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.
