Child Sleep: Parasomnias
What are "parasomnias"?
Parasomnias are essentially movements that occur during sleep. That's really the definition. Now, I think it's helpful to understand what's going on in your brain; if you look at your brain waves during a parasomnia, and then I'll explain what parasomnias are. So, usually these events, or these things, occur when you are transitioning from a deeper stage of sleep to a lighter stage of sleep. It's much like a transmission in a car, where a car will change gears from, say, fourth gear up to third gear; if you're driving a stick shift, and you're not so good at it, then you may get that sort of grinding thing in between, because you haven't successfully changed the gears properly. Well, a parasomnia is almost the same thing. What happens is when transitioning from your deep stage of sleep to your lighter stage of sleep you kind of get stuck between stages. It's almost like being in The Matrix; you're kind of not in one world and you're not in another world. You're kind of somewhere in between. When you're in that state you are still in sleep state, but you may be in a state of arousals; some form of arousal. Parasomnias actually manifest in different flavours, if you like. You can have sleep talking, sleep walking, and you can have something in younger children called confusional arousal, which is very similar to what happens in older kids and called a night terror. Often if you just leave them they will kind of subside on their own and the child will settle down. These are very frightening for parents to see, but it's important for them to understand that's not abnormal and that it can occur normally in about three to four percent of the childhood population.
Why do children have parasomnias?
Nobody really understands why children have parasomnias. There are a couple of things we do know. If there is a family history of parasomnias, it makes your child more likely to have them. The other thing that perpetuates these parasomnias is if you are sleep deprived. Somehow, it affects your rhythm; your ultradian rhythm, and your sleep cycle (how your brain cycles while you sleep) somehow is affected. So, if you have sleep deprivation, this will perpetuate these parasomnias. Now, you're kind of in a catch-22 situation because if your child has parasomnias, and has night terrors or sleepwalking and you try to wake them up, then what you're doing is you're fragmenting sleep, so their quality of sleep is impaired, so they become sleep deprived. So, you get into this vicious cycle where, inadvertently, you're actually perpetuating the problem. Now, when I say problem, I mean it's not really a problem unless it's a safety issue. Having a night terror is not bad for the child; it's not that the child is psychologically scarred. With sleepwalking, the same thing applies. It's just safety issues. So, one can inadvertently perpetuate the situation.
What is the most important thing to know about parasomnias?
The important issue with confusional arousals, night terrors and even sleepwalking is that if you try and wake up or arouse the individual, the child, during parasomnia, they'll often become more agitated. It perpetuates the problem, so if your child is having a night terror or a younger baby a confusional arousal and you try to wake them up from their parasonia they may become more confused, more agitated and more combative. Often if you just leave them the parasomnia will subside on its own and the child will settle down.
What is a "confusional arousal"?
Confusional arousal is usually a younger child, usually under 4 years of age, usually less than that, maybe under two. Usually occurs in infancy to early todderhood, where they will just suddenly start screaming and crying. When you go to attend to them, their eyes may be open and they just look confused and they may be moving around and thrashing in a purposeless way.
What is a "sleep terror"?
Sleep terror occurs in children usually from about four years up. These children tend to be terrified when they have these 'sleep terrors' or parasomnias: their eyes are wide open, they're maybe sweating, their heart is going very fast - they look absolutely terrified. Yet if you talk to them during a sleep terror, they don't respond. Some parents ask, "How do I know whether this sleep terror that this child is having is not a nightmare?" The difference is that with parasomnias, there is no recall. If a child has a nightmare, they will recall that they had a nightmare the previous night, but if it's a sleep terror, there's no recollection. You're stuck in a zone with parasomnias and there is no recall.
What is "sleep talking"?
Sleep talking is a type of parasomnia and it's just like all the others, it basically involves just doing something, some type of movement at night whilst asleep. In the case of sleep talking, it's simply talking in your sleep. What should be done about it? Nothing really. It's usually difficult to understand what children are saying anyway when they sleep talk, so it might make interesting listening for the parent, but really, a child sleep talking should be of no concern as there's really nothing to do about it.
What is "sleepwalking"?
Sleepwalking occurs when you're in this transition and you're asleep. That's why it's called sleepwalking, because you're not awake. The real issue with sleepwalking is safety. What you want to do, if you find your child sleepwalking, is to gently guide them. You don't have to wake them up. You can just turn them around, talk to them gently and say, "Let's go to your bed." Invariably, they will basically just walk back to their bed and go back to sleep.
What is the most important thing to know about sleepwalking?
When we talk about sleepwalking, your focus really is on the safety issues. If the child is predispositioned to go out of their room when sleepwalking, you may have to put a hook-lock on the door or you may have to double-lock the front door. You may have to find latches for the windows if they're opening windows while sleeping. You've got to focus on safety issues.
What are the treatments for parasomnias?
There are novel treatments to reduce these parasomnias, these events. The first one is to ensure that the child gets enough sleep. You've got to investigate why the child isn't getting enough sleep, and there could be a whole bunch of things. A child may not be getting enough sleep because they have some behavioural problems associated with it; they go into bed late, or it's a chaotic lifestyle in the home. They don't have good sleep hygiene and good sleep habits and they're going to bed at eleven. Your two-year-old is going to bed at eleven thirty because they're watching TV with the parent. One's got to investigate what's going on in the milieu to ensure that they're getting enough sleep, and if they're not find out why they're not getting enough sleep. If you've tried that; you've now ensured that this child's getting enough sleep and good quality sleep, but it's not working, and they're still having these events, then the next thing is to do something called scheduled awakening. These parasomnias are usually predictable. As they tend to occur when you transition from a deeper sleep to a lighter sleep, they tend to occur usually before midnight (this is because you tend to have more of the deeper sleep or slow wave sleep before midnight). So, most parents will usually be awake when these things happen, and they can be quite predictable. So, if you can identify that "Oh, my child is going to...", and usually they do this at quarter to twelve or eleven thirty, then this is when I know it's going to happen. In scheduled awakening what you do is about fifteen minutes before the anticipated event you briefly go in and you arouse the child, briefly, and you let them fall back to sleep. Somehow that seems to nudge the ultradian rhythm and nudge the sleep cycle, and seems to re-synchronize it. You may have to do that for a few nights but often that will cure the problem or at least reduce it. If that fails and it's a significant issue, then there are medications that one can do.
