Parasomnias in children

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Parasomnias in children

• M Maldonado MD

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Classification

• During REM sleep
• During Non-REM sleep
• Mixed. Not to a particular state
• Secondary

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Parasomnias. Clinical

• Tend to occur in the transitions between the
  three states of the brain
• Wakefulness- non-REM sleep-REM sleep
• Surprising no more parasomnias, given so many
  transitions

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Parasomnias/transitions

• Transition between REM Sleep and wakefulness
• -Sleep paralysis
• -Lucid Dreams
• -Hypnagogic hallucinations

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Parasomnias, transitions

• Between NON-REM-Sleep and wakefulness
• Confusional awakening
• Somnambulism
• Sleep terrors (Pavor nocturnus)

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Other parasomnias

• Within sleep itself ( Non REM to REM)
• Nightmares or Anxiety dreams
• -Behavioral disturbance during REM sleep
• -Hypnotic fright
• OTHERS. Bruxism, somniloquism, enuresis, restless
  leg

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Other disturbances during sleep

• CNS problems. Cephalgia (Headache), Seizures
• Cardiopulmonary problems
• Arrhythmia during sleep. Hiccups
  during sleep. Angor pectoris. Respiratory
  dyskinesis
• Gastrointestinal Problems.
• Gastroesophageal reflux. Spasm of
  esophagus

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Mixed disturbances/parasomnias

• Panic attacks during sleep
• Dissociative states that occur during sleep
• Nocturnal leg cramps
• Malingering during sleep (eg. pretend one is
  sleep waking)
• Night eating syndrome

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Nightmares

• Anxiety dream, vivid recollection, perception as
  if reality
• Association with autonomous nervous changes
• Child regains consciousness fully after the
  nightmare
• Recollection the next day
• Fear of another nightmare
• May occur during later part of the night

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Awaking disorders

• Lack of response to environmental cues during the
  episode
• Automatisms, automatic behaviors during the
  episode
• Some degree of amnesia about the episode

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Confusional awakening

• Tends to occur during the first part of the night
  (first 1-3 hs)
• At the end of the first cycle of sleep
• When sleep goes from deeper to more superficial
  sleep
• Child may cry, gibber, attempt to move in
  uncoordinated way, not really awake

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Sleep terrors

• Initiated with a scream
• Child appears frightened
• May move as if to get away, get something off, or
  say things
• Not awake
• Not remember next day
• May last several minutes, up to 5-10
• During the first part of the night

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Pavor nocturnus (sleep terror)

• Frequent cause of consultation and concern for
  parents
• Some children have more than one episode per
  night and they can be quite frequent
• Cause major disturbance to the possibility of
  rest and of the child waking up refreshed

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Sleep terror. Causes

• Genetic vulnerability and transmission
• Association with anxiety symptoms and
  preoccupations (Laberge et al, 2005)
• Possible association with traumatic experiences
  in some children?

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Awakening disorders, intervention

• Diminish sleep deprivation, deprivation
  predisposes to episodes
• Diminish the amount of stress
• Pre-emptive awakening during the first sleep
  cycle
• Medications? For severe cases

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Medications . Sleep terror

• Melatonin described as possibly useful
• L Trytophane
• Tricyclic antidepressants (e.g. amitriptyline or
  imipramine)

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