PARASOMNIAS
What are parasomnias?
Parasomnias are undesirable events that accompany sleep. They often involve complex and goal-directed behaviour. They can manifest themselves after you fall asleep, while you sleep or when you are waking up.
Parasomnias in children
I. Parasomnias in deep sleep (non-REM sleep, stage 3)
Confusional arousals usually occur in the early part of the night, but may also recur later. Clinical signs include grunting, crying and stirring. The child may appear to be awake but really be in a deep sleep. He/she refuses any comfort. Confusional arousals are common in children under five years old.
Sleepwalking refers to a series of complex motor behaviours. Clinical signs include sitting up in bed, walking and even leaving the house. Sleepwalking may be either calm or agitated with varying degrees of complexity and duration. People who sleepwalk are hard to wake, are often in a confused state and have no recollection of the episodes once awake. These episodes mostly occur in the first third of the night. Approximately 17% of children aged 10-13 suffer from sleepwalking. Thus, it affects older children.
Sleep terrors generally occur a few hours after the child falls asleep. The beginning of the sleep terror is often brutal and can typically be described as the following: The child is in bed, eyes wide open, frightened and screaming. Autonomic nervous system phenomena (tachycardia, tachypnea, flushing of the skin, diaphoresis or increased muscle tone or behavioural signs (intense fear, trying to jump out of bed) could be present. Although usually benign, sleep terrors may be violent causing injury to the person sleeping or others. As with sleepwalking, it may be hard to wake a child with sleep terrors and, once awake, he/she is often confused, with no recollection of what took place. A child with sleep terrors falls back asleep easily. About 1-3% of children under 15 years old presents with night terrors.
II. Parasomnias in REM Sleep
Nightmares occur towards the end of the sleep cycle, usually near the end of the night. Nightmares differ from dreams in that the content is frightening and stressful. They are accompanied by a state of fear or sadness when the child wakes up. Contrary to parasomnias in deep sleep, the child is easily awakened and presents with no confusion or disorientation. Even though the child may find it difficult to fall back asleep, he/she is easily comforted. About 10-50% of children between three and five years of age have occasional nightmares. Nightmares tend to decrease with age but sometimes persist into adulthood.
Adults
I. Parasomnias in deep sleep (non-REM sleep, stage 3)
Adults can also have confusional arousals, shouting or jolting in bed. The person may seem to be awake, disorientated or irritated and refuse any comfort. About 4% of adults present with confusional arousals.
II. Parasomnias in REM sleep
RBD (REM sleep behaviour disorder) is a sleep disorder associated with affections of the central nervous system such as Parkinson’s disease or vascular affections. This disorder is characterized by violent behaviour that occurs at the end of the night, while the subject is in REM sleep. Clinical signs include shouting, flailing, hurling oneself on the bed partner and suddenly bolting out of bed. Actually, you “act out your dreams” as if they were real and you were trying to escape the perceived danger. The particularity of RBD is that people act out their dreams in REM sleep, whereas, during this stage, partial paralysis (breathing and heart rate remain intact) usually occurs. RBD prevalence is 0.5% and it mainly affects older men over 50 years of age.
RBD may be idiopathic or associated with neurological disorders (chronic form). RBD may be the first sign of these conditions and even precede the neurological disorders by over ten years. A high incidence of RBD is observed in patients with narcolepsy. RBD is often associated with periodic limb movements during non-REM sleep and sometimes with sleep apnea.
In children and teenagers, as in adults, parasomnias can seriously affect both the patient and those close to him/her. Parasomnias can have major psychosocial repercussions in children and teenagers. It is therefore important to carefully establish the diagnosis with a clinical interview and sometimes, depending on the case, a polysomnography.
How is parasomnia treated?
Simple precautions can be taken to limit the occurrence of parasomnia:
Keep your room clean and clutter free
Secure all windows and doors
In the most severe cases, drug (benzodiazepines) or psychological therapy (clinical, hypnosis, behavioural) may be recommended.
Consult your physician to find the right treatment for your condition.
Signs of parasomnia
Sleep disruption of the patient, bed partner or both
Heavy breathing at night
Injuries in the morning
Relationship problems
References:
American
Mahowald, M and Schenck, C. “Insights from Studying Human Sleep Disorders.” Nature. 437: 1279-1285.
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