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Key Features

  • Refer to abnormalities of arousal, partial arousal, and transitions between stages of sleep

  • Parasomnias include confusional arousals, night terrors, sleeptalking, and sleepwalking

  • Night terrors

    • Commonly occur within 2 hours after falling asleep, during the deepest stage of NREM sleep

    • Often associated with sleepwalking

    • Occur in about 3% of children and most cases occur between ages 3 and 8 years

  • Sleepwalking

    • Occurs during slow-wave/deep sleep

    • Common between 4 and 8 years of age.

    • Often associated with other complex behaviors during sleep

  • Nightmares

    • Occur during REM sleep, typically followed by awakening, which usually occurs in the latter part of the night

    • Peak occurrence is between ages 3 and 5 years

    • Incidence between 25% and 50%

Clinical Findings

  • Night terrors

    • Child may sit up in bed screaming, thrashing about, and exhibiting rapid breathing, tachycardia, and sweating

    • Child is often incoherent and unresponsive to comforting

    • Episode may last up to 30 minutes, after which the child goes back to sleep and has no memory of the event the next day

    • Parents must be reassured that the child is not in pain and that they should let the episode run its course

  • Sleepwalking

    • Typically benign except that injuries can occur while the child is walking around

    • Steps should be taken to ensure that the environment is free of obstacles and that doors to the outside are locked

  • Nightmares

    • Child who awakens during these episodes is usually alert

    • He or she can often describe the frightening images, recall the dream, and talk about it during the day

    • Child often has difficulty going back to sleep


  • Clinical


  • Night terrors

    • Consists of reassurance of the parents plus measures to avoid stress, irregular sleep schedule, or sleep deprivation, which prolongs deep sleep when night terrors occur

    • Scheduled awakening (awakening the child 30–45 minutes before the time the night terrors usually occur) has been used in children with nightly or frequent night terrors, but there is little evidence that this is effective

  • Sleepwalking

    • Parents may wish to put a bell on their child's door to alert them that the child is out of bed

    • Steps should be taken to avoid stress and sleep deprivation

    • Scheduled awakenings may also be used if the child sleep walks frequently and at a predictable time

  • Nightmares

    • Usually self-limited and need little treatment

    • Can be associated with stress, trauma, anxiety, sleep deprivation that can cause a rebound in REM sleep as well as with medications that increase REM sleep

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