Growth and Development Conditions and Diagnoses

Parasomnias

Related Services

Parasomnias include a broad spectrum of sleep disorders that most often occur during sleep and are most often infrequent and mild in degree of severity. The most common parasomnias are "disorders of arousal" which include confusional arousals, sleepwalking and night terrors.

Confusional Arousals

Confusional arousals are most common in infants and toddlers. Confusional arousals occur when a person is in a transitional state between sleep and awake. These events may start with crying and thrashing around in bed. If your child is having a confusional arousal he may appear to be awake, confused and upset, but will resist your attempts to comfort or console him. A confusional arousal may last up to 30 minutes in duration. The arousal usually ends when agitation subsides; your child may awaken briefly, and then likely will want to return to sleep.

Sleepwalking

Sleepwalking is more common in older children and can range from simple behaviors such as getting out of bed to more complex tasks such as leaving the house and walking around outdoors. Sleepwalkers may speak, but usually any talking is not understandable. In children sleepwalking tends to decrease over time and rarely requires any treatment.

Sleep Terrors (Night Terrors)

Sleep terrors are the most dramatic of all of the arousal disorders and therefore are the most distressing for family members who have children experiencing sleep terrors. Common behaviors include "blood-curdling" screams, rapid breathing, sweating and extreme agitation and in some cases aggression.

Children experiencing sleep terrors usually have no conscious awareness of the event, and generally can not remember the terror upon awakening. Sleep terrors should not be confused with nightmares. Nightmares are vivid dreams that usually can be recalled after waking up and are often a source of anxiety for young children.

How should we treat our child's arousal disorder?

Generally speaking, most arousal disorders do not warrant a medical intervention. Simple precautionary measures protecting the safety of your child and promoting good sleep are important and the best way to treat such problems.
Obtaining adequate sleep and a normal sleep schedule may help to improve sleep disruptions related to arousals during the night. Overtired children do not sleep better. In fact, a child with insufficient sleep may be more prone to parasomnias.
The hour before bedtime should be a quiet one, avoiding television, exciting or scary stories and roughhousing. It may be helpful to take a warm bath as part of the evening routine if your child enjoys this activity. Make certain that no sudden loud noises disturb your child's sleep.
Clear your child's bedroom of obstructions that could cause injury if he / she gets up during sleep.
Secure all exits / entrances to the house (doors / windows) to prevent the sleepwalker from leaving the safety of their home.
Gate all stairs that your child has access to at night if sleepwalking.
You may want to tie bells or some other alerting device to your child's door in order to alert you if they are sleepwalking.
In extreme cases it may be safer for a child to sleep on the first floor of a multilevel home.
If you discover your child sleepwalking, escort her back to bed. Talk very quietly and calmly so as not to arouse your child. You may gently guide your child with light physical touch if she does not respond to calm verbal directives. You should not attempt to wake your child during sleepwalking because nothing is gained by waking your child and it may result in confusion and disorientation for your child. It is not uncommon for a child to want to stop at the bathroom to urinate on the way back to their bedroom.
If your child spontaneously wakes up after the sleepwalking episode (this is often true for older children) avoid teasing or questioning your child. It is unnecessary to bring it up the next day unless your child initiates such conversation.
If you encounter your child having a sleep terror, you should allow the terror to "run its own course". Parents should avoid trying to prevent the terror by waking the child. Stimulation (i.e., attempts to wake up your child) could extend the length or intensity of the terror. It is appropriate to stand back and observe your child and to make certain that he / she is safe. It is appropriate to provide brief and calm support and orientation (e.g., who you are; where the child is; assurance that he is O.K.) to your child if he / she wakes up after the terror is over.
If your child is at risk for physical harm during a night terror (e.g., running wild), you may need to take action (e.g., redirect behavior) to prevent injury. If you must take action to make sure that your child is safe, be extremely careful and calm in your approach. It is possible that you and your child could be injured if your child becomes agitated. Talk very calmly to your child and block his / her access to dangerous areas. Try to avoid physical restraint (e.g., grabbing on to your child) if possible.