The consideration of the State Dissociation paradigm facilitates the understanding of the sleep disorder and provides a classification of 10 core categories.

They are caused by a physiological activation in which the patient's brain exits from SWS and is caught in between a sleeping and waking state.

[8] Differential diagnosis for NREM-related parasomnias:[2] Confusional arousal is a condition when an individual awakens from sleep and remains in a confused state.

[10][11][12][13] Infants and toddlers usually experience confusional arousals beginning with large amounts of movement and moaning, which can later progress to occasional thrashings or inconsolable crying.

In rare cases, confusional arousals can cause injuries and drowsy driving accidents, thus it can also be considered dangerous.

[15] Sleep-related abnormal sexual behavior, Sleep sex, or sexsomnia, is a form of confusional arousal that may overlap with somnambulism.

It can include such acts as masturbation, inappropriate fondling themselves or others, having sex with another person; and in more extreme cases, sexual assault.

[19] Sleep terror is the most disruptive arousal disorder since it may involve loud screams and panic; in extreme cases, it may result in bodily harm or property damage by running about or hitting walls.

[22] However, SRED should not be confused with nocturnal eating syndrome, which is characterized by an excessive consumption of food before or during sleep in full consciousness.

[22] Unlike other parasomnias, rapid eye movement sleep behavior disorder (RBD) in which muscle atonia is absent is most common in older adults.

Patients may take self-protection measures by tethering themselves to bed, using pillow barricades, or sleeping in an empty room on a mattress.

[10] Besides ensuring the sleep environment is a safe place, pharmacologic therapy using melatonin and clonazepam is also common as a treatment for RBD, even though they might not eliminate all abnormal behaviours.

[22] However, clonazepam needs to be manipulated carefully because of its significant side effects, i.e., morning confusion or memory impairment,[22] mainly in patients with neurodegenerative disorders such as dementia.

[10] However, this prevalence in males could be biased due to the fact that women tend to have a less violent type of RBD, which leads to lower reports at sleep centres and different clinical characteristics.

[25][29] Typical clinical features of REM sleep behavior disorder are:[30] Acute RBD occurs mostly as a result of a side-effect in prescribed medication—usually antidepressants.

[22] There is a growing association of chronic RBD with neurodegenerative disorders—Parkinson's disease, multiple system atrophy (MSA), or dementia—as an early indicator of these conditions by as much as 10 years.

[25] The diagnosis is based on clinical history, including partner's account and needs to be confirmed by polysomnography (PSG), mainly for its accuracy in differentiating RBD from other sleep disorders, since there is a loss of REM atonia with excessive muscle tone.

[31] In a majority of cases, hypnogely is a genuine behavioural response and benign physiological phenomenon that occurs while the sleeper is dreaming in REM sleep.

[22] Children with parasomnias do not undergo medical intervention, because they tend to recover the NREM-related disorder with the process of growth.

[34] In those cases, the parents receive education on sleep hygiene to reduce and eventually eliminate precipitating factors.

[22][44] Behavioral treatments, i.e., relaxation therapy, biofeedback, hypnosis, and stress reduction, may also be helpful, but are not considered as universally effective.

[44] NREM-related parasomnias which are common in childhood show a good prognosis, since severity decreases with age, the symptoms tend to resolve during puberty.

[34][35] Adults with NREM-related parasomnias, however, are faced with a stronger persistence of the symptoms, therefore, full remission is quite unlikely and is also associated with violent complications, including homicide.

While exploding head syndrome usually resolves spontaneously, the symptoms for sleep-related hallucinations tend to diminish over time.