The Sleep Center

Parasomnias

Confusional arousals

Sleepwalking

Sleep terrors

Treatment

The term "parasomnia" refers to a wide variety of behaviors that occur during sleep. These events are usually infrequent and mild. However, they may occur often enough, or be sufficiently severe or bothersome enough, to require medical attention.

The most common type of parasomnia is the "disorder of arousal," which includes confusional arousals, sleepwalking (somnambulism), and sleep terrors. Experts believe the various types of arousal disorders are related and share some symptoms. Essentially, they arise because the child is in a mixed state of being both asleep and awake, generally coming from the deepest stage of non-dreaming sleep. The child is awake enough to act out complex behaviors, but asleep enough not to be aware of, or remember, them.

These disorders are very common in young children. They usually do not indicate significant psychiatric or psychological problems. Such disorders tend to run in families and might be made worse when a child is overly tired, has a fever, or is taking certain medications. They may occur during periods of stress, or wax and wane with "good" weeks and "bad" ones.

Confusional Arousals

These often occur in infants and toddlers. The episodes begin with crying and thrashing around in bed. The child will appear awake and may look confused or upset. The child often resists attempts to being consoled, and is difficult to wake up. These episodes may last up to half an hour. They usually end with the child calming and returning to a deep sleep. Sometimes, the child my wake briefly, but only wanting to return to sleep.

Sleepwalking

This is commonly seen in older children. It ranges from simply getting up out of bed and walking around the room to prolonged and complex actions, including going to another part of the house, or even outside to the yard or garage. The sleepwalker may return to bed or awaken in the morning in a different part of the house. Sleepwalkers might carry on conversations that are difficult to understand and make little or no sense. They are capable of acting out complicated behaviors (such as rearranging furniture), but usually the activities make little sense. Injuries during sleepwalking are uncommon.

Sleep Terrors

These are the most extreme and dramatic form of the arousal disorders, and are the most distressing to witness. Sleep terrors often begin with a "bloodcurdling" scream or shout, and cause behavior suggesting extreme terror, such as dilated pupils, rapid breathing, racing heart, sweating, and extreme agitation.

During a sleep terror, the child may bolt out of bed and run around the room or even out of the house. During the frenzied event, children may hurt themselves or someone trying to calm them. As disturbing and frightening as these events appear to the observer, children having them usually are totally unaware of what they are doing and do not remember the incidents in the morning. Sleep terrors are much worse to watch than to experience. Children who have sleep terrors do not remember the episode or recall vivid dream images, unlike those who have typical nightmares or bad dreams.

Treatment

In most cases, no treatment is necessary. These events rarely indicate any serious underlying medical or psychiatric problem. In children, the number of events tends to decrease as they get older, although they may persist into adulthood.

To be safe, simple measures should be taken, such as clearing the bedroom of obstructions, securing windows, sleeping on the first floor, and installing locks or alarms on windows and doors. In severe cases involving injury, violence, or disruption of others, treatment may be very effective. Treatment may include medical intervention with prescription drugs or behavioral modification techniques. Portions of this handout are excerpted from "Parasomnias" published by the American Sleep Disorders Association.

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