Dream Theories: Parasomnia, Brains Gone Wild!

Welcome back guest blogger “Dr.  C” to Drem Theories. She’s sharing her in-house know how about the sleeping mind. Today, let’s spook our way through the confused and abnormal disruption (and potential trauma) parasomniacs endure.This is the kind of science I LOVE to play with in my contemporary psychic fantasies. Understanding more about how our brains work in sleep and out, makes me a happy geeky girl ;o) And it opens worlds of plotting happiness for even bigger and more exciting stories about worlds that play out in our minds alone. Bwahahahaha!!!

So read on, then come back to Dream Theories often to hear more of my meanderings about my personal dream research–and more from Dr. C., as she feeds my (and your) imagination about the physiology behind oursleeping brains’ most intriguing, if disturbing, patterns. If you look closely enough, even in today’s post, you’ll see the bones of the “fringe” science on which I crafted the parapsychology of my first two Legacy books. No, NOT Exploding Head Syndrome (though I don’t know HOW I missed that one!).


Don’t forget to ask Dr. C. your strange dream/sleep questions in the comments… She’s SO much fun to talk to ;o)


Dreaming permits each and every one of us to be quietly and safely insane every night of our lives.  ~William Dement

Lady Macbeth: Out, damn’d spot! out, I say!—One; two: why, then ’tis time to do’t.—Hell is murky.—Fie, my lord, fie, a soldier, and afeard? What need we fear who knows it, when none can call our pow’r to accompt?—Yet who would have thought the old man to have had so much blood in him? ~William Shakespeare, Macbeth

What do these two quotes have in common other than being by men named William who like to ponder the weird things people do in their sleep?  It is often assumed that parasomnias, or “…unpleasant or undesirable behavioral or experiential phenomena that occur predominantly or exclusively during the sleep period,” (Mahowald & Bornemann, Principles & Practices of Sleep Medicine, 4th ed.) have their roots in some sort of psychological distress, including guilty consciences.  However, the cause is more physiological than psychological.

If you’ve learned to drive a stick-shift car or been in a car with a failing transmission, you know how it stalls out or moves jerkily from one gear to another if something is off, either with the driver’s clutch timing or in the transmission itself.  Remember that hypnogram from last week showing the different sleep stages?  Sometimes the brain doesn’t shift smoothly from one stage to another, or it gets interrupted, and that’s when parasomnias can occur.


Stage N-3 (formerly stages three and four) is when the body gets its deep, physically restorative sleep, and the brain puts out big slow waves.  Disorders of arousal, which include sleepwalking, night terrors, confusional arousals, and even sleep-eating and sleep-sex, occur during slow-wave sleep or during transitions into or out of it.  As you can see from the hypnogram, we get more slow-wave sleep during the first part of the night, so that’s when these disorders occur.  Since people tend to get confused between them, let’s talk about what they are.

During a sleepwalking episode, the person may get out of bed, walk around, and perform complex motor behaviors.  There is little to no awareness of what’s actually going on, and they won’t remember it the next morning.  Often, the only clues to sleepwalking if a person lives alone is that objects may be moved around or go missing.  I know of one case where a pet fish went missing for three weeks, and then reappeared, still alive but not in great shape, in its tank. 

A person with night terrors will seem to wake terrified, scream, cry, or make other noises associated with extreme fear, and perhaps jump out of bed and try to escape from something.  Although their eyes are open, witnesses say they seem to “see right through” them.  They often resist comforting, and will eventually settle down and remember nothing the next morning.

Confusional arousals fall somewhere between night terrors and sleepwalking.  It used to be thought that in all three of these disorders of arousal, the person wasn’t dreaming, but one study found that people who experienced them did have some sort of dream imagery occurring that corresponded with their behavior.  These disorders occur most often in children, which makes sense because kids’ brains are going through frequent reorganizations, but they are present in four to five percent of adults as well.

When someone literally acts out their dreams, REM behavior disorder, or RBD, is the culprit.  Typically, when we’re in REM, our brains shut off our voluntary muscles so we don’t act out our dreams.  Sometimes the signals get mixed up, and the muscles don’t get shut off, so people will do everything from talk to thrash around to get up and run or fight.  Since this occurs during REM sleep, it’s more likely to occur later in the night.  One of the first cases I heard about was an older woman who loved to sing in her church choir.  She’d wake her family early in the morning with shouts of “Praise Jesus!” 


True nightmares, which differ from stress or anxiety dreams, also tend to occur later in the night during REM sleep.  These are dreams that contain disturbing imagery and have negative emotional and fatigue effects that last into the next day.  They often co-occur with Posttraumatic Stress Disorder.

My favorite parasomnia is an extremely rare one called Exploding Head Syndrome, where the patient wakes hearing a loud noise and afraid their head has just exploded.  No, it doesn’t make sense – how would you have awareness your head was missing? – but very little does immediately upon awakening.  I’ve never seen a case of this, but one neurologist in a course I taught had.  Sadly, I didn’t get the chance to catch up with him after to ask him how he treated it.

Parasomnias, especially in adults, can have a wide range of causes.  Remember, the group of disorders that includes sleepwalking are called disorders of arousal, so we often look for reasons why someone’s sleep may be getting disturbed, but only partially.  Sometimes another sleep disorder like obstructive sleep apnea, when the airspace closes during sleep, or periodic limb movement disorder, when the movement system kicks into gear and makes someone kick their feet, is to blame.  These disorders also tend to run in families, so there is a genetic component.

A wide range of substances including alcohol and its withdrawal, caffeine, and some prescription medications have been associated with parasomnias.  I hear interesting Ambien stories from patients who have discontinued it due to eating, talking on the telephone, and other activities that they don’t remember later, including driving.  One tip:  don’t ever combine Ambien with alcohol.  Not only is it physically dangerous, but it could also have embarrassing results (and that’s all I’m going to say about that to protect confidentiality).


There are a range of pharmacological and behavioral treatments for parasomnias for those who experience true distress or impairment as a result.  The behavioral ones focus on re-training the brain so it will be more likely to sleep through the night, or so the imagery it produces will be less disturbing.  I sometimes end up doing psychotherapy focusing on underlying anxiety or depression, although this isn’t always the case.  Unlike Lady Macbeth, most sleepwalkers aren’t doing so because they have some sort of psychological distress.

I can’t diagnose or make treatment recommendations, but I look forward to hearing about the strange things you’ve done or heard of someone doing at night!


By day, “Doctor C.” is a licensed clinical psychologist and behavioral sleep medicine specialist.  That’s a long title, so she answers to any variations, including “Sleep Psychologist.” 

By night, she writes fantasy and science fiction, blogs about wine and life, and interacts with other wine lovers and writers on twitter as @RandomOenophile.  She’s a featured first-place winner in this year’s Mystery Times Ten, a Young Adult mystery anthology, for her fantasy story “The Coral Temple.” 

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2 Responses to “Dream Theories: Parasomnia, Brains Gone Wild!”

  1. Thanks, Anna! LOL at the Exploding Head Syndrome picture. Seriously, I’m available for questions and would love to hear the readers’ stories. :)

    “Doctor C”

  2. A very informative and helpful exposé on a complex and not-well-understood disorder. The brain really is an amazing “creature” when you think abut it. Thanks for this blog.

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