Please Note! This section provides a schematic overview of select sleep disorders that must be confirmed by a physician or sleep specialist. This information has been presented for educational purposes only.

Parasomnias: RBD & Other Behaviors


The Impacts of Poor Sleep Quality Are Significant


Characterization of Select Parasomnias

REM Behavior Disorders and NREM Confusional Arousals
The parasomnias consist of abnormal sleep-related movements, complex behaviors, emotions, perceptions, dreaming, and autonomic nervous system functioning. We outline a few important parasomnias below, including REM Behavior Disorder (RBD) and NREM Confusional Arousals like Sleepwalking, Sleep Terrors & Sleep Paralysis. In addition to those listed, there are other specific confusional arousal conditions associated with specific complex behaviors (such as eating).
REM BEHAVIOR DISORDER (RBD) is an abnormal set of behaviors that occur in REM sleep and may result in injury and subsequent sleep deprivation. A complaint of sleep-related injury is common with RBD because subjects attempt to physically enact an unpleasant, active, or violent dream outwardly. Basic REM mechanisms that are designed to actively paralyze skeletal muscle during dreaming (normally sparing the muscles required for respiratory breathing) periodically malfunction. Because the internal dream environment of our dream does not correspond to the external environment of our bedroom, injuries are likely if skeletal muscle is not inhibited, and the person acts out dream mentation with movements in the real physical environment. An association between RBD and narcolepsy has been made. In addition, evidence from basic research is suggestive that RBD may precede Parkinson’s Disease.


Confusional arousals are characterized by mental confusion or confusional behavior that occurs during or after arousal from sleep. These arousals are common in children and can occur in both nocturnal sleep and daytime naps. They occur during NREM sleep as opposed to REM sleep or dream periods within REM.

Sleepwalking is a series of complex behaviors that occur after sudden arousals from slow-wave sleep (SWS) and result in locomotor behavior in a state of altered consciousness that is similar to sleep. Our common language seems to imply that sleepwalking is a form of ‘dream state’ behavior, however, sleepwalkers do appropriately navigate the real physical environment in a near sleep state. Sleepwalking is not, therefore, a form of dream state behavior because the landscape of dream would not correspond to the actual physical environment that sleepwalkers navigate without the mismatch that is presented in RBD.
Sleep Terrors also occur from near SWS and are associated with a cry or a piercing scream. The person experiences autonomic level emotions of terror, including intense fear. The autonomic emotional response is thought to be due to activation of portions of the amygdala and other associated regions of the brain that instantiate fear. The fear is not mediated by cognitive thoughts or dream mentation, but occurs outside of REM stage dream sleep. Effectively, the experience of fear is turned on during deep slow-wave sleep, without the context of a mental thought or situation. Because the parasomnia occurs outside of dream mentation, it also bears a confusional aspect. Sleep terrors are more common in children than they are in the adult population.

Children exhibiting sleep terrors are hard to arouse and exhibit subsequent amnesia about the event soon after. Contrary to the soothing inquiries from parents, children awakened from Sleep Terrors do not report ‘nightmare’ storylines because the episode is associated with deep dreamless unconscious sleep, not the nightmare mentation of dream episodes. Sleep terrors and sleep walking may co-occur.

Recurrent Sleep Paralysis can occur at sleep onset or upon awakening from sleep, often along with sleep-onset hallucinations (hypnagogic) and hallucinations upon awakening (hypnopompic). Sleep Paralysis is characterized by an inability to perform voluntary movements, however, ventilation is unaffected. Sleep paralysis and hallucinations are part of the narcolepsy diagnostic 'tetrad', but both can occur with severe sleep restriction or sleep deprivation.

Diagnosis of Recurrent Sleep Paralysis thus requires the absence of narcolepsy. In addition, severe sleep restriction or deprivation may cause symptoms of sleep paralysis during sleep onset or upon awakening so transient episodes must be ruled out.

RBD not Sleepwalk

RBD is acting out dream mentation with movements that should not occur.



Sleepwalker's brains are in a near sleep state similar to NREM stage sleeping.


Sleep Terrors

Sleep Terrors may occur with sleepwalking. It occurs more often in children.


Sleep Paralysis

Sleep paralysis in seemingly wake states (but hallucinatory) is problematic.

If patients or practitioners need to find a sleep center in their area, the American Academy of Sleep Medicine (AASM) has developed a sleep center: locator.

Sleep Is Not Rest

Other Principle Sections

Although Nourish Sleep is a non-clinical entity, we do not operate outside of a responsible care pathway. Nourish Sleep screening does not constitute confirmation of a sleep disorder or lack thereof. Only a face-to-face clinical evaluation with a clinician or board certified sleep physician can affirm the necessity for further diagnostics or treatment. Our role is to educate you and provide you a rigorous, but highly tailored and comprehensive understanding of your specific sleep quality. Although we work collaboratively with a diverse array of clinical and educational resources to fulfill that mission, Tri-Nourish Inc and Nourish Sleep constitute non-clinical entities offering non-clinical services. Our goal is to assist your sleep quality in a pre-pathological (preventative) approach that takes into consideration domains that impact health and wellbeing before they transition into common sleep, mental or physiological disorders. Poor sleep quality radically impacts productivity, performance, health, emotional resilience, and safety— well before the sleep disorder threshold has been breached.