What are parasomnias?
Parasomnias are common sleep disruptions that can occur when a child is falling asleep or waking up. Parasomnias occur at the transition of deep sleep and consciousness where a child’s brain can be caught in between the two states, and explains why a child can appear awake but actually be sleeping. This article will discuss examples of parasomnias including sleep talking (somniloquy), sleep walking (somnambulism), night terrors (pavor nocturnus), and confusional arousals.
Common features to all Parasomnias
Parasomnias are common in childhood and share many features. They are generally harmless and most children outgrow them. A child may appear awake, but their brain is asleep and unaware of the event. Unlike nightmares, a child will awaken unaffected and have no recollection of it the next day. Other than sleep talking, most other parasomnias happen around the same time, usually within 4 hours of falling asleep. While parents may worry their child might have multiple events throughout the night, this isn’t the norm.
Categories of Parasomnias
To ease our understanding of how to approach these different conditions, we classify them into two distinct categories. The first category includes sleep talking (somniloquy) and confusional arousals, which are found to be innocent and generally do not require intervention. Sleep talking is a condition in which a child vocalizes during sleep. Confusional arousals are characterized by a child waking up briefly. He or she may have a slow reaction time, have trouble understanding questions, and act confused before returning to bed with no recollection of the event the next day.
Do you ever wonder if your child will wake up if you try moving them? Sleep talking is an easy way to determine how deeply your child is sleeping. If your child is speaking clearly, they are in a lighter stage of sleep and more likely to wake up if disturbed. Mumbling and incoherent speech indicate deeper sleep, during which your child is less likely to awaken.
The second category of parasomnia classification includes night terrors (pavor nocturnus) and sleepwalking (somnambulism), which are generally innocent, but in certain circumstances may require intervention. Night terrors are episodes that are named for their appearance rather than what a child is actually perceiving. If your child is having a night terror, he or she will appear panicked and exhibit behaviors such as screaming, sweating, breathing rapidly, and crying, when in fact he or she is actually asleep. A common misunderstanding is that your child is having a nightmare, yet not experiencing anything that is actually frightening them and will have no recollection of the event once awakened in the morning. Lastly, sleepwalking is commonly seen in school-aged children and is characterized by walking in a state of partial wakefulness.
Treatment options for Parasomnias
When observation is the only intervention:
Sleep talking and confusional arousals are harmless and require no intervention.
When observation is the preferred intervention:
When night terrors are infrequent (less than a few times a week) and brief (less than 20 minutes in duration), observation and reassurance are generally all that is needed. Talking to or touching your child during a night terror can prolong the episode, but by letting it run its course, you can significantly shorten the event.
When sleepwalking is infrequent, we recommend gently guiding your child back to bed without waking him or her. While it is not dangerous to wake a sleepwalker, it is not necessary. If there are concerns the child may leave the house or use sharp objects, take simple safety precautions such as securing knives and installing wireless door chimes on exit doors.
When behavioral strategies are the preferred intervention:
When night terrors and sleepwalking are frequent, particularly for a sleepwalker who has already engaged in a dangerous behavior (e.g. leaving the home, engaging in aggressive acts during sleep) ,“planned night awakenings” can prevent parasomnias. This involves waking a child briefly for 7 consecutive nights 30 minutes before the earliest possible event is likely to occur. Other strategies include avoiding sleep deprivation, setting a regular bedtime routine, and following healthy sleep habits.
When to consult your physician:
In severe cases where behavioral interventions fail, short term treatment with medications may be available to help. If your child’s condition does not seem to respond to typical suggestions, or you are worried there might be another cause for your child’s sleep problems, consult your pediatrician. In some cases, parasomnias have been linked to sleep apnea and your child’s doctor is the best source of information to determine if your child is at risk for this condition.
Authors: Cheryl Tierney, MD, MPH, Taylor Aves, Eugenia Gisin, Alexandra Lazzara, Megan Veglia
Cheryl Tierney, MD, MPH is a Board-Certified behavior and developmental pediatrician who has been in practice since 2002. She is a native of Brooklyn, New York and completed medical school at Tufts University in Boston. Her pediatric residency was at Carolinas Medical Center in Charlotte, North Carolina. She completed Fellowships in Health Services Research, where she received her MPH at Harvard School of Public Health as well as Behavior and Developmental Pediatrics in 2002. She is an active member of The Society for Developmental and Behavioral Pediatrics (SDBP) as well as the Academic Pediatric Association (APA). She enjoys participating in outdoor activities with her family.
President, ABA in PA INITIATIVE
Associate Professor of Pediatrics
Section Chief, Developmental Pediatrics, Penn State Hershey Children's Hospital
© 2021 American Sleep Association.