Peds

Parasomnia

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Parasomnia

  • See Also
  1. Sleep Problems in Children
  2. Insomnia in Children
  3. Insomnia
  4. Somnambulism (Sleepwalking)
  5. Sleep Talking (Somniloquy)
  6. Confusional Arousal (Sleep Drunkenness)
  7. Night Terrors (Pavor Nocturnus)
  8. Nightmares
  9. Nocturnal Enuresis
  10. Obstructive Sleep Apnea in Children
  11. Restless Legs Syndrome in Children
  • Definitions
  1. Parasomnia
    1. Abnormally disrupted sleep
    2. Causes include Sleep Walking, Sleep Talking, Nightmares, Bedwetting, Sleep Apnea or nighttime Seizures
  • Epidemiology
  1. Prevalence: 50% in childhood
    1. Persists into adulthood in 4% of cases
  • Risk Factors
  1. Family History
  2. Sleep deprivation
  3. Triggers
    1. Obstructive Sleep Apnea in Children
    2. Restless Legs Syndrome in Children
    3. Pediatric Reflux
    4. Pain or emotional stress
  • Types
  1. Sleep Onset Disorders (or on awakening)
    1. Sleep Paralysis
    2. Restless Legs Syndrome in Children
    3. Hypnagogic Hallucinations
    4. Hypnagogic jerks ("Sleep Starts")
      1. Involuntary Muscle Twitch, jerk or contraction that occurs near sleep onset
      2. Common, normal, physiologic phenomenon
  2. Light Non-REM Sleep Disorders
    1. Bruxism
    2. Periodic Limb Movement Disorder
  3. Deep Non-REM Sleep Disorders in first half of sleep (Sleep-wake transition disorders)
    1. Characteristics
      1. Complex, almost purposeful activity, but detached from environment
      2. Examples: Sits up in bed, appears confused, screams
      3. Difficult to arouse during episode and often returns to sleep without memory of the event
    2. Disorders
      1. Confusional Arousal (Sleep Drunkenness)
      2. Night Terrors (Pavor Nocturnus)
      3. Somnambulism (Sleepwalking)
  4. Parasomnias of REM Sleep in second half of sleep
    1. Characteristics: Child can recall the Nightmare on awakening
    2. Disorders
      1. Nightmares
      2. REM Sleep Behavior Disorder
  5. Nonspecific Parasomnias (may occur at any time of sleep cycle)
    1. Sleep Talking (Somniloquy)
    2. Nocturnal Enuresis
  • Differential Diagnosis
  1. Nocturnal Seizure
  • Diagnostics
  1. Polysomnogram Indications
    1. Atypical presentation or significant complications from Parasomnia (e.g. injury)
    2. Suspected specific conditions
      1. Nocturnal Seizures
      2. REM Sleep Behavior Disorder
      3. Obstructive Sleep Apnea in Children
      4. Periodic Limb Movement Disorder
  • Management
  1. Consider sleep medicine referral
  2. Reassurance that events are typically self limited and most resolve by teen years
  3. Sleep Hygiene
  4. Manage precipitating conditions
    1. Obstructive Sleep Apnea in Children
    2. Restless Legs Syndrome in Children
    3. Pediatric Reflux
  5. Prevent injury
    1. Lock doors and windows at night
    2. Activate motion alarms
    3. Remove access to knives, firearms and other weapons
    4. Put mattress on the floor
    5. Remove toys and other clutter from the floor before bed
  • References
  1. Deshpande (2022) Am Fam Physician 105(2): 168-76 [PubMed]
  2. Stores (2001) J R Soc Med 94(4):173-6 +PMID: 11317618 [PubMed]