Primary Sleep Disorders: Parasomnia

Parasomnias are common sleep disorders. They are characterized by strange or bizarre behavior or experiences during sleep. Parasomnias can occur during specific stages of sleep or during the transition between sleeping and waking. From childhood on, most people have had one or more parasomnias, including nightmares and sleep terrors.

Types of parasomnias

Types of common parasomnias:

• Nightmares and nightmare disorder

• Bedwetting

• Disorders of arousal: sleepwalking, sleep terrors, and confusional arousals

• Sleep-related behavior disorder (SRED)

• Nocturnal sleep-related eating disorder

• REM sleep behavior disorder (RBD)

Other types of parasomnias include sleep paralysis, sleep aggression, and sexsomnia.

Nightmares and nightmare disorder

Nightmares are frightening dreams that jolt the sleeper awake suddenly. People usually remember vivid details about their nightmares. Having the same nightmare over and over is called a nightmare disorder.

In adults, nightmares are often connected with conditions such as post-traumatic stress disorder, depression, and schizophrenia. They can happen more often during stressful life situations, such as the death of a loved one, a breakup or divorce, or loss of a job. They can also be related to certain medicines, such as antidepressants, narcotics, or seizure medicines.

Sleep terrors

Sleep terrors, also known as night terrors, are episodes of fear, confusion, and screaming during sleep. Toddlers who have sleep terrors may try crawling or walking in their sleep. If this happens, parents will need to watch them closely so that they don't hurt themselves. Sleep terrors usually last a few seconds to a few minutes and often occur with sleepwalking. Unlike a nightmare, a person having a sleep terror will not wake up and will not remember anything the next morning. Although usually short, sleep terrors can last up to 45 minutes.

Nightmares and sleep terrors are more common in children than adults. In children, they are rarely caused by a physical or mental illness. Both nightmares and sleep terrors are more common in people with other sleep problems, such as obstructive sleep apnea.

If your child has nightmares, he or she will usually wake up suddenly and may come to you for comfort. You can explain to your child that he or she has had a bad dream.

Children with sleep terrors might have their eyes open and seem to be awake, yet be confused, glassy-eyed, and unable to communicate. The child is often inconsolable. Your child might also:

• Sit up in bed

• Scream or shout

• Kick or thrash around frantically

• Breathe heavily and sweat

• Be hard to wake up or hard to calm down

• Stare wide-eyed

• Get out of bed and crawl or run around the house

If your child has a sleep terror, talk to your child calmly and gently and try to get him or her back into bed without shouting, shaking, or trying to wake the child.

Diagnosis

Nightmares and sleep terrors are usually diagnosed by history alone. Some adults might need to undergo more evaluation, such as psychiatric testing, to make sure they don't have an underlying problem related to the sleep terrors.

Treatment

Nightmares and sleep terrors can be frightening, but they are usually nothing to worry about.  Most children will outgrow them by the time they are teens.  But it's important to make sure your child or family member is safe from harm during the night. 

If your child has sleep terrors, you may need to place gates on staircases to prevent injury and remove dangerous objects from your home. Children who have frequent sleep terrors should not sleep in bunk beds. Be sure to talk with your doctor if you or a family member ever gets hurt while sleeping.

Adults who have frequent nightmares and sleep terrors may benefit from cognitive behavioral therapy (CBT). CBT can be done with a counselor or at a sleep medicine center and can be effective after only a few sessions. Some medicines can help reduce the frequency of nightmares associated with post-traumatic stress disorder.

Bedwetting

Doctors refer to nighttime bedwetting as nocturnal enuresis. This condition is fairly common in children. It's not unusual for children younger than 6 to wet the bed. It tends to affect boys more than girls. Bedwetting is also much more common in children whose parents both wet the bed as children. 

Bedwetting often occurs when a child makes too much urine for the amount that his or her bladder can store. Children with the condition don't wake up when their bladder is full.

Diagnosis

Take your child to the doctor if he is still wetting the bed after age 6. The doctor may ask you about your child's bathroom habits during the day and night and do a physical exam. The doctor will also do a urine test called a urinalysis to see if there is an obvious cause for the bedwetting, like a urinary tract infection or diabetes.

The doctor might ask you about how things are going at school and at home for your child. Although your child's bedwetting might be concerning to you, children who wet the bed are usually not more emotionally upset than other children.

If the doctor finds no underlying cause, the bedwetting is called primary nocturnal enuresis. If a separate medical condition, such as a urinary tract infection, diabetes, spinal cord problems, or defects of body parts like the urethra, is causing the bedwetting, it's called secondary nocturnal enuresis.

Treatment

Most children don't need treatment for bedwetting. If your doctor decides to treat your child, it will probably be with behavioral therapy or medicine. These are possible behavioral therapy treatments:

• Limit fluids before bedtime.

• Have your child go to the bathroom at the beginning of the bedtime routine and again right before getting into bed. Sometimes, waking the child up in the middle of the night to use the bathroom is advised.

• Reward your child for dry nights. On wet nights, don’t punish or embarrass your child.

• Have your child help you change the sheets when he or she wets the bed. This is not meant as a punishment, but to help the child become responsible. It can also help decrease your child's embarrassment. If you find yourself using it as a punishment stop using this technique.

• Give your child bladder training, which involves having your child practice holding his or her urine for a while throughout the day so that the bladder stretches to accommodate more urine.

• Know your child’s daily urine and bowel habits.

• Talk to your child about bedwetting. Let your child know it's not his or her fault and that most children stop bed wetting as they get older. Your child won’t think bedwetting is a big deal if you don’t. Remind your child that other children wet the bed.

• Establish a no-teasing rule in your family. This is especially important with your child’s siblings. Teach people that the bedwetting is not your child’s fault.

• Consider waking up your child 1 to 2 hours after going to sleep to use the toilet.

• Use a pad with an alarm that sounds when it becomes wet (bell and pad method or alarm therapy).

If behavioral therapy doesn't work for your child, and he or she is at least 7 years old, your doctor might prescribe medicine. One type of medicine helps the bladder hold more urine, and the other causes the kidneys to make less urine. These medicines can have side effects like flushing of the cheeks and dry mouth, and they are not a cure for bedwetting. 

Helping your child cope

It's important to remember that bedwetting is not a child's fault. It's not a mental or behavioral problem, and it does not happen because a child is too lazy to get out of bed. Don't make your child feel guilty or ashamed, or punish him or her for wetting the bed. 

Encourage your child to use the bathroom during the night, and place nightlights in hallways and rooms to make this easier. It may be helpful to use a waterproof mattress pad.

Sleepwalking

Sleepwalking, also know as somnambulism, is a disorder in which a person partially wakes up during the night and walks around without realizing it. The sleepwalker might make repetitive movements, such as fumbling with clothing, get out of bed and stroll around, or even talk to you. Sleepwalking is usually not a cause for concern. Most children will outgrow sleepwalking by their teens. 

If your child is sleepwalking, try to guide him or her gently back to bed. Don't shake or yell at your child in an attempt to wake him or her up. Another important consideration is your child's safety. As with sleep terrors, remove dangerous objects from the home and place gates on stairs to prevent falls. Keep doors and windows locked. 

Most children will not need treatment for sleepwalking. If your child sleepwalks for a long time or is having problems during the day due to lack of sleep, talk with your doctor. You might want to keep a sleep diary for a few weeks and record when your child sleepwalks. One method sometimes used to treat sleepwalking is waking your child up 15 minutes before he or she normally sleepwalks, but talk with your doctor before doing so.