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.