Sleep Behavior Problems (Parasomnias)

It's the middle of the night and everyone in your house is fast asleep. Suddenly, you are jolted out of bed when you hear your child scream. It's probably another nightmare, you think, as you head into his room to console him.

A nightmare is one type of parasomnia. Parasomnia, which means "around sleep," also includes sleepwalking, night terrors, bedwetting, and narcolepsy. All can create havoc in your home, and some can be harmful to your child. Keep reading to learn about the three categories of parasomnia (rhythmic, paroxysmal, and static disorders) and to find out how you can help your child.

Rhythmic Disorders
Rhythmic disorders, such as head-banging, head-rocking, and body-rocking, involve movements that range from mild to seizure-like thrashing. Other rhythmic disorders include shuttling (rocking back and forth on hands and knees) and folding (raising the torso and knees simultaneously).

During the rhythmic movements, the child may moan or hum. These movements seem to occur during the transition between wakefulness and sleep or from one stage of sleep to another.

There is no known cause for this type of disorder, but medical or psychological problems are rarely associated with it. Children who experience rhythmic disorders may have morning headaches, nasal problems, and ear infections.

Another rhythmic disorder is restless legs syndrome (RLS), a sensory and motor abnormality that seems to have a genetic basis. In RLS, the child's legs move repeatedly. Many people who have RLS also have periodic leg movement syndrome (PLMS) - this occurs during sleep when the legs move involuntarily.

Treatment for RLS can include:

• music therapy (rhythmic sounds, such as the ticking of a metronome, may help induce and regulate sleep)
• psychotherapy
• hypnotism
• motion-sickness medications
• tranquilizers
• stimulants

Paroxysmal Disorders
Paroxysmal disorders are those that come on or recur suddenly. They include night terrors, nightmares, sleepwalking, and bedwetting.

Night Terrors
Night terrors (also known as Pavor Nocturnus) are characterized by a sudden arousal from sleep with a piercing scream or cry. During the episode, heart and breathing rates may increase and the child's eyes may be open, but he probably won't remember what happened - other than waking up and feeling scared.

Night terrors occur in the first third of the sleep cycle, when the child is in deep sleep. Instead of waking or moving into another stage of sleep, the child gets "stuck" between stages. This can occur in as many as 15% of young children and can be caused by being overly tired or having an interrupted sleep cycle.

By themselves, night terrors are not dangerous, but what happens during one can be. A child may jump out of bed and do something that he might not otherwise do.

There is no known cause of night terrors, but some doctors believe that it has to do with physical causes. Apnea may be present.

Following evaluation to eliminate any possible physical causes (such as neurological conditions), medication may be used as treatment.

Nightmares
Nightmares differ from night terrors in that they are usually psychologically based, are more often remembered, and aren't usually dangerous.

Nightmares also occur only during REM (rapid eye movement) sleep. During REM sleep, the sleeping person's eyes move quickly, heart rate and breathing may be erratic, and dreams (or nightmares) may occur. Non-REM sleep (also called slow wave sleep) is deeper.

Sleepwalking
Sleepwalking, which is usually mild, can be hazardous when it's frequent or intense.

Because the child is not awake during an episode, dangerous objects should be removed from the room where he sleeps and the windows should be locked.

Following a medical evaluation, these treatments may help reduce or eliminate sleepwalking:

• medication
• consistent sleep-wake cycle

Bedwetting
Bedwetting, also called enuresis, is a common problem that can affect a child's self-esteem as well as his sleep. Because it occurs at night and can affect sleep, bedwetting is classified as a parasomnia.

It typically occurs in children who are between the ages of 3 and 8. Bedwetting usually stops on its own, but it sometimes continues into adolescence. A child who regularly wets the bed should see a doctor to rule out any physical cause.

Static Disorders
Static disorders, which are not disruptive, include sleeping with open eyes (this can be common in infants and young children) or in odd positions (such as upside down or arched).

Even though static disorders are not harmful, children who sleep in odd positions or with their eyes open should be examined by a doctor, especially if the behaviors persist or they are accompanied by other unusual symptoms.

Helping Your Child
If you're worried about your child's sleeping patterns, talk with your child's doctor. He or she may refer you to a sleep specialist or encourage you to establish good sleep hygiene for your child, which would include:

• following a fixed bedtime and wake-up time (and nap times)
• keeping consistent play and meal times
• avoiding stimulants, such as caffeine, near bedtime
• making the bedroom quiet, cozy, and conducive to sleeping
• using the bed only for sleeping - not for homework, playing, or watching TV
• limiting food and drink before bedtime if gastroesophageal reflux (GER) or bedwetting is a problem

It may also help to keep a pre-sleep diary for your child. In the diary, record what your child does before he goes to bed, when he goes to the bathroom, and what he eats and drinks. Other information you can include, such as the weather conditions, may help your child's doctor create a successful treatment program.