When Should I Seek Professional Help?
Consider speaking with a healthcare professional when episodes:
- Cause an injury or create a substantial risk of injury
- Involve leaving the home
- Include driving, cooking, or another complex hazardous activity
- Include repeated punching, kicking, or falling from bed
- Begin unexpectedly in adulthood
- Become more frequent, intense, or complex
- Cause significant fear or emotional distress
- Make the person afraid to sleep
- Affect concentration, energy, school, work, or relationships
- Seriously disrupt a partner’s or family member’s sleep
- Occur with breathing problems or severe daytime sleepiness
- May be related to a medication or substance
- Are difficult to distinguish from another health condition
Do not stop or change a prescribed medication without first speaking with a physician or pharmacist.
When Is Emergency Care Needed?
Seek emergency assistance when an episode involves:
- A serious injury
- Severe bleeding
- Difficulty breathing
- Loss of consciousness or unusual unresponsiveness
- Immediate danger to the person or someone else
- A situation that cannot be made safe
The website should direct visitors to the appropriate emergency service for their location.
This emergency information should be reviewed and approved by the project’s clinical team before publication because the supplied parasomnia articles are not emergency-care guidelines.
This section should begin by explaining that treatment is specific to the condition and that some evidence is limited. Case reports from the supplied collection should be described as preliminary evidence, not standard recommendations.
Treatment & Support
Treatment for a parasomnia depends on:
- The type of sleep-related event
- How often it occurs
- Whether there is a risk of injury
- The person’s age and health
- Possible triggers or contributing factors
- Other sleep or health conditions
- Current medications and substances
- How the episodes affect daily life
Not every parasomnia requires medication. Depending on the condition, care may focus on education, reassurance, improving sleep, reducing safety risks, addressing contributing conditions, psychological or behavioural treatment, dental protection, or condition-specific medication.
The same treatment is not appropriate for every parasomnia.
Before Beginning Treatment
A healthcare professional may ask about:
- What happens during an episode
- When the episode occurs
- How long it lasts
- Whether the person can respond
- Memory or dream recall afterward
- Injuries or safety concerns
- Sleep schedule and recent sleep loss
- Other sleep symptoms
- Physical and mental-health history
- Prescription and non-prescription medications
- Alcohol or other substances
- Observations from a partner, roommate, parent, or caregiver
In selected cases, further assessment may include a physical or neurological examination, dental assessment, or overnight sleep study.
Addressing Possible Contributing Factors
A first step may be to identify factors that could trigger episodes, fragment sleep, or make complete awakening more difficult.
Depending on the condition, this may include:
- Protecting adequate sleep time
- Keeping sleep and wake times reasonably consistent
- Addressing repeated nighttime disruptions
- Assessing another sleep condition
- Reviewing medications and substances
- Reducing injury risks
- Managing stress or emotional distress
- Treating a relevant medical, psychiatric, neurological, or dental condition
A person should not stop or change a prescribed medication without consulting the prescriber or a pharmacist.
Treatment of Sleepwalking
Treatment may not be required when episodes are infrequent, uncomplicated, and not causing distress or danger.
Safety measures
The supplied articles emphasize reducing injury risk. This may include:
- Clearing bedroom and hallway hazards
- Securing windows and exterior doors
- Protecting stairways
- Avoiding a top bunk
- Storing sharp or dangerous objects securely
- Keeping car keys in a secure location
- Creating a plan with household members
Improving sleep
Because sleep deprivation and sleep fragmentation may contribute to NREM disorders of arousal, support may include:
- Allowing enough time for sleep
- Keeping a consistent schedule
- Reducing avoidable nighttime interruptions
- Assessing symptoms of another sleep disorder
- Reviewing sedating medications or substances with a professional
Scheduled awakenings
Scheduled awakenings may be considered when episodes occur at a predictable time.
This approach generally involves:
- Recording when episodes usually happen.
- Gently waking the person shortly before the expected time.
- Keeping them awake briefly.
- Allowing them to return to sleep.
The supplied non-pharmacological review discusses this approach, but the available evidence is limited. Families should obtain professional guidance before using it, especially when episodes are irregular or complex.
Psychological and behavioural approaches
The supplied review discusses approaches such as:
- Education
- Reassurance
- Relaxation
- Stress-management strategies
- Cognitive-behavioural approaches
- Mindfulness-based stress reduction
- Hypnosis
Evidence for these approaches is not equally strong. Some findings come from small studies or case series.
Medication
Medication may be considered when episodes are frequent, dangerous, or highly disruptive and other measures have not been sufficient.
The supplied literature discusses several medications, but evidence is limited and often based on uncontrolled reports or small case series. A medication that appears helpful in an individual report should not be considered an established treatment for everyone.
Medication decisions require assessment of possible side effects, other health conditions, and alternative explanations for the episodes.
Primary supplied sources: Irfan et al. (2021); Ntafouli et al.; Zergham (2023); Mayo Clinic (2017). Nigam (2019) and other case reports provide preliminary individual evidence rather than general treatment guidance.
Treatment of Sleep Talking
Sleep talking does not usually require specific treatment when it is occasional and not causing distress or significant disruption.
Support may focus on:
- Protecting adequate sleep time
- Maintaining a regular sleep schedule
- Reducing avoidable nighttime disturbance
- Managing stress
- Reviewing possible medication or substance contributors
- Addressing another sleep condition when symptoms suggest one
For a partner or roommate, earplugs, white noise, or temporary changes to sleeping arrangements may reduce disruption.
Further assessment may be helpful when sleep talking:
- Begins suddenly
- Becomes frequent or intense
- Seriously disrupts sleep
- Is accompanied by forceful movement
Treatment of Sleep Terrors
In children, education and reassurance for the family may be an important part of care.
Safety and reassurance
Support may include:
- Making the bedroom safer
- Protecting adequate sleep time
- Keeping a regular bedtime routine
- Reducing avoidable sleep disruption
- Responding calmly during episodes
- Avoiding abrupt or forceful attempts to wake the person
- Explaining that the behaviour is not intentional
Scheduled awakenings
When episodes are frequent and occur at a predictable time, scheduled awakenings may be considered under professional guidance.
Evidence is limited, and the approach may not be appropriate when episodes are unpredictable.
Addressing other conditions
Assessment may consider whether another sleep condition, medication, substance, or mental-health concern is contributing to the episodes.
Psychological support
The supplied non-pharmacological review discusses psychotherapy in selected cases, particularly when stress or emotional factors may be relevant. Evidence remains limited.
Medication
Medication is not required for every person with sleep terrors. It may be considered in selected severe or persistent cases following professional assessment.
The supplied literature discusses medications used in individual cases and small studies, but it does not support presenting one medication as a universal treatment.
Primary supplied sources: Irfan et al. (2021); Ntafouli et al.
Treatment of Nightmare Disorder
Treatment may depend on whether nightmares are:
- Idiopathic, meaning that no specific cause has been identified
- Associated with trauma or post-traumatic stress
- Related to another mental-health condition
- Associated with medication or substance use
- Occurring alongside another sleep disorder
Imagery rehearsal therapy
The supplied nightmare review identifies imagery rehearsal therapy as an important non-medication treatment.
A simplified description is:
- The person identifies a recurring or distressing nightmare.
- While awake, they create a less threatening storyline or ending.
- They mentally rehearse the revised dream.
- The exercise is repeated according to the treatment plan.
The purpose is not to prove that the original dream was unimportant. It is to reduce repetition and distress by developing and rehearsing a different dream script.
People with trauma-related nightmares should consider undertaking this work with an appropriately trained professional.
Other psychological approaches
The supplied review also discusses:
- Cognitive-behavioural approaches
- Exposure-based approaches
- Relaxation
- Rescripting
- Lucid-dreaming approaches
The strength of evidence differs across approaches.
Medication
The supplied review discusses prazosin for trauma-related nightmares. It also notes that study findings have not been entirely consistent.
Medication should therefore not be presented as automatically appropriate for every person with nightmares. Selection depends on diagnosis, health history, other medications, and professional judgment.
Treating related conditions
Treatment may also address:
- Post-traumatic stress
- Anxiety or mood symptoms
- Insomnia
- Another sleep condition
- A medication or substance that may be contributing
Primary supplied source: Stefani and Högl (2021).
Treatment of Sleep Paralysis
An isolated episode may not require treatment. Treatment is more likely to be considered when episodes recur, cause intense fear, or lead to avoidance of sleep.
Education and reassurance
Understanding that sleep paralysis involves REM-related muscle immobility continuing briefly into awareness may reduce fear.
The vivid perceptions that can accompany an episode should be explained without dismissing how real or frightening they may feel.
Sleep and schedule changes
The supplied articles identify the following as possible predisposing factors:
- Sleep deprivation
- Irregular sleep schedules
- Jet lag
- Disrupted sleep
Support may therefore include:
- Allowing sufficient time for sleep
- Keeping sleep and wake times consistent
- Planning for travel or shift changes
- Addressing persistent insomnia or disrupted sleep
Psychological approaches
The Sharpless review discusses a structured cognitive-behavioural approach for recurrent isolated sleep paralysis. Its components may include:
- Education about sleep paralysis
- Reframing frightening interpretations
- Relaxation
- Coping strategies to use during an episode
- Rehearsing those strategies while awake
Evidence is still developing, and access to a clinician familiar with sleep paralysis may be limited.
Medication
The supplied review discusses medications that have been used to reduce REM sleep or treat symptoms in selected circumstances. The evidence is limited, and medication is not necessary for most isolated episodes.
Professional assessment is particularly important when sleep paralysis occurs with severe daytime sleepiness or other symptoms that may suggest another sleep disorder.
Primary supplied sources: Sharpless (2016); Stefani and Högl (2021); Cleveland Clinic (2021).
Treatment of REM Sleep Behaviour Disorder
REM sleep behaviour disorder requires professional assessment because it may lead to injury and may be associated with another condition.
Making the sleeping environment safer
The supplied reviews emphasize injury prevention. Measures may include:
- Removing sharp, heavy, or breakable objects
- Moving furniture away from the bed
- Protecting the floor beside the bed
- Reducing the risk of falling from bed
- Securing dangerous objects outside the bedroom
- Considering temporary separate sleeping arrangements when a bed partner is at risk
Environmental changes reduce risk but do not replace medical assessment.
Reviewing possible contributing factors
Assessment may include:
- Medication review
- Evaluation for another sleep disorder
- Neurological history and examination
- Overnight video-polysomnography
- Ongoing clinical follow-up
A person should not stop an antidepressant or another prescribed medication without professional guidance.
Melatonin
The supplied RBD reviews discuss melatonin as a commonly used treatment option. Reported advantages may include fewer concerns about sedation, balance, or breathing than some alternative medications, although individual responses vary.
Supplement quality, dosage, interactions, and health circumstances should be discussed with a qualified professional.
Clonazepam
Clonazepam is also discussed as a commonly used treatment. The supplied literature reports possible improvement in dream-enacting behaviours but also identifies concerns such as:
- Daytime sedation
- Balance difficulties
- Falls
- Cognitive effects
- Possible worsening of sleep-related breathing problems
These considerations may be especially important in older adults.
Follow-up and neurological context
The supplied reviews discuss an association between RBD and certain neurological conditions. This does not mean that every person who moves during sleep has RBD or will develop a neurological disease.
A confirmed diagnosis may require ongoing follow-up so changes in symptoms or neurological health can be monitored appropriately.
Primary supplied sources: Dauvilliers et al. (2018); Jung (2016); Pacheco (2023); Roguski et al. (2020).
Treatment of Confusional Arousals
Treatment may not be needed when episodes are infrequent, uncomplicated, and not dangerous.
Initial approaches
Support may include:
- Education and reassurance
- Protecting adequate sleep
- Keeping a regular sleep schedule
- Reducing nighttime disruption
- Making the sleep environment safer
- Reviewing sedating medications
- Assessing another sleep condition
Because confusional arousals involve incomplete awakening, household members should respond calmly and avoid demanding immediate, logical answers from the person.
Scheduled awakenings
Scheduled awakenings may be considered if episodes occur predictably. Evidence is limited, and professional guidance may help determine whether this approach is appropriate.
Medication
The supplied literature does not support one medication as a standard treatment for all confusional arousals.
Medication may be considered in selected severe cases, but the potential benefits should be weighed against sedation, impaired balance, memory effects, and possible worsening of other sleep problems.
Primary supplied sources: Irfan et al. (2021); Ntafouli et al.
Treatment of Sleep-Related Bruxism
Treatment goals may include:
- Protecting the teeth
- Reducing pain or discomfort
- Preserving jaw function
- Reviewing contributing medications or conditions
- Improving sleep-related or behavioural factors
- Reducing disruption for the person or sleep partner
The Guaita and Högl review emphasizes that evidence for many bruxism treatments remains limited.
Education and counselling
Initial care may include:
- Discussing grinding or clenching habits
- Reviewing stress sensitivity
- Supporting healthy sleep habits
- Limiting nighttime alcohol, caffeine, and tobacco
- Using relaxation approaches
- Reviewing medication and health history
The supplied review notes that these measures are commonly suggested but that strong evidence for reducing sleep-related jaw activity is limited.
Occlusal splints
A dentist may recommend an occlusal splint or related oral appliance.
Possible goals include:
- Protecting teeth from wear
- Protecting dental restorations
- Reducing grinding sounds
- Reducing some symptoms
The supplied review indicates that the effect on the underlying jaw-muscle activity may be temporary.
An oral appliance should be selected with appropriate dental assessment. Particular care may be needed when another sleep condition, such as sleep-disordered breathing, is suspected.
Medication
Several medications have been studied, often in small samples or over short periods. The evidence is not strong enough to recommend one general medication treatment for all sleep bruxism.
The review specifically cautions against translating short-term or case-report findings directly into routine treatment.
Botulinum toxin
The supplied review discusses botulinum toxin in selected severe secondary cases, particularly when jaw activity is associated with a neurological condition and interferes with functions such as speaking, chewing, or swallowing.
This is not presented as routine treatment for ordinary tooth grinding and requires specialist assessment.
Follow-up
Dental follow-up may monitor:
- Tooth wear
- Restorations
- Jaw discomfort
- Oral function
- Whether a protective device remains appropriate
Primary supplied sources: Guaita and Högl (2016); Suni (2023); Ucar et al. (2022).
Medication & Supplement Warning
Never start, stop, or change a medication or supplement based only on information from this website.
A treatment mentioned in an article may have been studied:
- For one specific parasomnia
- In a small number of participants
- For a short period
- In a case report involving one or two people
- In people with particular coexisting conditions
This does not mean that the treatment is safe or effective for everyone.
Always consult a licensed physician or pharmacist before making medication or supplement changes.
Supporting The Person Beyond Treatment
Parasomnias may cause fear, embarrassment, disrupted sleep, or tension within families and relationships.
Helpful support includes:
- Listening without judgment
- Avoiding blame or teasing
- Recognizing that the behaviour is not intentional
- Respecting privacy
- Creating a shared safety plan
- Including the person in treatment decisions
- Allowing partners and caregivers to discuss their own sleep and safety needs
- Seeking support when the episodes are affecting emotional wellbeing or relationships
The goal is not only to reduce episodes. It is also to improve safety, sleep, understanding, and quality of life.
Questions To Ask A Healthcare Professional
Patients and families may find it helpful to ask:
- What conditions could explain these episodes?
- Does another sleep condition need to be considered?
- Could a medication or substance be contributing?
- Is a sleep diary useful?
- Is an overnight sleep study needed?
- What safety changes should we make?
- Does this condition require treatment?
- What are the benefits and risks of the suggested treatment?
- How strong is the evidence supporting it?
- How will we know whether it is working?
- What side effects should we watch for?
- When should we arrange follow-up?
- Should a sleep specialist, neurologist, mental-health professional, dentist, or another professional be involved?
Please always consult a licensed doctor or pharmacist before starting any new medication.
