How Does a Sleep Psychologist Treat Parasomnias?

Why episodes may occur

NREM parasomnias are understood as incomplete arousals from deep N3 sleep—the stage previously divided into stages 3 and 4. During an episode, movement and emotion may become active before awareness and memory are fully awake.

One proposed model involves the interaction of two influences: factors that increase deep-sleep pressure and factors that disrupt sleep. Sleep deprivation can increase the drive for N3 sleep. Stress or anxiety may make sleep more fragmented or increase arousal. Together, deeper sleep pressure and repeated attempts to awaken may increase the opportunity for an incomplete arousal in a person who is vulnerable to NREM parasomnias. These are contributing factors, not proof that anxiety alone causes an episode.

Sleep extension

Sleep extension means creating enough time for sleep and gradually increasing sleep opportunity when a person has been chronically sleep deprived.

Anxiety reduction

Anxiety reduction focuses on lowering cognitive and physical arousal that may disrupt sleep. Depending on the person, this may include education, relaxation training, cognitive strategies, scheduled time to address worries, and treatment of a coexisting anxiety condition. The aim is not to eliminate ordinary stress, but to reduce sleep disruption and other identifiable triggers.

Safety and coordinated care

Care may also include securing doors and windows, removing hazards, protecting a bed partner, reviewing medications and substances, and addressing other sleep disorders. Coordination with a sleep physician or another healthcare professional is appropriate when sleep testing, neurological evaluation, or medication management may be needed.

Self-hypnosis

Self-hypnosis can be considered, though Dr. Rosenblum advises patients to work with clinicians who have experience in self-hypnosis and are knowledgeable about parasomnias.