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Parasomnias
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.
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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.
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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.
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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