II. Definitions
- Parasomnia
- Abnormally disrupted sleep
- Causes include Sleep Walking, Sleep Talking, Nightmares, Bedwetting, Sleep Apnea or nighttime Seizures
III. Epidemiology
-
Prevalence: 50% in childhood
- Persists into adulthood in 4% of cases
IV. Risk Factors
- Family History
- Sleep deprivation
- Triggers
- Obstructive Sleep Apnea in Children
- Restless Legs Syndrome in Children
- Pediatric Reflux
- Pain or emotional stress
V. Types
-
Sleep Onset Disorders (or on awakening)
- Sleep Paralysis
- Restless Legs Syndrome in Children
- Hypnagogic Hallucinations
- Hypnagogic jerks ("Sleep Starts")
- Involuntary Muscle Twitch, jerk or contraction that occurs near sleep onset
- Common, normal, physiologic phenomenon
- Light Non-REM Sleep Disorders
- Bruxism
- Periodic Limb Movement Disorder
- Deep Non-REM Sleep Disorders in first half of sleep (Sleep-wake transition disorders)
- Characteristics
- Complex, almost purposeful activity, but detached from environment
- Examples: Sits up in bed, appears confused, screams
- Difficult to arouse during episode and often returns to sleep without memory of the event
- Disorders
- Characteristics
- Parasomnias of REM Sleep in second half of sleep
- Characteristics: Child can recall the Nightmare on awakening
- Disorders
- Nonspecific Parasomnias (may occur at any time of sleep cycle)
VI. Differential Diagnosis
- Nocturnal Seizure
VII. Diagnostics
-
Polysomnogram Indications
- Atypical presentation or significant complications from Parasomnia (e.g. injury)
- Suspected specific conditions
VIII. Management
- Consider sleep medicine referral
- Reassurance that events are typically self limited and most resolve by teen years
- Sleep Hygiene
- Manage precipitating conditions
- Prevent injury
- Lock doors and windows at night
- Activate motion alarms
- Remove access to knives, firearms and other weapons
- Put mattress on the floor
- Remove toys and other clutter from the floor before bed