Parasomnias in Adults: Sleep Walking, Sleep Talking, and More

Adam Moore
Published: 11/14/2025 | Updated: 11/14/2025
Authored by: Adam Moore, MPharm
Edited by: Jemma Strain, B.S. Psychology
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There are few things in life as restorative as a good night’s sleep. What’s more, getting through the day when you’re underslept can be a challenge – especially if you have a busy job and home life. 

If you’re frequently affected by poor sleep, chronic fatigue can really take a toll. If this is the case for you, it may be worth considering whether the issue could be due to a sleep disorder. 

Parasomnias are a group of sleep disorders that involve unusual physical, behavioral, or emotional events that occur while we sleep. While many believe that parasomnias mostly happen in childhood, they can persist into or even appear in adulthood. Further, ongoing disruptions to sleep can be caused by or contribute to mental health conditions. In fact, the link between parasomnias and emotional distress is well-documented.1-3

Those with sleep disorders too often write themselves off as “poor sleepers” and try to carry on with life as normal. However, these disorders can worsen without treatment and may continue to negatively impact mental health. Recovery is possible, and a mental health professional can help you achieve your goals. 

This page can work as a useful guide to understanding parasomnias in adults, exploring:

  • What parasomnias are and the different types
  • Sleepwalking
  • The link between trauma and parasomnias
  • Sleep disorder evaluation and treatment options
  • How Mission Connection can help
tired woman in bedroom in pyjamas yawning and stretching after experiencing parasomnias in adults

What Are Parasomnias?

To truly understand sleep disturbances, it’s good to first consider the sleep cycle.

One key phase during our sleeping hours is called “rapid eye movement” (REM) sleep. It’s aptly named, given that a feature of the REM sleep stage is eye movement behind the eyelids at a time when the brain is highly active. Vivid dreams often occur in this stage, but the body is temporarily paralyzed to prevent us from physically acting out our dreams. REM sleep accounts for about 20-25% of the sleep cycle in healthy adults, and the rest is classed as “non-REM sleep.”
 

Non-REM sleep is the deep, restful stage where the brain slows down. Restorative functions happen in this phase, like repairing tissue, building muscle and bone, and strengthening the immune system. Getting ample non-REM sleep is key to feeling refreshed in the morning. 

Parasomnias can be grouped into either non-rapid eye movement (REM) or REM-related disorders. The following sections cover these types of parasomnias in more detail.

Parasomnia Symptoms and Types

As mentioned, parasomnias can be broadly grouped into two categories: non-REM parasomnias and REM-related parasomnias:

  • Non-REM (NREM) parasomnias typically occur in the first third of the night, during deep sleep. Common examples include sleepwalking, sleep talking, and sleep terrors.4-6  We’ll discuss these in more depth later. 
  • REM-related parasomnias occur during rapid eye movement sleep. REM sleep behavior disorder (RBD) falls into this category. While the body typically goes limp during the REM phase, the absence of this paralysis can cause those with RBD to physically enact their dreams. For instance, they might lash out, punch, kick, shout, and so on.4-6 These actions can also be particularly disturbing for partners. We’ll go into RBD in greater detail later. 

Put simply, the sleep cycle alternates between REM and non-REM phases. So, while parasomnias differ in how they show up, the one feature they all share is that they happen when the brain is partially awake and partially asleep. This, in turn, can lead to complex behaviors that the person may not be able to control or be consciously aware of – or even remember when they wake up.7

The following sections explore the different types of parasomnias that someone may experience and their symptoms. 

Sleepwalking

When we hear the term “sleepwalking,” it’s easy to picture a child in their pyjamas, up out of bed, and disoriented. While sleepwalking can certainly be present in children, it’s no less of a feature in adulthood. Moreover, it can be potentially more dangerous. 

Sleepwalking happens in the non-REM stage of sleep, meaning we’re in the stage where our muscles aren’t limp, so we can move around. Yet the brain isn’t fully awake, meaning that the part associated with decision making and conscious awareness – the pre-frontal cortex – is inactive. 

Sleepwalking can be as simple as walking around aimlessly, or more serious actions like leaving the house, or in some extreme cases, attempting to drive. So, it’s easy to see why sleepwalking can cause nighttime safety concerns for adults, as falls, injuries, or even burns aren’t uncommon. 

However, sleepwalking can be linked to certain triggers. Understanding these triggers can help people prevent future episodes by developing effective prevention strategies. 

Some of the most common sleepwalking triggers include: 

  • Sleep deprivation or irregular sleep schedules
  • Stress, anxiety, or trauma. One study found that adults with a history of stress or psychiatric disorders were more likely to report recurrent instances of sleepwalking11 
  • Substance use, including sedatives or alcohol, can predispose someone to an episode
  • Certain medications, such as hypnotics or antidepressants
  • Medical conditions, including sleep apnea or restless legs syndrome, can mean the sleep cycle is more prone to interruption, setting conditions for sleepwalking8-10

Importantly, sleepwalking episodes may worsen during periods of heightened stress or emotional upheaval, demonstrating sleepwalking mental health issues.1-3

Sleep Talking

Sleep talking is relatively common and usually harmless. Put simply, it describes moments when someone vocalises in their sleep, for example, mumbling or talking, without conscious awareness. 

However, sleep talking can become a concern when these moments involve shouting, screaming, or emotionally charged words. Such sleep disturbances often mean that someone is highly stressed or affected by past traumas. In fact, research confirms the link between sleep talking and high-stress circumstances or post-traumatic symptoms.12 

Like sleepwalking, sleep talking can usually be attributed to a number of triggers. 

Common contributing factors include:13

  • Stress and anxiety disorders
  • Sleep deprivation
  • Fever or illness
  • Depression or mood instability
  • Use of alcohol or medications that suppress REM sleep

While sleep talking rarely requires treatment, it can serve as an important marker. If you or someone you care about talks in their sleep, and it sounds emotionally charged, then this could flag some underlying stress issues. Maintaining awareness of this could allow for opportunities to have open discussions about day-to-day stressors and sleep talking anxiety.

REM Sleep Behavior Disorder (RBD)

REM sleep behavior disorder (RBD) happens during the REM cycle of sleep, but without the usual muscle paralysis that should occur in this phase. So, people with RBD are able to physically act out their dreams – potentially even violently so. For example, those affected may shout, punch, kick, or leap from their bed in response to vivid dreams. The following are other symptoms of RBD.

Symptoms of RBD:

  • Sudden, intense movements during sleep
  • Dream enactment behavior, often with violent content
  • Injuries to self or bed partners
  • Vivid dream recall upon waking

RBD most frequently appears in men over 50, but it can affect anyone. Notably, studies have seen RBD show in people taking certain antidepressants. For instance, it may occur in people taking selective serotonin reuptake inhibitors (SSRIs), like Prozac and Lexapro, as their side effects can often affect sleep quality.14

Interestingly, research confirms that RBD can serve as a warning for the development of neurodegenerative diseases such as parkinson’s disease or dementia, in later life.15
Given this important link, it’s crucial that signs of RBD aren’t ignored. 

If you or someone you care about displays these symptoms, then a sleep disorder evaluation should be considered. This is guided by a qualified sleep specialist or neurologist. Diagnosis of RBD usually involves polysomnography, where the person’s sleep is monitored overnight to assess muscle tone, brain waves, and movement patterns. 

Treatment options for RBD typically include: 16-17

  • Medications: Such as melatonin or clonazepam, as these can suppress excessive movements
  • Environmental adjustments: Like padding furniture and removing sharp objects
  • Monitoring for neurological changes: Examining differences in brain function over time, conducted by specialists16,17

Sleep Terrors vs. Nightmares

Although both involve fear during sleep, sleep terrors and nightmares are distinct from each other. 

Sleep terrors, or “night terrors,” occur during deep non-REM sleep, often in the first part of the night, and involve intense fear, screaming, thrashing, or rapid heartbeat. They can be very distressing, and those affected usually appear awake but are confused and rarely remember the episode the following morning. Sleep terrors are much more likely in people with a history of trauma or high stress, or those who have issues with other parasomnias, like sleepwalking.18-21 

Treatment for sleep terrors typically focuses on establishing a consistent sleep pattern, as well as safety measures like removing sharp objects and obstructive furniture from the individual’s bed area, and encouraging stress reduction.18-21 If trauma is present, a trauma-informed therapy approach may also benefit. 

In contrast, nightmares occur during REM sleep and are typically remembered in detail the next morning. They’re usually less violent and distressing than sleep terrors. However, they also often reflect underlying anxiety, stress, or trauma. They’re more common than sleep terrors across all ages and often serve as a signpost to emotional distress. 18-20

Treatment for nightmares is usually therapy-based, such as:

  • Trauma-focused therapy: Recounting trauma and trauma-related sleep events under the guidance of a therapist21
  • Cognitive behavioral therapy (CBT): Identifying unhelpful thinking patterns and reframing thoughts in a more balanced, positive way. This promotes emotional well-being.
  • Imagery rehearsal therapy (IRT): Involves recalling and documenting nightmares. Then, modifying the narrative for a more positive ending, and during waking hours, visualizing this new version. This practice can help “retrain” the brain to adopt this more positive scenario during sleep.18-20

Adolescent and Young Adult Parasomnias

We’ve covered how parasomnias in adulthood can show up. However, sleep disorders can also have a significant negative effect on young people, especially considering the pressures many adolescents are under academically and socially. 

As stress and trauma are risk factors for sleep disturbances (which we’ll cover next), it’s perhaps unsurprising that students may be particularly vulnerable to parasomnias. In fact, studies have confirmed that sleep disorders are more common in transition periods, like leaving home or starting college.24-25

For this reason, if a teen or young adult is showing signs of parasomnias or adolescent sleep disturbances, early intervention may be key to getting them the support they need. We discuss these options slightly later in this article.

The Link Between Trauma and Parasomnia

It’s confirmed by research that trauma and stress can disturb the sleep cycle. In particular, they can influence the regulation of the REM and non-REM phases, causing arousal of the brain during these sleep states. Therefore, trauma related sleep events such as nightmares, vocalizations, or body movements can occur alongside increased anxiety.²² 

Studies suggest that sleep disturbances following trauma aren’t just symptoms of distress, but also a factor in reinforcing stress. As a result, those who are impacted by ongoing sleep disorders and nightmares can become even more anxious and distressed.23 This can create a cycle of increased distress, more sleep disturbances, and further trauma related sleep events.

The good news is that this cycle can be broken with appropriate diagnosis and treatment, which we discuss next.

Sleep Disorder Evaluation and Treatment

The appropriate treatment plan for your needs can only follow an accurate diagnosis. A healthcare professional can assess sleep disorders by looking at your medical and mental health history. 

They may advise you to keep a sleep diary to make notes of the appearance of sleep disturbances and identify patterns and triggers. Further, your provider may also want to conduct a sleep study to monitor behaviors during sleep – especially if symptoms are complex or violent. 

Once diagnosed, sleep disorder management may involve:

  • Lifestyle interventions: These may include introducing sleep schedules or stress management techniques 
  • Medication: These may be considered when appropriate. For example, melatonin can help achieve deeper sleep under the guidance of a specialist 
  • Therapy: Including CBT or trauma-focused therapy, or relaxation training for stress-related parasomnias
  • Residential behavioral treatment: This may involve admission into a facility for overnight supervised stays. It’s usually only considered in severe or complex cases where symptoms occur with psychiatric issues or harmful behaviors

If symptoms persist or worsen, consultation with a sleep specialist or neurologist is strongly recommended. Many sleep centers offer assessments for parasomnia and related disorders.

Coping With Sleep Movement and Other Issues 

Parasomnia symptoms can be distressing, but with proper care and coping strategies, they can be treated and prevented. For example, coping strategies for parasomnias can include:26

  • Maintaining a consistent bedtime routine to reduce sleep fragmentation
  • Limiting caffeine and alcohol, especially in the evening
  • Practicing relaxation techniques before bed, such as deep breathing
  • Keeping a sleep journal to note episodes, triggers, and stress levels
  • Seeking professional support if behaviors lead to injury, fear, or relationship stress

Rest Easy: How Mission Connection Supports Healthier Sleep

Mission Connection understands the importance of a good night’s sleep and the impact of sleep disturbances on the quality of life. Understanding the triggers, addressing nighttime safety concerns, and seeking professional evaluation are key steps toward restoring healthy, restorative sleep.

Our experienced team is on hand to provide behavioral strategies, therapy, and medical management to regain restful nights and improve day-to-day well-being. We also provide a variety of evidence-based treatment options that can be tailored to your specific needs, whether you require immediate support or more long-term continued help. Our telehealth services also mean that you can fit therapy for sleep disorders into your schedule flexibly, allowing you to receive care from the comfort of your home.

If you’re ready to explore our treatment options, contact us today or complete our confidential contact form for more information. 

man in bed sleeping peacefully after treatment for parasomnias in adults

References

  1. American Academy of Sleep Medicine. (2023). International classification of sleep disorders (3rd ed.).
  2. Cleveland Clinic. (2022). Parasomnia: Types, causes, symptoms & treatment.
  3. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
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  5. Bjorvatn, B., et al. (2021). Stress and parasomnia: Clinical perspectives. Sleep Medicine Clinics, 16(3), 457–470. https://doi.org/10.1016/j.jsmc.2021.05.011
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  26. Laroche, M., Biabani, N., Drakatos, P., Selsick, H., Leschziner, G., Steier, J., Young, A. H., Eriksson, S., Nesbitt, A., Kumari, V., Rosenzweig, I., & O’Regan, D. (2023). Group cognitive behavioural therapy for non-rapid eye movement parasomnias: Long-term outcomes and impact of COVID-19 lockdown. Brain Sciences, 13(2), 347. https://doi.org/10.3390/brainsci13020347