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, 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.
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 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 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 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 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 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 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 (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.
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.