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Sleep disorders involving night terrors, nightmares, and sleepwalking are clinically referred to as “parasomnias.” A parasomnia interferes with non-REM and REM sleep by causing a person to awaken themselves with sometimes vigorous physical actions or verbal outbursts. While parasomnias are common, especially among children, does it indicate the need for mental health treatment? Research into this question suggests that it is possible parasomnias may point to a mental health problem, but not in all cases.
What are the Different Types of Sleep Issues?
Sleep Terrors
Sleep terrors happen during the early stages of sleep called non-REM sleep. Breathing, brain waves, heartbeat, and eye movements gradually begin slowing down as the body prepares for deep, REM sleep.
Sleep, or “night,” terrors are characterized by the sleeper yelling, gasping, or even screaming in terror while remaining unconscious. They don’t respond to someone trying to awaken or soothe them. Usually lasting less than one minute, a sleep terror episode will pass without the person waking up. After falling back asleep, they won’t have any memories of the night terror in the morning. Sleep terrors are not nightmares because they occur during non-REM sleep. Nightmares only occur during REM sleep.
Somnambulism (Sleepwalking)
Sleepwalking also happens in non-REM sleep. Although it is more common for children to walk in their sleep, adults can suffer from this parasomnia as well. People who sleepwalk are known to engage in a variety of activities with their eyes open. However, a sleepwalker’s eyes look glazed and won’t respond to stimuli.
Sleepwalkers may talk, walk around their house, reach for objects that aren’t there, or act like they are doing a household chore, such as cleaning or cooking. In some cases, sleepwalking presents a danger to the sleepwalker if they leave their home, drive a car, or become aggressive towards others. Sleepwalkers rarely remember sleepwalking or what they did while sleepwalking.
People sleepwalk after entering stage III of non-REM sleep. This is the stage just before entering REM sleep and is considered a “deep sleep” stage.
Eating While Partially Awake (Non-REM Parasomnia)
This disorder involves someone eating and drinking while they aren’t fully asleep. The problem with sleep-eating is that the person usually eats a large amount of food, which leads to gaining weight. They may also eat food they normally don’t eat or eat something that they are allergic to.
Nightmares
Everybody has a nightmare occasionally but having at least two nightmares a week may be a sign of a nightmare disorder. This parasomnia happens during the deepest stage of sleep–REM–when brain waves and eye movements are most active.
Nightmares can cause feelings of terror, disgust, or shame. A nightmare may or may not awaken the sleeper. The inability to yell for help or move commonly affects people having a nightmare. Since nightmare disorder is a REM sleep disorder, a person usually has nightmares several hours after falling asleep or just before they wake up in the morning.
Sleep Paralysis
Sleep paralysis (hypnagogic sleep paralysis) occurs just as someone is falling asleep. Symptoms of sleep paralysis include:
- Inability to move or speak for several seconds, even though you are still conscious
- Disruption of the transition period between wakefulness and sleep
- Experiencing a sense of choking or pressure on the face and neck
- Maybe co-morbid with narcolepsy, another sleep disorder in which people suffer from an uncontrollable need to sleep at any time during the day
During sleep, the body and brain cycle between non-rapid eye movement (NREM) and rapid eye movement (REM) sleep stages. Each cycle lasts for about an hour and a half, with NREM sleep comprising at least 75 percent of sleep. When you reach the end of NREM, the brain signals the body that it is time to enter REM sleep. People suffering from sleep paralysis undergo an altered form of consciousness that invades their sleep while cycling from REM back to NREM. This makes the person acutely aware of the fact that they cannot speak or move.
Affecting more older adults than children or younger adults, RSBD causes someone to laugh, talk, shout, and/or move aggressively (kick, punch, or grab at others) while asleep. Some, but not all, adults with RSBD may have an underlying neurological disease, such as Lewy body dementia or Parkinson’s disease.
Causes and Diagnosis of Sleep Disorders
A variety of environmental, emotional, or physical stimuli can induce night terrors, nightmares, sleepwalking, and other sleep disorders:
- Lack of sleep/jet lag/disrupted sleep-wake schedules
- Antidepressants, anti-psychotics, high blood pressure, and anti-seizure medications may cause parasomnias
- Acute or chronic stress
- High fever
- Substance abuse
- Menstruation or pregnancy (hormonal fluctuations often interfere with normal sleep patterns)
- Head injuries
- Brain tumors (rare)
Experiencing body pain or being too cold or too hot while sleeping may manifest as a nightmare. A few studies indicate that jumpstarting metabolic rates by eating junk food before bedtime may energize the brain into being more active during REM sleep.
Accurately diagnosing a sleep disorder involves ruling out all primary causes with complete physicals and blood tests. When no apparent cause of a sleep disorder can be found, doctors may recommend the person undergo a sleep study (polysomnogram) that monitors vital signs and brain activity while they sleep. The results of a polysomnogram are used to develop a treatment plan to reduce or eliminate a specific sleep disorder. If the results suggest a neurological cause, the person may need an MRI or CT scan to detect abnormalities in the brain.
Are Night Terrors, Nightmares, or Sleepwalking a Sign of Mental Illness?
Having an occasional sleep disorder episode is not a sign of mental illness. Experiencing stress and anxiety due to life events such as marriage, divorce, the birth of a child, or a death in the family can cause sleep disorders temporarily and does not indicate a mental illness.
Individuals with anxiety or depression who take antidepressants may begin sleepwalking or having night terrors. Researchers think that SSRIs and tricyclic antidepressants may prevent a person from entering REM sleep by increasing serotonin levels in the brain.
Psychiatric Disorders and Parasomnias
Other studies show that a distinct association exists between parasomnias and mental illness that cannot be attributed to medications. A review of the literature found that nearly 40 percent of people with a psychiatric disorder have nightmares, 10 percent sleepwalk regularly, and about four percent have REM Sleep Behavior Disorder. Substance abuse and medical issues are the other leading risk factors affecting people with parasomnias and mental illness.
Can Sleep Disorders Worsen an Existing Mental Health Problem?
Lack of good, quality sleep will worsen any physical or mental health condition. Although we still aren’t sure why we dream, we do know that sleep has powerful restorative abilities necessary for optimizing overall health. Sleep researchers have found that unless brain cells experience “downtime,” i.e., sleep, they become so stressed they can no longer function. Sleep-deprived neurons cannot correctly process images sent from the retina to the visual part of the brain. Nor can they send sounds detected by inner ear structures to the brain’s auditory cortex. This is why people hallucinate when sleep-deprived.
When sleep is consistently interrupted by a sleep disorder, the condition of your mental and physical health may deteriorate. Poor sleep affects emotion regulation, decision-making, memory, and the ability to cope with daily problems. Being afraid to go to sleep because you might have a nightmare, a night terror, or sleepwalk just exacerbates the stress of not getting enough sleep.
If you can’t control a sleep disorder and feel it is worsening, call FHE today. Through innovative treatments like neuro rehabilitation, we are able to treat the root causes of mental health issues that may be contributing to the problem.
