Parasomnias

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), parasomnias are classified as abnormal behavioral or physiological events occurring during sleep or sleep-wake transitions. They are divided into two main categories—Non-REM (NREM)–related parasomnias and REM-related parasomnias—each with distinct features.

• Sleepwalking (Somnambulism): Repeated episodes of rising from bed and walking about, usually occurring during the first third of the night, often with eyes open but minimal awareness.
• Sleep Terrors (Night Terrors): Sudden arousals from deep sleep accompanied by intense fear, autonomic arousal, and unresponsiveness to comfort efforts.
• Confusional Arousals: Episodes of incomplete awakening with disorientation or confused behavior, often without full recall.

• REM Sleep Behavior Disorder (RBD): Repeated episodes of vocalization or complex motor behaviors during REM sleep associated with dream enactment.
• Recurrent Isolated Sleep Paralysis: Temporary inability to move or speak when falling asleep or upon awakening, despite full awareness.
• Nightmare Disorder: Repeated, vividly disturbing dreams that cause distress or impairment and lead to awakenings with full recall of the dream content.

• Substance- or Medication-Induced Parasomnia: Abnormal sleep behaviors linked to medication use (e.g., sedative-hypnotics) or substance effects.
• Other Specified/Unspecified Parasomnia: For symptoms that don’t meet full criteria for a specific diagnosis but still cause clinically significant distress or impairment.

Parasomnias can result from a combination of neurological, psychiatric, and environmental factors. Common contributors include:

• Stress, anxiety, or trauma
• Sleep deprivation or irregular schedules
• Certain medications, such as antidepressants or sedatives
• Alcohol or substance use
• Underlying sleep disorders such as obstructive sleep apnea

Our psychiatrists conduct a detailed assessment to identify triggers and rule out coexisting conditions that may worsen parasomnia symptoms.

We develop individualized treatment plans that may include:

Behavioral and Environmental Strategies

Adjusting sleep hygiene, reducing nighttime stimuli, and maintaining a consistent sleep schedule can significantly decrease episodes. Safety modifications—such as securing doors or removing hazardous objects—are often important first steps.

Medication Management

For cases associated with anxiety, depression, or REM behavior disorder, targeted medications may help reduce frequency and intensity of episodes. Our psychiatrists select and monitor treatments carefully to balance safety and sleep quality.

Stress and Anxiety Management

Parasomnias often worsen during periods of emotional distress. Techniques such as relaxation training, therapy, and mindfulness can help regulate the body’s arousal system to promote calmer sleep.

Why Seek Psychiatric Care for Parasomnias

Parasomnias are complex conditions that bridge sleep medicine, neurology, and psychiatry. Our psychiatrists specialize in evaluating both the psychological and biological aspects of these disorders, ensuring that treatment addresses root causes rather than surface symptoms. When needed, we collaborate with sleep medicine specialists to provide coordinated, comprehensive care.

Care in Greenwich Village and Online

Located in the heart of Greenwich Village, our team provides both in-person and virtual consultations for patients throughout New York City. We offer a compassionate, discreet environment to discuss and treat sleep-related concerns.