some sleep behaviors can still create meaningful safety risks.
How are parasomnias diagnosed?
A healthcare provider, often a sleep specialist, diagnoses parasomnia through a combination of history, examination, and testing. The evaluation may include a physical exam, neurological exam, discussion of symptoms, family history, current medicines or supplements, and use of alcohol or non-prescribed substances. A bed partner or another observer may be asked what they noticed. [1]
Diagnosing non-REM parasomnias is mainly based on clinical descriptors and can be challenging. [6]
A provider may ask for a sleep diary for at least one week. The diary records bedtime, when sleep begins, wake time, and any events or symptoms. This record can help show patterns in sleep and nighttime behavior.
Evaluation step | What it can show |
Medical history and observer report | The timing, behavior, memory of events, family history, medicines, supplements, alcohol, and non-prescribed substance use. |
Physical and neurological exams | Information that helps the provider assess symptoms and possible contributing conditions. |
Sleep diary | Bedtimes, sleep onset, wake times, and events recorded over at least one week. |
Sleep study | Brain waves, heart rate, eye movements, and breathing while asleep. |
Video EEG or sleep EEG | Brain activity during a brain event while sleeping. |
CT or MRI | Possible brain degeneration or other causes. |
How are parasomnias treated?
Parasomnias have no single cure, but treatment based on the type and health history, including good sleep habits, therapy and sometimes medicine, can help manage symptoms. Some children notice that parasomnias reduce or go away as they get older. The right approach depends on the type of parasomnia, health history, and any underlying medical conditions. [1]
General measures include aiming for seven to nine hours of sleep, keeping a regular bedtime and wake-up time, turning off lights and electronic devices, keeping the room cool, avoiding caffeine and strenuous exercise near bedtime, limiting alcohol, avoiding non-prescribed drugs or substances, taking prescribed medicines as directed, and participating in cognitive behavioral therapy. [1]
Medications used to treat parasomnias can include benzodiazepines, selective serotonin reuptake inhibitors, tricyclic antidepressants, clonazepam, and melatonin. Medicines may be prescribed for REM parasomnias, while they are less likely to be used first for non-REM parasomnias unless episodes are long-lasting or potentially harmful. Medication is not the first-line treatment for every parasomnia. [1]
For children, some parasomnias need no treatment because they resolve with age. Calm reassurance can help during occasional episodes. A pediatrician should know if episodes happen often or affect daytime functioning. When medicine is needed in children, it is typically prescribed for three to six weeks. [1]
Occasional parasomnias such as nightmares are normal throughout life, and natural aging can bring on more sleep disturbances. Not all causes of parasomnias can be prevented. [1]
How can you reduce the risk of parasomnia injuries?
A provider can offer individualized safety suggestions when sleepwalking or REM sleep behavior disorder creates injury risk. Practical steps include sleeping on the first floor, avoiding bunk or loft beds, keeping the mattress close to the floor, avoiding bed-sharing, moving or padding hazardous furniture and lamps, using a plastic cup instead of glass, using childproof doorknobs, locking up weapons or dangerous items, and installing alarms on windows and doors.
Safety focus | Examples |
Sleeping surface | Use the first floor when appropriate, avoid bunk or loft beds, and keep the mattress close to the floor. |
Room layout | Move furniture or lamps away from the bed, or pad potentially hazardous areas. |
Breakable or dangerous items | Use a plastic cup instead of glass and lock up weapons or other dangerous items. |
Doors and windows | Use childproof doorknobs and install alarms on doors and windows. |
Bed-sharing | Avoid co-sleeping when injury risk is a concern. |
When should you see a healthcare provider?
Contact a healthcare provider if you are not getting enough sleep, sleep quality is poor, disturbances happen often, you wake confused, you feel unable to move when you wake, or you wet the bed often after toilet training. If any part of your sleep routine concerns you, a provider can help you identify the next step.
Before an appointment, it may help to write down when the events occur, what an observer notices, how often they happen, what you remember, and any medicines, supplements, alcohol, or non-prescribed substances involved. Keeping a sleep diary for at least one week can help show patterns.
What questions should you ask a provider about parasomnias?
Question | Why it may help |
What type of parasomnia might this be? | Different types occur in different sleep-stage contexts and may need different management. |
How can I improve my sleep habits? | Sleep routines and sleep hygiene are part of general management. |
What treatment do you recommend? | Treatment depends on the type and the person’s health history. |
Could treatment cause side effects? | This helps clarify what to watch for after a treatment plan is chosen. |
How can I improve sleep safety? | A provider can tailor safety suggestions to the behaviors and home setting. |
How soon might symptoms change? | A provider can explain what to expect after treatment begins. |
Conclusion
Parasomnias can involve movements, vocalizations, dreams, fear, confusion, sleep paralysis, or other behaviors around sleep. They are grouped into non-REM, REM, and other types, and the same symptom does not always point to the same sleep condition. [1]
When events are frequent, unsafe, disruptive, or linked to poor daytime functioning, professional evaluation can help clarify what is happening and what support is appropriate. [1]
Frequently Asked Questions
Is parasomnia a sleep disorder?
Yes. A parasomnia is a type of sleep disorder that causes abnormal experiences or behaviors during sleep, while falling asleep, or shortly before waking.
Can a person have a parasomnia without remembering it?
Yes. A person may not remember what they did while sleeping, and someone who shares the living space may notice the event first.
Are parasomnias more common in children or adults?
It depends on the type. Children and young adults ages 5 to 25 are more likely to develop non-REM parasomnias, while REM parasomnias most often affect adults.
Can stress trigger parasomnia?
Stress is listed as one possible trigger. Other possible triggers include fever, certain noises, physical touch, alcohol before bed, some medications, and not getting enough sleep.
Is there one cure for all parasomnias?
No. There is not a single cure for every parasomnia. Management depends on the type, the person’s health history, and any underlying medical conditions.
Can parasomnias cause injury?
Parasomnias can. Possible complications include physical injury to the person or others, although fatal physical injuries are very rare. A provider can suggest ways to make the sleep environment safer when needed.
Is REM sleep behavior disorder linked to other conditions?
REM parasomnias most often affect adults and usually appear alongside an underlying neurological or degenerative brain condition. A provider can assess whether further evaluation is appropriate.
When should I seek help for possible parasomnia?
Seek care when you are not getting enough sleep, sleep quality is poor, disturbances are frequent, you wake confused or unable to move, you wet the bed often after toilet training, or anything about the sleep routine concerns you.
What is the difference between nightmares and night terrors?
Nightmares happen during REM sleep, and the person usually wakes up and remembers the dream. Night terrors happen during deep non-REM sleep, often early in the night, and the person is hard to wake and rarely remembers it.
Should you wake someone who is sleepwalking?
It is usually best to gently guide them back to bed without startling them. Waking a sleepwalker suddenly can leave them confused or upset. Remove hazards and lock doors and windows if sleepwalking is frequent.
Related guides
References
Cleveland Clinic. Parasomnias. Cleveland Clinic. Last updated January 25, 2025. https://my.clevelandclinic.org/health/diseases/12133-parasomnias--disruptive-sleep-disorders
Tomic T, Mombelli S, Oana S, et al. Psychopathology and NREM sleep parasomnias: a systematic review. Sleep Med Rev. 2025;80:102043. PMID 39721218. https://doi.org/10.1016/j.smrv.2024.102043
Wang C, Chen F, Li Y, Liu J. Possible predictors of phenoconversion in isolated REM sleep behaviour disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2022;93(4):395-403. PMID 34937751. https://doi.org/10.1136/jnnp-2021-328062
Mundt JM, Schuiling MD, Warlick C, et al. Behavioral and psychological treatments for NREM parasomnias: a systematic review. Sleep Med. 2023;111:36-53. PMID 37716336. https://doi.org/10.1016/j.sleep.2023.09.004
Irfan M, Schenck CH, Howell MJ. NonREM disorders of arousal and related parasomnias: an updated review. Neurotherapeutics. 2021;18(1):124-139. PMID 33527254. https://doi.org/10.1007/s13311-021-01011-y
Bruni O, DelRosso LM, Melegari MG, et al. The parasomnias. Psychiatr Clin North Am. 2024;47(1):135-146. PMID 38302202. https://doi.org/10.1016/j.psc.2023.06.009
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional with any questions about a medical condition or treatment.
A qualified healthcare provider should tailor evaluation, treatment and safety measures to the type of parasomnia, health history and home setting. Do not stop or change a prescribed medicine, or start a sleep medicine, based on this article.
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