Have you ever wondered how someone can walk, talk, or even scream while asleep without being aware of what they are doing? And can dreams actually turn into movements and behaviors that appear remarkably real? Sleep is not simply a period of rest and stillness. It is a complex state during which the brain and body go through several distinct stages. During these stages, unusual behaviors or experiences may sometimes occur, a group of conditions known as parasomnias.Parasomnias include a wide range of sleep disorders that can manifest in different ways, such as sleepwalking, sleep terrors, recurrent nightmares, sleep talking, sleep paralysis, and other unusual behaviors during sleep. While some of these experiences may be mild and temporary, others may require medical evaluation, particularly when they occur frequently, result in injuries, or negatively affect sleep quality and daily life.In this article, Dalili Medical explores the different types of parasomnia, its symptoms and causes, how it is diagnosed, available treatment options, and practical tips for managing the condition and preventing potential risks. Understanding parasomnia can help us better recognize what happens during sleep and distinguish between common sleep phenomena and disorders that may require medical attention.

Frequently Asked Questions About Parasomnia

What Is Parasomnia?

Parasomnia refers to a group of sleep disorders characterized by unusual behaviors or experiences that occur during sleep or during transitions between sleep and wakefulness. These disorders may manifest in several forms, including sleepwalking, sleep terrors, nightmares, sleep talking, and other unusual movements or behaviors during sleep.

Is Parasomnia Dangerous?

In most cases, parasomnia does not pose a direct threat to a person’s health. However, certain types may result in injuries caused by falls, sleepwalking, or violent movements during sleep. Therefore, the potential risk varies depending on the type of parasomnia, the severity of symptoms, and how frequently the episodes occur.

Is Parasomnia Contagious?

No. Parasomnia is not a contagious condition and cannot be transmitted from one person to another through physical contact or sleeping near someone who has the disorder.

Is Parasomnia Hereditary?

Some types of parasomnia, particularly sleepwalking and sleep terrors, may be associated with genetic factors and a family predisposition. The likelihood of developing these conditions may be higher in individuals with a family history of parasomnia. However, having an affected family member does not necessarily mean that other family members will develop the condition.

Does Parasomnia Occur in Children?

Yes. Parasomnia can occur in children, and certain types, such as sleepwalking and sleep terrors, are relatively common during childhood. In many cases, these behaviors gradually decrease with age and do not cause lasting problems.

Can Parasomnia Develop in Adults?

Yes. Parasomnia can occur in adults. However, the first appearance of unusual sleep behaviors during adulthood warrants medical evaluation, particularly if the behaviors are frequent or violent. This helps rule out other sleep disorders, neurological conditions, or medication-related effects.

Is a Person Who Sleepwalks Conscious?

A person who sleepwalks is usually in a state of partial awareness. Their eyes may be open, and they may be able to walk or perform certain activities, but they are generally not fully awake or completely aware of their surroundings.

Does a Person Remember What Happened During a Parasomnia Episode?

The ability to remember an episode varies depending on the type of parasomnia. In conditions such as sleepwalking and sleep terrors, memory of the episode is often limited or completely absent. In contrast, people who experience nightmares or REM Sleep Behavior Disorder (RBD) may remember the dream or experience more clearly.

Should You Wake Someone Who Is Sleepwalking?

It is generally preferable to remain calm and gently guide the person back to bed rather than trying to wake them abruptly or frightening them. The priority should be to ensure their safety by removing potentially dangerous objects and securing doors, windows, and stairways when necessary.

Is Parasomnia the Same as Nocturnal Epilepsy?

No. Parasomnia and nocturnal epilepsy are different conditions, although some symptoms may overlap, particularly sudden or unusual movements during sleep.

When movements are repetitive, highly stereotyped, or violent, a doctor may recommend a sleep study with video monitoring and electroencephalography (EEG) to help determine the nature of the episodes and distinguish parasomnia from nocturnal epilepsy or other sleep disorders.

Can Parasomnia Be Caused by Stress?

Yes. Stress, anxiety, and sleep deprivation may trigger certain types of parasomnia or increase the frequency of episodes in people who are already predisposed to them. Therefore, reducing psychological stress and maintaining a regular sleep schedule may help decrease the frequency of episodes.

Can Sleep Deprivation Cause Parasomnia?

Sleep deprivation and fatigue can be important triggers for some types of parasomnia, particularly sleepwalking and sleep terrors. Therefore, getting enough sleep and maintaining consistent sleep and wake times are recommended.

Can Caffeine Cause Parasomnia?

Caffeine is not considered a direct cause of parasomnia. However, excessive caffeine intake, especially in the evening, may cause difficulty falling asleep or fragmented sleep, which can indirectly contribute to an increase in certain sleep disturbances in susceptible individuals.

Does Alcohol Increase Parasomnia?

Alcohol can affect the structure and stages of sleep and may increase sleep disturbances or trigger certain parasomnia episodes in some people. Therefore, avoiding alcohol may be beneficial, particularly if a person notices a clear connection between alcohol consumption and the occurrence of episodes.

Can Parasomnia Be Cured?

Many cases of parasomnia can be effectively managed, and some types may gradually disappear with age, particularly certain forms that occur during childhood. Parasomnia associated with another sleep disorder, a specific medication, or an underlying health condition may also improve significantly when the underlying cause is identified and appropriately treated.

Causes of Parasomnia

Parasomnia can occur due to several factors. In many cases, more than one factor may contribute to the onset or worsening of symptoms.

1. Genetic Predisposition

Some types of parasomnia, particularly sleepwalking and sleep terrors, may be associated with genetic factors and a family predisposition. The likelihood of developing these conditions may be higher in people who have a parent or sibling with a similar condition. However, having a family history does not necessarily mean that a person will develop parasomnia.

2. Sleep Deprivation and Fatigue

Insufficient sleep, fatigue, and disrupted sleep are common triggers for certain types of parasomnia. Sleep deprivation can increase sleep pressure and affect transitions between sleep stages, which may contribute to episodes such as sleepwalking and sleep terrors in susceptible individuals.

3. Stress and Anxiety

Psychological stress, anxiety, and stressful life events may increase the frequency of certain types of parasomnia, particularly in people who are already predisposed to these conditions. Changes in lifestyle or daily routines may also disrupt sleep and contribute to more frequent episodes.

4. Irregular Sleep Schedules

Irregular sleep and wake times may disrupt the normal sleep-wake cycle. Factors that can contribute to an irregular sleep schedule include:

• Shift work.

• Frequent travel and changes in time zones.

• Persistent late-night sleeping.

• Significant variations in bedtime and wake-up times from one day to another.

Disrupted sleep schedules may increase the likelihood of certain types of parasomnia in susceptible individuals.

5. Fever and Acute Illness

Fever and certain acute illnesses may increase sleep disturbances and partial arousals, particularly in children. During these periods, episodes such as sleep terrors or sleepwalking may occur more frequently.

6. Other Sleep Disorders

Certain sleep disorders may contribute to or trigger parasomnia episodes. These include:

• Obstructive Sleep Apnea (OSA).

• Restless Legs Syndrome (RLS).

• Periodic Limb Movements During Sleep (PLMS).

• Certain circadian rhythm sleep-wake disorders.

In some cases, diagnosing and treating the underlying sleep disorder may help reduce parasomnia episodes.

7. Medications and Certain Substances

Some medications can affect sleep architecture or sleep stages and may increase certain types of parasomnia in susceptible individuals. Examples include some sedatives, antidepressants, and medications that affect the nervous system and sleep.

Alcohol may also disrupt normal sleep architecture and increase certain sleep disturbances in some individuals.

A prescribed medication should never be discontinued without medical advice. If parasomnia symptoms begin after starting a new medication or changing its dose, it is important to inform the treating physician so that the possible relationship between the medication and the symptoms can be evaluated.

8. Mental Health Conditions

Some types of parasomnia, particularly in adults, may occur alongside mental health conditions such as anxiety, post-traumatic stress disorder (PTSD), and depression.

However, having parasomnia does not necessarily indicate the presence of a mental health disorder. These conditions may occur independently, and the relationship between them varies depending on the type of parasomnia and the individual’s overall health.

9. Neurological Disorders

Certain sleep-related behaviors may be associated with neurological conditions. Therefore, medical evaluation is important when unusual sleep behaviors first appear during adulthood, or when episodes are severe, frequent, or associated with injuries.

One important condition in this context is REM Sleep Behavior Disorder (RBD). In this disorder, a person may make movements or sounds during sleep that appear to correspond to dream content, such as talking, shouting, kicking, or punching.

What Are the Types of Parasomnia?

First: NREM Sleep Arousal Disorders

These disorders typically occur during deep stages of non-rapid eye movement (NREM) sleep, particularly during the first part of the night. The person experiences a partial arousal from sleep and may therefore have limited awareness of their surroundings and actions. In many cases, they have little or no memory of the episode after waking.

The main types include:

1. Sleepwalking (Somnambulism)

Sleepwalking occurs when a person partially awakens from sleep and begins walking or performing certain activities while remaining in a state of limited awareness and responsiveness to their surroundings.

Behaviors may include:

• Getting out of bed and walking around.

• Opening doors or moving objects.

• Performing routine activities.

• Occasionally talking during the episode.

The person often has little or no memory of these events the following morning.

2. Sleep Terrors

Sleep terrors involve a sudden episode of intense fear during sleep, which may be accompanied by screaming, abruptly sitting up in bed, or displaying obvious signs of fear.

Although the person may appear to be awake, they are usually not fully aware of what is happening around them. They often have little or no memory of the episode after waking.

3. Confusional Arousals

Confusional arousals involve a partial awakening from sleep while the person remains confused and not fully alert.

Symptoms may include:

• Slow responses.

• Unclear or slurred speech.

• Limited awareness of their surroundings.

• Difficulty communicating normally.

• Little or no memory of the episode afterward.

4. Sleep-Related Eating Disorder

In sleep-related eating disorder, a person may eat or drink while asleep or during a state of partial arousal. They may also prepare food without being fully aware of what they are doing.

A characteristic feature is that the person may have little or no memory of eating during the night the following morning.

Second: REM-Related Parasomnias

These parasomnias occur during rapid eye movement (REM) sleep, the stage of sleep commonly associated with vivid and intense dreaming.

1. REM Sleep Behavior Disorder (RBD)

In REM Sleep Behavior Disorder, a person may physically or verbally act out the content of their dreams through various movements or sounds, rather than remaining relatively still as normally occurs during REM sleep.

Symptoms may include:

• Talking or shouting.

• Laughing or crying.

• Moving the arms or legs.

• Kicking or punching.

• Falling out of bed in some cases.

The person may remember the dream after waking and may be able to relate the movements or behaviors to the dream content.

2. Sleep Paralysis

Sleep paralysis occurs during the transition between sleep and wakefulness. The person feels awake but is temporarily unable to move or speak.

It may be accompanied by:

• A sensation that someone is present in the room.

• Seeing people or shapes that are not actually present.

• Hearing sounds or voices.

• A feeling of pressure on the chest.

• Intense fear during the episode.

Sleep paralysis usually lasts for a short period and resolves on its own.

3. Nightmare Disorder

Nightmares are disturbing or frightening dreams that may cause a person to wake up. The person can usually remember the content of the dream after awakening.

Frequent nightmares may lead to:

• Sleep disruption.

• Difficulty returning to sleep.

• Anxiety or fear of going to sleep.

• Daytime fatigue and sleepiness.

Third: Other Types and Phenomena Associated With Parasomnia

Several other behaviors and experiences may occur during sleep or during the transition between sleep and wakefulness. These include:

1. Sleep Talking (Somniloquy)

Sleep talking involves speaking words or phrases while asleep. The speech may be simple and difficult to understand, or it may consist of complete sentences or even conversations.

In most cases, the person is unaware that they were talking during sleep.

2. Sleep-Related Sexual Behaviors (Sexsomnia)

Sexsomnia refers to sexual behaviors that occur during sleep without the person being fully conscious or aware of their actions. The individual may have little or no memory of what happened after waking.

3. Sleep-Related Hallucinations

Sleep-related hallucinations involve unusual sensory experiences that occur while transitioning from wakefulness to sleep or from sleep to wakefulness.

They may be:

• Visual, such as seeing people, objects, or shapes.

• Auditory, such as hearing sounds or voices.

• Tactile, such as feeling that someone has touched the person or that something is near or moving on the body.

These experiences may sometimes occur together with sleep paralysis.

4. Exploding Head Syndrome

Exploding Head Syndrome is a sleep-related phenomenon in which a person suddenly hears a loud or intense sound inside their head while falling asleep or waking up. The sensation may resemble an explosion, a loud bang, or a powerful удар.

Despite its alarming name, there is no actual explosion or physical injury to the head.

The experience may cause fear or anxiety, but it is not generally associated with an actual external sound source.

5. Unspecified Parasomnia

This classification is used when a person experiences unusual behaviors or events during sleep that do not meet the criteria for a specific type of parasomnia.

The diagnosis may be used when there is insufficient information to classify the symptoms more precisely or when the sleep-related behaviors do not fit neatly into another defined category.

What Are the Symptoms of Parasomnia?

The symptoms of parasomnia vary depending on the specific type of sleep disorder. They may include unusual movements, behaviors, vocalizations, partial awakenings, vivid dreams, or unusual sensory experiences during sleep or during the transition between sleep and wakefulness.

1. Sleepwalking (Somnambulism)

Sleepwalking most commonly occurs during deep non-rapid eye movement (NREM) sleep, particularly during the first part of the night.

A person sleeping near someone who sleepwalks may notice behaviors such as:

• Suddenly sitting up in bed.

• Getting out of bed and walking around the room or house.

• Opening doors or windows.

• Walking to the bathroom or kitchen.

• Moving or relocating objects.

• Performing routine activities that appear purposeful despite incomplete awareness.

• Being difficult to wake during the episode.

• Keeping the eyes open with a blank or distant gaze and limited interaction with others.

• Responding to speech in a limited or inappropriate manner.

After the episode, the person may be confused upon awakening and often has no memory or only partial memory of what happened.

2. Sleep Terrors

Sleep terrors typically occur during deep sleep and differ from nightmares in terms of the nature of the episode and the person’s level of awareness.

Symptoms may include:

• Sudden, loud screaming.

• Sitting up or jumping out of bed.

• Obvious signs of intense fear.

• Wide-open eyes.

• Rapid heartbeat.

• Rapid breathing.

• Sweating.

• Attempting to escape or pushing away someone who tries to wake them.

• Limited or abnormal responsiveness to people around them.

• Difficulty calming the person during the episode.

• Little or no memory of the episode the following morning.

3. Confusional Arousals

Confusional arousals occur when a person partially awakens from sleep without the brain reaching a fully alert state.

Symptoms may include:

• Opening the eyes without being fully aware of the surroundings.

• Sitting up in bed.

• Severe confusion.

• Speaking slowly or unclearly.

• Temporarily being unaware of their location or surroundings.

• Slow responses to questions.

• Engaging in unusual or inappropriate behaviors.

• Returning to sleep without a clear awareness of what occurred.

• Poor or absent memory of the episode the following morning.

4. REM Sleep Behavior Disorder (RBD)

Under normal circumstances, most of the body’s muscles are temporarily inhibited during rapid eye movement (REM) sleep. In REM Sleep Behavior Disorder, however, a person may make movements and sounds that correspond to the content of their dreams.

Symptoms may include:

• Talking during dreams.

• Shouting or screaming.

• Laughing or crying.

• Kicking.

• Punching.

• Moving the arms or legs violently.

• Sitting up or getting out of bed.

• Making defensive or aggressive movements related to dream content.

• Falling out of bed.

• Injuring themselves or their bed partner.

One characteristic feature of RBD is that the person may remember the dream after waking and may be able to describe its content and relate their movements to events in the dream.

When these symptoms first appear in an adult, particularly when violent movements or injuries are involved, medical evaluation by a sleep specialist is important.

5. Nightmare Disorder

Nightmares differ from sleep terrors because the person usually wakes up more aware of their surroundings and can often remember the content of the dream.

Symptoms may include:

• Having frightening or disturbing dreams.

• Waking up suddenly from sleep.

• Feeling frightened or anxious after waking.

• Remembering details of the dream.

• Difficulty returning to sleep.

• Developing a fear of going to sleep because of recurrent nightmares.

• Experiencing daytime fatigue or sleepiness when nightmares occur frequently.

• Heart palpitations or sweating after waking in some cases.

6. Sleep Paralysis

Sleep paralysis occurs during the transition between sleep and wakefulness. Its main symptom is being aware of one’s surroundings while temporarily being unable to move the body or speak.

It may be accompanied by:

• A feeling of heaviness or pressure on the chest.

• A sensation of being unable to move despite being able to breathe.

• Seeing a person or shadow in the room.

• Hearing sounds or whispers.

• Feeling that someone is near the bed.

• A sensation of falling or floating.

• Intense fear during the episode.

Sleep paralysis usually lasts for a short period, ranging from a few seconds to several minutes, and typically resolves on its own.

7. Sleep Talking (Somniloquy)

Sleep talking can vary considerably in complexity, ranging from simple sounds to complete sentences or conversations.

It may include:

• Mumbling.

• Producing unclear words.

• Speaking in short sentences.

• Engaging in lengthy conversations.

• Laughing or crying.

• Screaming in some cases.

The person is usually unaware that they have been talking during sleep and may not remember what they said after waking.

8. Sleep-Related Eating Disorder

In this condition, a person may partially awaken during the night and begin eating without being fully aware of what they are doing.

Symptoms may include:

• Searching for food during the night.

• Preparing food.

• Eating large amounts of food.

• Consuming foods that are unusual for the person.

• Eating non-food substances in some cases.

• Leaving food or kitchen utensils in unusual places.

• Having little or no memory of eating the following morning.

• Sustaining cuts or burns if kitchen utensils are used during an episode.

9. Sleep-Related Sexual Behaviors (Sexsomnia)

Sexsomnia involves sexual behaviors occurring during sleep while the person is not fully conscious or aware of their actions. They may have little or no memory of what happened after waking.

Symptoms may include:

• Touching.

• Sexual movements or behaviors.

• Making sounds associated with sexual behavior.

• Attempting to engage in sexual activity.

• Little or no clear memory of the event after waking.

This type of parasomnia warrants medical evaluation, particularly if it occurs repeatedly or results in injuries or problems for the person or their bed partner.

10. Sleep-Related Hallucinations

These sensory experiences may occur while transitioning from wakefulness to sleep or from sleep to wakefulness. They can involve different types of sensory perceptions.

Examples include:

• Visual hallucinations: Seeing a person, shadow, or shape that is not actually present.

• Auditory hallucinations: Hearing sounds, knocking, or voices.

• Tactile hallucinations: Feeling as though someone has touched the person or sensing something moving on the body.

• A sensation that someone or some presence is in the room.

These experiences may sometimes occur together with sleep paralysis.

11. Exploding Head Syndrome

Despite its name, this condition does not involve an actual explosion inside the head.

A person typically experiences a sudden, intense sound when falling asleep or waking up. The sound does not come from an external source and may be described as:

• An explosion.

• A loud bang.

• A powerful knocking sound.

• A sudden buzzing or electrical sound.

The experience may be accompanied by fear or a temporary increase in heart rate. However, it does not indicate an actual explosion or physical injury to the head.

Medical Treatment of Parasomnia

Treatment for parasomnia depends on the specific type, severity, frequency of episodes, associated risks, and any underlying condition. Medication is not necessary for every person with parasomnia.

1. NREM Sleep Arousal Disorders

This group includes:

• Sleepwalking.

• Sleep terrors.

• Confusional arousals.

In mild cases, medication is usually not required, particularly when episodes are infrequent and do not cause injuries.

However, if episodes are severe, frequent, or associated with injuries, a sleep specialist may consider medication in selected cases. Potential treatment options include:

Clonazepam

Clonazepam may be used in certain cases to reduce parasomnia episodes, but it is not appropriate for everyone. It may cause drowsiness, dizziness, and balance problems and can lead to physical dependence with long-term use.

Doctors may need to avoid it or use it cautiously in people with certain sleep-related breathing disorders.

Melatonin

Melatonin may be considered in some cases, particularly when there is a problem with sleep timing or sleep patterns. However, its effectiveness varies depending on the type of parasomnia and the individual’s circumstances.

Neither medication should be started without medical advice and an appropriate assessment of the type of sleep disorder.

2. REM Sleep Behavior Disorder (RBD)

Medication is more commonly considered for REM Sleep Behavior Disorder, particularly when movements are severe or cause injuries.

Potential treatment options include:

Melatonin

Melatonin is used in some patients and may help reduce dream-related movements and behaviors. It may be a suitable option for certain patients because it is generally well tolerated.

Clonazepam

Clonazepam is one of the medications used to treat REM Sleep Behavior Disorder and may help reduce movements and vocalizations associated with dreams.

It requires medical supervision, particularly in older adults and people who are at increased risk of falls or who have sleep-related breathing disorders.

When RBD is diagnosed, the physician should also assess for medications or underlying health conditions that may be associated with the development of the disorder.

3. Sleep Paralysis

Isolated sleep paralysis usually does not require direct drug treatment. Management generally focuses on addressing factors that may contribute to episodes, such as:

• Sleep deprivation.

• Irregular sleep schedules.

• Disrupted sleep-wake patterns.

• Insufficient sleep.

If sleep paralysis occurs as part of narcolepsy, the patient may require medication specifically directed at narcolepsy, based on medical evaluation, rather than treatment of sleep paralysis alone.

4. Recurrent Nightmares

Occasional nightmares usually do not require medication. However, when nightmares are frequent, distressing, or associated with an underlying condition, treating the underlying cause is an important part of management.

In certain cases, particularly nightmares associated with post-traumatic stress disorder (PTSD), a physician may consider specific treatment options.

5. Treatment of Parasomnia Associated With Another Disorder

In some cases, treating parasomnia itself is not the primary solution. Instead, the goal is to identify and treat the underlying disorder or contributing factor.

Examples include:

Parasomnia Associated With Obstructive Sleep Apnea

After obstructive sleep apnea is properly diagnosed, treating the breathing disorder may help reduce parasomnia episodes in some patients.

Parasomnia Associated With Restless Legs Syndrome

Treatment may involve managing the underlying movement disorder or correcting iron deficiency when confirmed, according to the physician’s assessment.

Parasomnia Associated With a Specific Medication

If a physician suspects that a medication is causing or worsening the episodes, they may adjust the dose or change the medication when appropriate. Patients should never stop a prescribed medication on their own.

Symptoms That Resemble Nocturnal Epilepsy

The diagnosis should be confirmed first. If the symptoms are determined to be caused by epilepsy, treatment involves anti-seizure medications according to a neurologist’s assessment rather than the medications typically used for parasomnia.

Medication Treatment for Parasomnia

Treatment for parasomnia depends on the type of disorder, the severity of symptoms, and the underlying cause. Not all cases require medication.

• NREM disorders, such as sleepwalking and sleep terrors: Mild cases usually do not require medication. In severe or recurrent cases, a doctor may prescribe medications such as Clonazepam or Melatonin, depending on the individual’s condition.

• REM Sleep Behavior Disorder (RBD): Melatonin or Clonazepam may be used under medical supervision to reduce dream-related movements and behaviors.

• Sleep paralysis: Usually does not require medication. Treatment focuses on improving sleep and addressing contributing factors, such as sleep deprivation or narcolepsy, when present.

• Recurrent nightmares: The underlying cause should be addressed first. Prazosin may be considered in some cases associated with post-traumatic stress disorder (PTSD).

• Parasomnia caused or worsened by another sleep disorder: Treating the underlying condition, such as obstructive sleep apnea or restless legs syndrome, may be an important part of reducing parasomnia episodes.

Tips for Managing Parasomnia

• Maintain a regular sleep schedule: Go to bed and wake up at consistent times, get enough sleep, and avoid sleep deprivation and excessive fatigue.

• Reduce stress: Practice relaxation and breathing exercises and limit the use of electronic devices before bedtime.

• Avoid triggers: These may include sleep deprivation, severe stress, alcohol, and excessive caffeine intake, particularly in the evening.

• Make the sleeping environment safe: Remove sharp or breakable objects and secure doors, windows, and stairways, especially when sleepwalking occurs repeatedly.

• Respond calmly during an episode: Avoid forcibly waking the person. Instead, gently guide them back to bed while removing potential hazards.

• Keep a sleep diary: Record sleep and wake times, episode timing and duration, and possible triggers. If safe, recording an episode on video may also help the doctor with the evaluation.

• Treat coexisting sleep disorders: Conditions such as obstructive sleep apnea or restless legs syndrome should be evaluated and treated when present, as this may help reduce parasomnia episodes.

• For children: Encourage adequate and regular sleep, avoid fatigue and excessive stress, ensure a safe sleeping environment, and avoid frightening or punishing the child for behaviors that occur during sleep.

When Should You See a Doctor?

Medical evaluation is recommended if parasomnia episodes:

• Occur frequently.

• Cause injuries to the person or their bed partner.

• Involve violent or dangerous movements.

• Appear for the first time during adulthood.

• Are accompanied by severe snoring, choking, or pauses in breathing during sleep.