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Understanding Parasomnias in Children: Classification and Interventions

Learn about parasomnias in children, including classifications, causes, and interventions to manage sleep disorders. Explore various types of parasomnias, such as night terrors, nightmares, and transitional disturbances. Discover recommended interventions and potential medications for severe cases.

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Understanding Parasomnias in Children: Classification and Interventions

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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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