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Parasomnias in children

Parasomnias in children. M Maldonado MD. Classification. During REM sleep During Non-REM sleep Mixed. Not to a particular state Secondary. Parasomnias. Clinical. Tend to occur in the transitions between the three states of the brain: Wakefulness- non-REM sleep-REM sleep

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Parasomnias in children

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  1. Parasomnias in children M Maldonado MD

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

  3. 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

  4. Parasomnias/transitions • Transition between REM Sleep and wakefulness : -Sleep paralysis -Lucid Dreams -Hypnagogic hallucinations

  5. Parasomnias, transitions • Between NON-REM-Sleep and wakefulness: • Confusional awakening • Somnambulism • Sleep terrors (Pavor nocturnus)

  6. 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

  7. 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

  8. 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

  9. 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

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

  11. 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

  12. 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

  13. 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”

  14. 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?

  15. 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

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

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