Have you or someone you know ever experienced an abnormal event during sleep?
Parasomnias only occur during sleep, and although many people may have first
hand experience, these disorders are considered rare. This doesn't mean medical
attention isn't indicated, because in some cases it is. Three commonly reported
parasomnias are sleep walking, sleep terrors and disoriented arousals. It's
believed that these abnormalities occur in a mixed state of sleep and
wakefulness, where the sleeper is alert enough to perform complex behaviors, yet
remains unaware of his or her actions. Younger children are more likely to
experience parasomnias; however, typically these occurrences do not indicate
significant psychiatric or psychological problems. These disorders are
hereditary and are often more severe when a child is sick, sleep deprived, or
taking certain medications. Another factor to consider is stress, during
increased times of stress, parasomnias may be seen more frequently.
Disoriented Arousals
Disoriented arousals, though sometimes occur in adults, are more commonly seen
in infants and children. These arousals may begin with yelling or crying and
violently moving around in bed. The sleeper seems to be alert and upset, but may
resist any attempt to be comforted. In most cases, awakening a person who is
experiencing a parasomnia can be very difficult. Disoriented arousals can last
any where from a few minutes to half-an-hour. After the agitation ceases, the
sleeper may awaken for a short time and then return to sleep.
Sleepwalking
Walking around the room, rearranging the furniture, talking and even eating
during sleep is referred to as sleepwalking. Sleepwalking affects both sexes of
all ages, but is more commonly seen in younger women. Just as in disoriented
arousals, the sleeper is awake enough to perform these acts, but is unable to
recall anything in the morning. Injuries related to sleepwalking are rarely
reported. If you or someone you know experiences some form of sleepwalking, see
a sleep specialist about precautions you can take to prevent injuries in the
future. With sleepwalking treatment is rarely needed and usually does not
indicate any underlying medical or psychological problems.
Sleep Terrors
Sleep terrors are usually the most intense of the arousal disorders. A sleep
terror often begins with a loud scream and can produce signs that suggest
extreme terror. For example, you may observe irregular breathing, a rapid pulse,
excessive sweating, dilated pupils, and or agitation. During the startling
event, sleepers can cause injury to themselves and others. The sleeper may jump
out of bed and run frantically around the room, house or even outside. Again,
the sleeper is usually unable to recall the event. Sleep terrors are not usually
associated with vivid dreams or nightmares that are remembered upon awakening.
When should I contact a sleep specialist?
You should contact a sleep specialist if a child’s sleep exhibits:
* Potentially dangerous behavior
* Extreme disturbance of other household members
* Excessive daytime sleepiness.
Precautions should be taken to ensure safety for those with arousal disorders.
For example, clearing the floor and bedroom of obstructions, securing the
windows, sleeping on the ground floor level may be useful. Installing locks and
or alarms on windows and doors may increase the safety of the entire household.
Hypnagogic Hallucinations and Sleep Paralysis
Hypnagogic hallucinations are brief periods of dreaming while between the stages
of sleep and consciousness. These dreams can be frightening and can often cause
a sudden jerk and arousal just before sleep onset. For example, you may see
yourself falling and awaken with a sudden jerk, just before impact.
Sleep paralysis is the sensation of feeling paralyzed upon awakening, usually
immediately following a dream. This is commonly associated with the loss of
muscle tone during dreams, called atony. This loss of muscle tone during the
dreaming stage, prevents one from acting out his or her dreams. Hypnagogic
hallucinations and sleep paralysis can occur together. Although commonly seen in
people with narcolepsy, they can also affect others, especially those
individuals who are sleep-deprived. While they can be frightening, these events
are not physically dangerous and usually last only a few minutes.
Nocturnal Seizures
Nocturnal seizures occur during sleep and are commonly diagnosed by undergoing a
overnight sleep study (PSG). They can cause the sleeper to cry, scream, walk,
move about and or curse. These seizures can be treated with medications.
REM Behavior Disorder
REM Behavior Disorder is the ability to act out your dreams. The obvious problem
with acting out your dreams, is the potential to cause injury. All body muscles,
with the exception of those used in breathing are usually paralyzed during REM
(dreaming) sleep. In some cases this paralysis is incomplete or absent, thus
allowing dreams to be acted out. Behavior such as this can be violent and result
in serious injuries to the victim and bed-partner. After awakening the sleeper
will usually be able to recall vivid dreaming. Medication is used to treat this
disorder.
Grinding Your Teeth
Grinding of the teeth during sleep or bruxism, is a very common occurrence and
little evidence suggests that it is associated with other medical or
psychological problems. In some cases oral appliances are used to reduce dental
injury. For an example see the bottom portion of
OSA.
Rhythmic-movement Disorder
Rhythmic-movement disorder is seen most often in younger children, yet can also
occur in adults. The movements usually consist of recurrent headbanging,
headrolling and body rocking. The individual may also moan or hum during these
movements. Typically these movements will occur just before sleep begins or
during sleep. Medical or psychological problems are unlikely to be associated
with this disorder. Behavioral treatments may be effective in some cases, the
majority of children will eventually grow out of it.
