Parasomnia

Parasomnia usually refers to unwanted events or behaviors that occur around or during sleep. Parasomnia events include sleepwalking, sleep terrors and confusional arousals.

These are “disorders of arousal” that happen when some parts of the brain are asleep while other parts are awake. They often happen during slow wave sleep, a deep sleep that occurs during the night when your brain is not dreaming. There is more slow wave sleep earlier in the night, so episodes of parasomnia usually happen in the first third to first half of the night. The episodes are often short, but can last as long as 30 to 40 minutes. Children’s eyes are usually open, but glazed over. They seem confused and are hard to awaken. Children usually do not remember these events or have control over them.

These types of parasomnia are common in childhood. Experiencing parasomnia does not usually mean your child has a psychiatric or psychologic concern. Parasomnia can run in families and can be triggered by stress, sleep deprivation (getting less sleep than recommended for a child’s age), certain medications or medical conditions like obstructive sleep apnea.

Confusional arousals

During confusional arousals, children will usually sit up in bed and seem confused. They may moan or call out briefly but do not appear fully awake. Up to 17% of children have confusional arousals, and they are most common between the ages of 2 and 5 years.

Sleepwalking

Sleepwalking often starts as a confusional arousal, but when the child gets out of bed, it becomes sleepwalking. Children can have odd behaviors like urinating in a trashcan or complex behaviors like opening the front door and leaving the house. You may find the child back in bed after sleepwalking or in another location. About 18% of people will have sleepwalking at some point in their life. Sleepwalking typically improves as children get older.

Sleep terrors

Sleep terrors, also known as night terrors, can be very frightening to witness. Children often scream or cry out and look scared. Sometimes children can look flushed and experience sweating, dilated pupils, quicker heartbeat and breathing. Even though your child may appear scared, they often will not respond when someone tries to comfort them. Sleep terrors are most common between the ages of 4 and 12 years.

Overall, parasomnia often improves as children get older and does not require any treatment. Children can become more agitated if someone attempts to wake them up during a parasomnia, so it can helpful to gently guide them back to bed without talking or waking them up.

If a trigger for the parasomnia is identified, like obstructive sleep apnea or not getting enough sleep, treating the trigger can help improve the parasomnia. The National Sleep Foundation has recommendations for sleep duration at every age, from birth to adulthood.

It is important to keep children safe by making the household environment safe, such as locking doors to the outside, keeping furniture or objects on which children can climb away from windows, securing windows, keeping sharp objects like knives securely stored, installing alarms on doors and windows, and protecting children from stairs by installing baby gates or sleeping on the first floor.

In rare instances, a medical provider may prescribe a medication.

The interdisciplinary team at CHOP's Sleep Center features leading experts who can provide support for children with parasomnia and their families. Children can be evaluated for co-morbidities that may trigger parasomnia and receive treatment for those triggers at the center.

• For more information: The American Academy of Sleep Medicine has a comprehensive Sleep Education website: www.sleepeducation.org
• Reference: The American Academy of Sleep Medicine’s International Classification of Sleep Disorders, 3rd Edition (2014) was used as a reference to write this article.