Parasomnias encompass the undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep. Basic drive states emerge pathologically with the parasomnias, as seen with sleep-related aggression and locomotion, sleep-related eating disorder, and sleep-related abnormal sexual behaviors (sexsomnia). Complications from parasomnias include injuries, sleep disruption, adverse health effects, and adverse psychosocial effects. Parasomnias often involve complex, seemingly purposeful, and goal-directed behaviors. This article describes the therapeutics for the parasomnias that carry the greatest health risks in adults: rapid-eye movement (REM) sleep behavior disorder, disorders of arousal from non-REM sleep (confusional arousals, sleepwalking, sleep terrors), sexsomnia, and sleep-related eating disorder.