Parasomnia, which
means "around sleep," includes sleepwalking, night terrors,
bedwetting, and narcolepsy. All can create family difficulties, and
some may be harmful to the child.
They are a group of acute, undesirable, episodic physical phenomena
that usually occur during sleep, or are exaggerated by sleep. Even
though parasomnias occur during different stages of sleep and at different
times during the night they are characterized by partial arousals
before, during, or after the event. Most parasomnias are precipitated
or perpetuated by stress, and an interaction between biological and
psychological factors is presumed in many cases.
Disoriented
Arousals
Disoriented arousals,
though sometimes occur in adults, are more commonly seen in infants
and children. These arousals may begin with yelling or crying and
violently moving around in bed. The sleeper seems to be alert and
upset, but may resist any attempt to be comforted. In most cases,
awakening a person who is experiencing a parasomnia can be very difficult.
Disoriented arousals can last any where from a few minutes to half-an-hour.
After the agitation ceases, the sleeper may awaken for a short time
and then return to sleep.
Sleepwalking
During sleep walking
vision seems to remain intact; coordination of the central nervous
system is maintained to some extent, although accidental injuries
have been reported (see photograph). An episode can last from minutes
to an hour. More than one episode a night is rare, as is the likelihood
of complex manoeuvres.
Night/Sleep
Terrors
Night terrors
usually start with a terrifying scream, increased heart and breathing
rates, sweating and a frightened expression. They last from one to
several minutes, and should be distinguished from nightmares. Nightmares
are parasomnias associated with REM sleep and occur during the middle
and last third of sleep, when REM periods are more abundant and intense;
patients arouse easily and quickly. In contrast to nightmares, which
are frightening dreams with vivid recall, patients rarely remember
specific details of a night terror.
Hypnagogic
Hallucinations and Sleep Paralysis
Hypnagogic hallucinations
are brief periods of dreaming while between the stages of sleep and
consciousness. These dreams can be frightening and can often cause
a sudden jerk and arousal just before sleep onset. For example, you
may see yourself falling and awaken with a sudden jerk, just before
impact.
Sleep paralysis
is the sensation of feeling paralyzed upon awakening, usually immediately
following a dream. This is commonly associated with the loss of muscle
tone during dreams, called atony. This loss of muscle tone during
the dreaming stage, prevents one from acting out his or her dreams.
Hypnagogic hallucinations and sleep paralysis can occur together.
Although commonly seen in people with narcolepsy, they can also affect
others, especially those individuals who are sleep-deprived. While
they can be frightening, these events are not physically dangerous
and usually last only a few minutes.
Many childhood
sleep disorders are actually types of parasomnia. Somnambulism, night
terrors, bedwetting, talking while asleep, and body rocking are much
more common in children than they are in adults. Most children outgrow
these problems before adolescence. Parents may note an increase in
frequency or intensity when their child is ill, under stress, or taking
certain medications.
Nocturnal
Seizures
Nocturnal seizures
occur during sleep and are commonly diagnosed by undergoing a overnight
sleep study (PSG). They can cause the sleeper to cry, scream, walk,
move about and or curse. These seizures can be treated with medications.
REM Behavior
Disorder
REM Behavior Disorder
is the ability to act out your dreams. The obvious problem with acting
out your dreams, is the potential to cause injury. All body muscles,
with the exception of those used in breathing are usually paralyzed
during REM (dreaming) sleep. In some cases this paralysis is incomplete
or absent, thus allowing dreams to be acted out. Behavior such as
this can be violent and result in serious injuries to the victim and
bed-partner. After awakening the sleeper will usually be able to recall
vivid dreaming. Medication is used to treat this disorder.
Grinding
Your Teeth
Grinding of the
teeth during sleep or bruxism, is a very common occurrence and little
evidence suggests that it is associated with other medical or psychological
problems. In some cases oral appliances are used to reduce dental
injury. For an example see the bottom portion of OSA.
Rhythmic-movement
Disorder
Rhythmic-movement
disorder is seen most often in younger children, yet can also occur
in adults. The movements usually consist of recurrent headbanging,
headrolling and body rocking. The individual may also moan or hum
during these movements. Other rhythmic disorders include shuttling
(rocking back and forth on hands and knees) and folding (raising the
torso and knees simultaneously). Typically these movements will occur
just before sleep begins or during sleep. Medical or psychological
problems are unlikely to be associated with this disorder. Behavioral
treatments may be effective in some cases, the majority of children
will eventually grow out of it.
Restless
Legs Syndrome
Restless legs
syndrome (RLS), a sensory and motor abnormality that seems to have
a genetic basis. In RLS, the child's legs move repeatedly. Many people
who have RLS also have periodic leg movement syndrome (PLMS) - this
occurs during sleep when the legs move involuntarily.
Treatment:
Acute insomnia is common and
easily treated by your primary care practitioner. Insomnia accompanying
depression needs psychiatric treatment. Primary insomnia is treated
with behavioral management to improve sleep habits and restrict time
in bed, or with medicines that work on brain chemicals. Restless legs
and PLMs are treated with medicines. Parasomnias are treated with
appropriate medicines after accurate diagnosis.
