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Parasomnias
Parasomnias are a group of sleep disturbances that include bizarre behaviors
and unusual motor actions. They occur more frequently in children and are usually
benign in nature. The main parasomnias include Sleepwalking, Sleep Terrors,
Nightmares, Nocturnal Seizures, and REM Sleep Behavior Disorder (RSBD).
Sleepwalking:
Sleepwalking occurs
more often in children, and is characterized by an episode of walking during
slow-wave sleep (deep sleep) especially in the first half of the night. The
majority of sleepwalkers, especially children, may not leave the bed, but rather
sit up in bed and make repetitive movements. When these children leave the bed,
they will tend to walk around the house with their eyes open, avoiding obstacles,
and sometimes even handle objects like bathroom items or kitchen utensils. If
awakened, the child appears confused and disoriented. The child will return
to bed without resistance, and has no recollection of the episode the following
day. The sleepwalking episodes can last from a few seconds to a few minutes.
However, episodes of up to 1 hour in duration have been reported in literature.
Sleepwalking can be quite dangerous, as some sleepwalkers have reported actual
injuries or potential for injuries during these episodes. Adult sleepwalking
tends to have a later onset of symptoms and is more serious. It is often related
to major stresses. Most children with sleepwalking will grow out of the symptoms.
Reassurance of parents and the child is important. Management consists of protecting
the patient from harm by appropriate locks on the doors, closing windows, blocking
stairs, and securing balconies. It is often advantageous to allow the sleepwalker
to sleep on the ground floor to avoid the risk of falling out of a window. It
is also important to avoid sleep deprivation by monitoring proper sleep hygiene.
Sleep
Terrors:
This parasomnia is related to sleepwalking. It is common in children between
the ages of 4 and 12 years. Like sleepwalking, it also occurs in slow-wave sleep
(deep sleep) especially in the first half of the night. Sleep terror episodes
are characterized by a sudden awakening from deep sleep with a loud scream that
abruptly interrupts parents' sleep. Parents often find the child sitting up
in bed crying while breathing rapidly with a fast heart rate, dilated pupils,
and sweating. The typical episode lasts for about 6 minutes. The disorientation
may continue for up to 30 minutes after arousal from the episode. Like sleepwalking,
these episodes are not remembered the next morning. Most children will grow
out of the symptoms with increasing maturity. Reassurance of the parents of
the benign nature of this disorder is important.
Nightmares:
Nightmares are long
and frightening dreams that occur in the dream stage (REM sleep) especially
during the second half of the night. They are most common in children. Adults
also report an occasional nightmare. Frightening and stressful life experiences
can precipitate nightmares in vulnerable individuals as in the case of the PTSD
(Post Traumatic Stress Disorder) seen in military personnel exposed to war.
REM Sleep Behavior Disorder (RSBD):
RSBD is a parasomnia characterized by bizarre behavior during REM sleep. Punching,
kicking, vocalizing, walking, running, jumping in apparent attempts to act out
of dreams are typically seen and can be a cause of serious physical injury.
RSBD predominates in men in their 60s and 70s. This disorder may result from
damage to the brain systems that control the normal muscle atonia of REM sleep
(in normal REM sleep the muscles controlling body movements are paralized), and
may be associated with certain neurological disorders such as dementia, or degeneration.
An overnight sleep study may be required for a proper diagnosis.
Nocturnal Seizures:
Sleep and sleep deprivation may activate seizure activity. One should suspect
a seizure disorder in sleep if they complain of sudden awakenings from sleep,
unexplained incontinence of urine, or abnormal movements in sleep, automatic
behaviors (lip smacking, picking at bed covers, etc.), tongue biting, forceful
cry, and confusion or lethargy after this event. An overnight sleep study may
be required to confirm the diagnosis.
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