Strange Sleep – Parasomnias of Childhood
Parasomnias are bizarre or strange behaviors, movements, or emotions that occur during sleep. They are a common part of growing up, with most people experiencing some type of parasomnia during childhood, but are usually outgrown prior to adulthood. They can occur during transitions between different sleep states, or during deeper sleep states. Parasomnias can be very disruptive to the sleep of both children and their parents.
There are two basic categories of parasomnias, based on the sleep state in which they occur: Non-Rapid Eye Movement sleep (NREM) or Rapid Eye Movement sleep (REM). The body cycles through these stages of sleep throughout the night.
NREM sleep is a period of slowed brain activity and heart rate, along with deep sleep that is difficult to rouse from. NREM parasomnias tend to occur early on in the night, and include sleepwalking, night terrors, confusional arousals.
REM sleep is a period of increased brain activity and lighter sleep. Dreams occur during REM sleep, while at the same time the large muscles of the body cannot move. REM parasomnias tend to occur later in the night. These include nightmares, and sleep paralysis.
The most common parasomnias of childhood are sleepwalking, nightmares, night terrors, and confusional arousal. We will discuss each of these below.
Sleepwalking
Like the name implies, this parasomnia involves getting out of bed and walking around without being aware of it. Children may try to get dressed, walk around the house, even talk to you. Sleepwalking is not typically a cause of concern, except in regards to safety. You may need to install door alarms on external doors or baby gates on stairs
Most children will not require treatment for sleepwalking, and will outgrow it by the time they are teenagers.
Nightmares
It should be obvious, but nightmares are frightening dreams that usually awaken the child suddenly. These are usually vivid and easily remembered. In adults, these usually occur in relation to post traumatic stress disorder, depression, a major life change, or as a side effect to medications. In children, these seem to occur more frequently when they are overtired or are experiencing increased stress. Younger children may have nightmares due to separation anxiety or fears over fictional monsters. Older children have nightmares due to scary or violent movies and social stress.
It is important to keep in mind that younger children have a hard time differentiating between reality and make believe. Movies and television shows can easily trigger nightmares and should be carefully monitored for this age.
If your child is going through a period of having frequent nightmares, there are some things you can do to help:
- Keep the bedtime routine easy and happy.
- Talk about the nightmare during the day to help work through if there is underlying cause.
- Comfort your child at the time of awakening from the nightmare, and do not belittle or reprimand them for coming to you.
- Make sure your child is getting enough sleep at night.
- Address any night time fears, such as monsters under the bed or fear of the dark. Help your child think of ways to overcome this and feel safe in his or her room.
Night terrors
These are sudden episodes of confusion and screaming that occur during sleep. They are common in toddlers. These episodes last a few seconds to a few minutes, and though the child’s eyes may be open, he or she is not truly awake and will not be able to communicate with parents. Upon awakening, the toddler will not remember anything or feel fear. They often are confused as to why they are suddenly awake. If your child has night terrors, try to wake them gently, talk to him or her calmly, and ease back into sleep. Do not shout or shaky your child.
While this type of parasomnia is certainly startling and disruptive, it is a phase that usually passes without intervention.
Confusional arousal
This type of parasomnia is notable mental confusion or disoriented behavior while the child is still in bed. These episodes are not associated with fear or terror. He or she may appear to be awake but the behavior is unusual and includes disorientation, confusion of thought, and slowed speech.
Treatment of Parasomnias
Most of the time, parental reassurance is the only thing to be done and children simply need time to outgrow their particular parasomnia. Adjustments to the child’s sleep environment – placing door alarms at all exit points for a sleepwalking child, for example – can be helpful in preventing injury but will not affect the underlying parasomnia. Certain triggers for parasomnias may be identified, including sleep deprivation, restless leg syndrome, or sleep apnea. Talk to your child’s Pediatrician for specific testing that may identify treatable triggers.
*We are not discussing sleep apnea or restless leg syndrome today because while they may be triggers, they are not parasomnias. This will be discussed in a future post.
Final thoughts
For parents of young children, a full night of sleep can be an elusive thing. We expect it with newborns, but when toddlers and even school-aged children start to wake us in the middle of the night it often comes a surprise. Hopefully today’s discussion can reassure those parents who have little ones waking up screaming with night terrors, or first graders wandering down the hallways mumbling gibberish as they go. Just like when they were newborns and waking every few hours, this too shall pass. Give it time and talk to your child’s Pediatrician if you are worried.
Resources
https://bestpractice.bmj.com/topics/en-us/1177
For more info about sleep cycles: https://my.clevelandclinic.org/health/articles/12148-sleep-basics
https://www.stanfordchildrens.org/en/topic/default?id=primary-sleep-disorders-parasomnia-134-139
If you enjoyed this post, please sign up below to subscribe for blog emails. You will receive notification when new posts are available. If you do not receive a welcome email upon registering, please check your spam folder.
