Description

Sleep Disorders

Sleep is a
situation that a person is most vulnerable against its absence, which needs to
be put into place in inevitable and unavoidable way.  It is not a process
that brain rests, but active, complex and dynamic process.  Although it’s real
function is still unknown, it’s being a required physiological need for life
such as eating and drinking is apparent.

Sleeping
is not a simple process. Sleeping is an active process that consists of various
stages controlled by a large number of parts of brain. These stages repeat
during all night and each stage has different functions. Sleeping stages;
consists of falling asleep, slumber, deep and dream sleep stages. A healthy
sleep can be maintained with all these stages being seen in sufficient times.

Average
sleeping period accepted as normal is 7-8 hours a day. However this period
changes from person to person according to age, our way of work and energy that
we spend as well as calories need that we should take everyday. While 18 hours
of sleeping period is accepted as normal for a baby, it falls below half of
this at 10-12 ages. 7-8 hours in average for adults and 6 hours of sleep for
elderly should be enough. Short sleepers who can be ready for the next day with
sleeping 3-5 hours and long sleepers who needs 10-12 hours of sleep to be ready
for the next day evaluated as normal alternatives out of these periods that are
usual for the great majority.

Insomnia
(Inability To Sleep)

Although
there is enough chance and opportunity for sleep, it is characterized in
starting sleep, maintaining it, difficulty in relaxing and quality sleep and
finally disorders in intra-day functionality.

Intra-day
indications: Exhaustion, weakness, difficulty in attention, concentration or
memory, disorder in social or occupational function or low school performance,
mood disorder or irritability, diurnation, decrease in motivation, energy or
initiative, increase in making a mistake or accident tendency while at work or
driving, tenseness related to sleep withdrawal, headache or symptoms belong to
gastro-intestinal system, anxiety and occupations about sleep, in most cases
sleeplessness is the result of a few factors combined. Your thoughts about
sleep, selection of living conditions and the place you sleep fall into these factors.

In some
situations, medications taken for medical or psychiatric problem reasons are
the reason of sleeplessness. If you are having trouble with your sleep for more
than a month and it is affecting your daily functions, it is time for you to
seek assistance. Consult your doctor and ask for a meeting with a sleeping
disease specialist.

Your
medical background, physical examination and some blood tests are helpful to
reveal the reasons of lack of sleep. Your bed partner and other family members
may have valuable information about your sleep. The basic rule of sleep hygiene
is to wake up early and at the same time and go to bed when the sleep comes.

Many
people around us complain about not having sleep. When does this come to
disease level (insomnia)?

Sleeplessness
(Insomnia): Although there is enough opportunity and possibility, it is
characterized with having difficulty perpetually in starting sleep, maintaining
it and quality sleep and finally disruptions on intra-day functionality.

Symptoms
seen on intra-day:

Exhaustion,
Weakness, Difficulty in attention, concentration or memory, Disorder in social
or occupational function or low school performance, Mood disorder or
irritability, Diurnation, Decrease in motivation, energy or initiative,
Increase in making a mistake or accident tendency while at work or driving,
Tenseness related to sleep withdrawal, headache or symptoms belong to
gastro-intestinal system, Anxiety and occupations about sleep, Sleep disorder
and related intra-day signs being three times a week and continuing for at
least three months is defined as chronic sleep disorder. Sleep disorder and
related day symptoms must be shorter than three months in acute insomnia.

How often
is insomnia seen?

30-40% of
adults define lack of sleep complaints in a period of their life, 10-13% of
them encounter lack of sleep diagnosis in such level that will affect their
lives.

In a study
made in Turkey, 9% of people meet the requirements of insomnia diagnosis
(TUTDER, TAPES study)

Do we have
to sleep at night? Is it possible to support sleep at daylight or different
hours of the evening? Or is it right?

Night
sleep is important for a quality and productive sleep. Between 13.30-15.00 are
the hours that day sleep doesn’t effect night sleep. Sleeps that are at other
hours of the day affect the duration and quality of night sleep in a bad way.

For sleep
health, the best way is to wake up in the morning in time and sleep when you
feel sleepy.

What is
the effect of good sleep on our mental health? How does the opposite effect?

A good
sleep is a necessary process for physical, spiritual repair and regeneration.
When this regeneration hasn’t been met, beside physical signs, unwillingness,
loss of motivation, temper, attention and memory disorders show up as mentally.

Development
risk of depression or other psychiatric disorder is high at insomniacs. At
insomniacs in 3.5 years (according to those who are not insomnia), depression
development is seen 4 times more, development of anxiety disorder is seen 2
times more, misuse or addiction of drug is seen 7 times more. On the other
hand, lack of sleep show up at significant and high rates in nearly all
psychiatric disorders.

Is there a
difference between female and male in terms of frequency?

Females
are diagnosed with sleep disorder nearly two times more than males. The signs
of lack of sleep increases with age (in elderly individuals over the age of 65,
lack of sleep sign frequency reaches to 50%).

Lack of
sleep frequency increases at individuals who have low income and low education
level, more often at unemployed than workers, more often at estranged, divorced
and widows.

Is it
possible to mention about genetic susceptibility?

Yes. There
are evidences about insomniac people showing physical and mental signs of
increased stimulation and having high level of anxiety.

While lack
of sleep which arose after an acute stressor is temporary for most individuals,
the tenseness and anxiety about not having sleep that arose in these patients
cause a vicious circle and make the problem increased and chronic.

Patient is
extremely focused on their lack of sleep and the affects about their daily
life.

Is it
right to try to sleep in front of television?

Trying to
sleep in front of television is one of the methods frequently resorted to.
Light that comes from television screen and changes is a stimulator.

Even if it
eases the sleeping phase, it disturbs the inner quality of sleep. Each effort
shown to sleep affects sleep in a bad way. Sleep is a situation that escapes
when summoned.

Is it
possible to mention an increasement in the past years?

The
discovery of electricity caused average sleep time to be decreased according to
100 years before.

Computer,
television, work life, time spent in traffic, duties, smart phones, homeworks,
factors that generates stress from city life causes increasement of insomnia.

Is not
having sleep related to personality structure etc.?

Insomnia
diagnosis rate is high in those who have high anxiety level, show obsessive
personality characteristics and people obsessed with control.

Have the
factors such as conditions, stress, economic distress, exam anxiety, fear of
death etc. which surround us effect on not having sleep?

Stress
factors which have developed in our daily life, play a starting role as well as
there is difference individually in chronic lack of sleep. For lack of sleep to
become chronic, maintaining factors such as genetic factors, personality
structure, spending long time in bed are also necessary and important.

Can it be
seen in children?

It can be
seen in childhood. In children, sleeping difficulty (sleeping difficulty can be
resistance to sleeping time or not sleeping independent) often noted by their
keeper.

Nowadays,
working mother and father wait for their children to sleep right after they
come from work and have their dinner. And the child wants to spend time with
his/her parents who he/she haven’t seen all day.

On one
hand mother and father wants to get rid of the tiredness of day, on the other
hand they want their child to sleep early and take their sleep for health.
After this dilemma, an obstinate happens between parent and child about either
sleeping or not.

And this
situation results child to have problems about sleep both in childhood and
adulthood.

I hear it
often in teenagers. Do you have an observation like this in clinic?

Physical,
hormonal and mental changes can affect sleep in a bad way in puberty. Internet
habit which is dense among youngsters nowadays is also a leading factor which
disrupts sleep order.

Internet
habit causes youngsters to spend long times in front of computer. “Youngsters
who spend their daytime at school and work, waste their evenings on internet.

Internet
and strategy games played online late at night even until morning causes sleep
disorder by increasing stimulation. As this situation affects school life, it
causes adaptation problem in youngsters who start in working life. These people
cannot get used to normal shift order.”

Is being
unable to sleep a psychological issue?

Physical
diseases and medication used in treatment also causes lack of sleep as well as
mental factors.

 Some
primary sleep disorders such as movement disorders, parasomnias, respiratory
disorder in sleep also causes lack of sleep.

How the
treatment is performed?

Before
starting the treatment, a good evaluation should be made and the cause should
be revealed. Treatment aimed at cause is the main principal. If insomnia
appeared as a sign of mental or physical disease, treatment of this disease
must be priority in the treatment of lack of sleep.

In
insomnia which appear after a primary sleep disorder such as movement disorder
in sleep, treatment is made with completely different principals.
Nonpharmaceutical therapies such as sleep hygiene education, mental and
physical treatment methods are primary treatment options.

Common
suggestions are to take the wake up time early and sleep when the sleepiness
come, the time not slept is not being spent in bed. Should sleeping pill be
taken? Secondary reasons which causes lack of sleep (respiration disorders,
restless legs syndrome, psychiatric disorders and other medical disorders about
sleep) must be determined and treatments aimed at these must be prioritized.

(Benzodiazepines)
which will be given to person to sleep will harm them in sleep apnea. And some antidepressives
will make the scene worse in restless legs syndrome and periodic movement
disorder. Insomniacs generally refer to medication and alcohol for
self-treatment without consulting a doctor and this situation causes disease to
become chronic. Hypotonic medications must be preferred in temporary lack of
sleep situations primarily.

However in
chronic insomnia, it can be used for patients not responding to treatment
approaches and events whose underlying case can’t be treated.

Which
precautions should be taken individually? Behavior, bedroom, bed etc. Can you
write item by item please?

One should
get out of bed when woke up in the morning. Continuing sleep on the purpose of
rest can disrupt sleep rhythm as well as it isn’t relaxing. -One should wake up
at the same hour each morning.

One should
get up from bed between defined hours to regulate circadian rhythm.

Should not
sleep in daytime.

Regular
exercise must be made but activities which will cause excitement in evening
hours must be avoided.

Bedroom must
be protected from noise, light and heat.

Bedroom
should not be used to work except sleep.

Should not
eat close to sleeping time.

One should
avoid drinks with cafein, alcohol, cola extract and usement of tobacco.

One should
not go to bed and try to sleep in bed without feeling sleepy. Is it right to
wait in bed for sleep to come? No. The most important reason of lack of sleep
becoming permanent is spending long time in bed.

A great
deal of theories which try to explain the reason for lack of sleep show a
genetic susceptibility and spending long time after that as primary cause.

Draggy
thoughts come to mind while struggling to sleep. Distress increased by these
thoughts causes stimulation and thus sleep drives away and while sleep drives
away distress increases. The way to fix this situation is to get out of bed and
deal with something.

Problems
caused by insomnia

A long
list can be counted such as common muscle and arthralgias, tiredness,
exhaustion, fatigue, daytime sleep, memory troubles, decrease in work
performance, tenderness, reactiveness, lack of attention, clumsiness, speech
defect, headache, redness on eyes, shaking hands, increasement in diabetes
risk, increasement in blood pressure as physical signs caused by insomnia.

We know
that one of the five traffic accident is sleep related. Driving without sleep
is as dangerous as drunk driving. While stress hormones’ release increases
during lack of sleep, growth hormone release decreases during night sleep.

Growth
hormone repairs our body while sleeping and while accelerating wound healing,
decelerates aging. This hormone directly affects especially children to grow
up.

Thus our
elderly are so right while saying “Sleep my little baby and grow up”. WEIGHT
GAIN: Sleep deprivation disrupts the release of various hormones. While the
release of leptin hormone saying “I am full” decreases, Ghrelin hormone saying
“I am hungry, I need to eat” increases when slept little. And this causes
weight gain, decrease in energy consumption, high-calorie foods addiction.
Obesity is seen 30% more at those who sleep less than 6 hours than those who
sleep 7-9 hours. Sleeping in enough time and quality makes weight loss easier.

WEAKINING
OF IMMUNITY: Those who sleep less get infected easier. With sleep time
reduced, increasements seen on various protein rates in immunity. And molecules
level that protects from infection released from blood cells also decreases.
Tendency to both virus and bacterial contaminations increases. In those who
sleep less than 7 hours, common cold and flu-like infections develop 3 times
more often.

DIABETES: Insulin
resistance increases at those who sleep less. Diabetes development increased 3
times at those who sleep less than 5 hours as well as patients who suffer lack
of sleep.

Respiration
Disorders in Sleep

Are
clinical pictures which develop based on the changes in respiration pattern
during sleep and cause morbidity and mortality to increase in these patients.

The most
often seen respiration disorder in sleep is an obstructive (occlusion) sleep
apnea. Fundamental signs are snoring, diagnosed apnea, day-time somnolency.
Increases in prevalence with age and overweight. If you are told that you are
snoring and your breath stops sometimes, if you are waking up tired, if you are
having day-time snoozes, if your tension can not be regulated, if your weight
losing efforts doesn not come to an end consult a doctor expert in sleeping
disease.

Snoring

Physical,
hormonal and mental changes can affect sleep in a bad way in puberty. Internet
habit which is dense among youngsters nowadays is also a leading factor which
disrupts sleep order. Internet habit causes youngsters to spend long times in
front of computer. “Youngsters who spend their daytime at school and work,
waste their evenings on internet.

Internet
and strategy games played online late at night even until morning causes sleep
disorder by increasing stimulation. As this situation affects school life, it
causes adaptation problem in youngsters who start in working life. These people
cannot get used to normal shift order.”

What are
the Stimulant Signs of Sleep-Apnea Syndrome?

Patients
who have obstructive sleep-apnea syndrome cannot breathe regularly at nights,
as a consequence enough oxygen isn’t moved to tissues, and the next day they
become tired and sleepy.

Apneas may
cause diseases such as hypertension, heart attack and paralysis. That is why,
people who have severe and constant snore need to consult a sleep disorders
center and pass the required tests. Snorings’ being cut with short breaks and
after that starting to breath with a deep and noisy voice at night should be
considered as apnea.

In some
patients, breathe stops are repeated 300-400 times a night and one can stay
breathless during 3/4 of sleep. This also means that sleep has been interrupted
300-400 times a night but most of the time patients are not aware of this
interruptions. However this kind of poor quality sleep causes tiredness and
sleepiness the next day.

How Does
The Sleep-Apnea Syndrome Affect Life Quality?

Patients
who have obstructive sleep apneas can sometimes fall asleep at inappropriate
places, live serious problems at work and private life because of sleepiness.

It is
shown in researches that these patients who sleep on wheel time to time are
having 6-7 times more traffic accidents than normal people. Sleep apneas may
cause unwillingness and reducement in productivity at patients. This kind of
complaints often develop slowly as well as they can happen suddenly. With the
effects of hormonal changes, patients’ sexual interest may be reduced.

Patients
generally state that they fall asleep easily and they have no complaints about
their sleep. Some of them complain about waking up constantly with air hunger
and the need to go to bathroom when they woke up. At night they have an anxious
sleep and they can have sweats in the neck and head area. They have headache
and feel dry mouth when they wake up in the morning.

What is
the Reason to Stop Breathing During Sleep?

During
sleep, respiratory muscles also relax as well as other muscles. This relaxion
which causes no problem at normal people is more distinct at some patients for
unknown reasons. This relaxion makes respiration difficult and turns sleep into
danger.

Over
weight, abnormal throat, nose, mouth and jaw structure makes respiratory
passage narrower and with the effect of relaxion during sleep, respiration
passage closes and apnea occurs. However factors themselves do not cause the
respiration to stop, it is considered that brain centers which provides the
control of respiration in sleep have an unknown role.

Inspections
Done in Sleep-Apnea Syndrome Doubt: When you consult to your doctor with the
complaints above, they will probably want to speak with your bed partner or
your relatives and ask for detailed information about you, and if they decide
that your complaints are compatible with obstructive sleep apnea syndrome, they
will refer you to a sleep disorders center. In sleep disorders centers, they
will inspect you for a night through electrodes planted on various areas of
your body. During this test called all night polygraphic sleep examination,
your sleep and various body functions are recorded during all night, in your
home conditions as possible, and videotaped while monitored by technicians in
charge.

Recorded
body functions number and method used to record might vary in sleep centers.
However it is obligatory to record electroencephalogram (EEG), electrooculagram
(EOG, eyeball movements), electromyogram (EMG, muscle strain) records, air
breathed with tiny devices attached to mouth and nose, respiration movements in
sleep with belts wore to chest and abdomen, oxygen level and heart rhythm with
a detector in the shape of latch wore to finger or ear, laying position with
the purpose of sleep periods to be discriminated as a standard. All night
polygraphic sleep examinations are evaluated the next day by experienced
doctors and your snore being either dangerous or not, the duration time and
frequency of respiration stops and abnormal findings are reported to you.

Sleep
examination defines the volume of your disease and gives valuable clues about
how to treat your treatment. Patients who have obstructive sleep apnea syndrome
need to go through ear-nose-throat examination after the night test, sometimes
it can be necessary to perform some respiration function tests.

Restless
Legs Syndrome

Restless
Legs Syndrome (RLS) is a movement disorder. Patients feel the need to move
their legs irresistibly.

The
symptoms vary from patient to patient. Most of the patients have difficulty to
describe the disturbing feelings on their legs. It is often described as
‘paresthaesia’ or ‘tingling’. This is a feeling way different from cramp. This
restlessness feeling on the legs is most frequently at the calves. 

Sitting
still and laying increases these unpleasant feelings in the legs. Moving and
stretching the legs decreases these complaints temporarily for a while. In
evening hours, if you are having unpleasant feelings that you have difficulty
to describe especially in your legs while you are resting, if it passes with
movement and restarts with resting, if it causes you to not sleeping, consult a
doctor experienced about sleep disorders.

What is
Restless Legs Syndrome?

Restless
Legs Syndrome (RLS) is a movement disorder. Patients feel the need to move
their legs irresistibly. The symptoms vary from patient to patient. Most of the
patients have difficulty to describe the disturbing feelings on their legs. It
is often described as ‘paresthaesia’ or ‘tingling’. This is a feeling way different
from cramp. This restlessness feeling in the legs is most frequently at the
calves. Sitting still and laying increases these unpleasant feelings in the
legs. Moving and stretching the legs decreases these complaints temporarily for
a while. At some patients there are unpleasant feelings on arms as well as
legs.

While the
complaints of some RLS patients are temporary, others have those every night.
Therefore, many patients have poor sleep quality. They can be so tired in
daytime as a result of not having a good sleep and thus, their occupational and
social lives can fail. Daytime sleep situation is only one of the problems RLS
created. These patients often have difficulties on car or plane trips.

Likewise,
they have difficulty at cinema, theater and job meetings that they need to sit
for a long time. RLS can cause anxiety and depression because it causes poor
sleep quality and sleep interruptions. At most of the patients who have RLS,
they also have a disease called ‘Periodic Limb Movement Disorder in Sleep’.
While patients sleep, their toes bend backward often. Joint motion in the shape
of ankle, knee and hip stretching can also accompany to this. Sometimes these
movements are described as leg pulsating or kicking by their partners.
Periodical leg movements are in tendency of emerging regularly. The space is
generally like 20-40 sec.

They
emerge more often at the first half of the night. This disease can also emerge
at arms as well as legs just as its sibling disease. ‘Periodic Limb Movement
Disorder in Sleep’ happens always in sleep different from RLS. Patients don’t
realize this situation, thus it is not likely to control it.

Nevertheless,
the signs of RLS appear in daytime and legs are moved voluntarily due to
unpleasant feelings at legs. ‘Periodic Limb Movement Disorder in Sleep’ can
disrupt sleep quality just as RLS. It can cause short term interruptions during
sleep.

These
short term interruptions not notices from patient are called ‘microarousal’.
Thus, interrupted and relaxing ‘Periodic Limb Movement disorder in Sleep’ can
disrupt the sleep of not only the patient but also partner who share the same
bed.

These
partners can mention that they got kicked all night by the patient. And because
of leg movements, bed lining which they cover on themselves can be uncovered or
fall down.

Is RLS a
Frequently Seen disease?

At most of
the RLS patients, there is no other important diseases. It occurs in both men
and women. In our country, every three people of 100 have this disease. In
western counties, these rates are reported higher. Regression of the disease on
itself is rare except for some special situations such as pregnancy. It goes at
the same progress for years without an underlying reason. It is seen more often
at women than men.

Especially
children whose family member has RLS, might have RLS. Sometimes these
complaints at children are described as ‘pains related to growth’. And
sometimes, these children are mistakenly diagnosed with ‘attention
deficit-hyperactivity syndrome’ colloquially known as ‘’hyperactive’.

Yet these
children are unable to contain themselves because they feel the need to move
their legs due to RLS, not because they are hyperactive. RLS can appear in
pregnancy or become severe.

This
situation can become apparent especially at the last 6 months of the pregnancy.
80% of patients with RLS also have ‘Periodic Limb Movement disorder in Sleep’.
But opposite is not valid. Most of the patients diagnosed with ‘Periodic Limb
Movement disorder in Sleep’ do not have RLS.

What is
the reason of RLS?

Patients
who have RLS have difficulty in describing their complaints. This situation can
be mistakenly understood as a sign of a psychological disease. But RLS is not a
psychological disease. The reason of disease is not found certainly. ‘Dopamine’
a material which works as contact especially in brain is dwelled on.

Because
dopamine increasing medicine have effect on neural system. At some patients,
the RLS is high in prevalence. In other words, it can be said that these
diseases trigger RLS.

These
diseases can be anaemia related to iron deficiency:

Blood flow
disorder at legs Hernia or disorder at leg nerves

Kidney
diseases -Muscle diseases Alcoholism

Some
vitamin and mineral deficiencies can be RLS genetic transition. The possibility
of RLS occurrence in one of the relatives of RLS patients who has none of the
above diseases is 50%. And this is a sign which shows that the disease can be
genetic transition. This genetic transition form can start at teen ages, even
at childhood ages and its treatment is way more difficult than the form which
is not genetic. Some depression medication, allergy medication and painkillers
may aggravate or show up the RLS signs. The usage of caffeine, alcohol and
cigarette aggravates the signs of the disease.

How to
diagnose RLS?

Doctors
who can diagnose you are specialist physicians who deals with sleep diseases.
There is no blood test or radiologic examination to diagnose RLS yet.

The
diagnosis is made by the detailed medical history and physical inspection of
the physician. The RLS findings are generally typical and does not require
additional tests. When there is a suspicion on diagnosis or there is an
additional disease that eases RLS to appear, blood examination, EMG or all
night performed sleep examination might be needed to diagnose it.

You have
RLS, if you have all the complaints below:

1.
Restlessness feeling at your legs and the desire to move them related to this.

2.
Decreasement and vanishment of this feeling temporarily while moving your legs.

3.
Complaints appear or become more obvious while staying motionless and at
nights.

Parasomnia

Parasomnia
is a word used to define abnormal situations occur during sleep. These
situations generally occur at sleep. But it occurs fewer at most people. In
addition to this, sometimes it gets dense, become violent and require
treatment. Confussional Wakings: The most frequent at infants and children.
However sometimes it can occur at adults. It starts with crying and roaming
bemusedly around the bed.

When
looked from an external perfective they are awake yet confused. It is really
hard to wake them at this point. Its time can lengthen out to half an hour.
They usually finally wake up, don’t remember what happened and want to go to
bed and sleep. Sleepwalking: It is frequent at older children. Sometimes they
just get out of bed and take a few step. However they can even get out of house
sometimes. Sometimes they talk, yet what they say is not understandable. They
can do more complicated things too. For example they can change the places of
furnitures. In meantime, injuries may happen too. It might be necessary to take
precautions for this. How are Awareness Disorders Evaluated: There is no need
to go to doctor in awareness disorders as expressed above and in childhood age.

However
you need to take medical assistance in these situations:

1. When it
makes other family members uncomfortable

2. When
there is excessive somnolency in daytime.

3. When it
happens too frequent and there are episodes of getting away from room or house
in sleepwalking. In these situations, a sleep disorders center must be
consulted.

Also, if
these complaints continue after childhood, medical assistance must be seeked.
At some patients, these disorders appear due to sleep apnea, stomach disorders
or leg movements in sleep. Sleep medical specialist will evaluate these
situations. But most of the time it does not require a treatment. Patient and
their family must believe that this is not a serious sign of disease.

In
children with increasing age, occurrence frequency decreases. It can continue
at adult age rarely. Eating related to Sleep: Something is eaten unconsciously
in sleep. At the end, this results weight gain. Despite it can be seen at any
age and sex, it is more often at young females.

Sleep
Terror: Awareness is the most dramatic one of the disorders. It generally
starts with a ‘hair-raising’ scream. They are like scared too much. Their
pupils dilate, pulse increases, breathing accelerates, they sweat and are
restless. They jump out of bed, wanders around the room and even in house like
crazy. Meanwhile, they can harm both themselves and surroundings. Even though
this situation horrifies the watchers, the person is not aware of it. When they
wake up, they remember nothing. The greatest difference from nightmare or bad
dreams is this, so it is not related to a dream. Simple precautions should be
taken in order to prevent the person who has awareness disorder from injury.
Arranging furnitures in bedroom as to prevent injuries, closing windows well,
putting lock or alarm on door and windows are the precautions that can be
taken. Awareness disorders which cause injuries, violence against surroundings,
excessive eating or disturbing surroundings requires treatment.

What are
the other Parasomnias?

They can
be seen in situations below as less frequently, Hypnagogic
Hallucinations and Sleep Paralysis: Hypnagogic hallucinations are
generally the situations of seeing dreams while awake right before sleeping.
These dreams can be scary as they are like real. Sleep paralysis (heaviness) is
the situation of not being able to move arm and legs as being paralyzed when
woken up. It generally happens right after a dream. Hypnagogic hallucinations
and sleep paralysis can occur together. It is often at narcolepsy disease. It can
also occur at people who could not have their sleep. Convulsions Which occur at
Nights: These are just convulsions which occur at sleep only. Patient can
scream, get up and walk, run or fall down from bed. It can be thought as
awareness disorder. Rapid Eye Movement (REM) Sleep Behavior Disorder: During
REM sleep period when we see the most of our dreams, all of our muscles are
like paralyzed except for respiration muscles. At some people, this paralyzing
process does not completely occur.  Consequently, they do things which
they do in their dreams during dream in person. So they play their dreams as a
manner of speaking. And this can harm both themselves and surroundings.
Irritations in Sleep: Most people lived this situation at least once or several
times. Sudden irritation occur at whole body while falling asleep. It can occur
at different shapes except for the irritations of the body. For example it can
occur as sudden light or voice detection. It is harmless most of the time.
Eurythmy Disorder: It is often seen at children; It can occur less often at
adults. It occurs in the way that shaking of head or body, or turning head to
right-left. This situation occurs right before falling asleep or during sleep.
In some severe situations, treatment might be needed.