What are the symptoms of insomnia and parasomnia? Insomnia is poor sleep, whereas parasomnia is the presence of abnormal events in sleep. When insomnia or parasomnia persists most nights a week for weeks, it can cause increased tension, decreased energy, and personality and mood changes. Movement disorders such as restless legs at bedtime can cause difficulty falling asleep. In this condition, the legs feel restless when going to bed, and moving them about helps. This is usually accompanied by periodic limb movements (PLMs) or jerks of the arms or legs which cause repeated arousals. Sleep apnea can cause non-refreshing sleep. Difficulty staying asleep is often related to depression. In the absence of other causes, insomnia is considered primary insomnia. In parasomnia, repetitive abnormal or violent behaviors such as sleepwalking and sleep-terrors can cause injury to the sleeper or others, or damage to surroundings. Such behaviors can occur with sleep-related seizures, Rapid Eye Movement behavior disorder (REMBD), and confusional arousals in NREM sleep. In REMBD, normal muscle paralysis during dream sleep fails to occur. In confusional arousals, partial arousals occur from sleep. Enuresis or bedwetting is also a parasomnia.

How are they diagnosed? Sleep testing helps determine whether insomnia is being caused by sleep apnea or periodic limb movement disorder. If there is no evidence of sleep apnea or daytime sleepiness, sleep testing for insomnia may not be necessary. Parasomnias, when frequent or unusual, are best diagnosed with sleep testing.

 How are they treated? Acute insomnia is common and easily treated by your primary care practitioner. Insomnia accompanying depression needs psychiatric treatment. Primary insomnia is treated with behavioral management, or with medicines (not sleeping pills) that work on brain chemicals and improve sleep. It is also important to not get too much time in bed. Restless legs/ PLMs are treated with medicines. Parasomnias are treated with appropriate medicines after accurate diagnosis.