Parasomnias
Sleep walking (Somnambulism): In this conditionin dividuals suddenly sit up in bed, walk or carry out automatic and complex activities. Patients remain unconscious and will resist being aroused. On occasion dangerous acts such as climbing out of a window can occur.
Parasomnia, which means "around sleep," includes sleepwalking, night terrors, bedwetting, and narcolepsy. All can create family difficulties, and some may be harmful to the child.
These disorders are often hereditary and are often more severe when you are sick, sleep deprived, or taking certain medications. Another factor to consider is stress. During increased times of stress, parasomnias may be seen more frequently, precipitated or perpetuated. Parasomnias are usually accompanied by periodic limb movements, like: twitching, jerks of the arms or legs which cause repeated arousals. When parasomnia persists most nights a week for weeks, it can cause increased tension, decreased energy, and personality and mood changes.
Sleep attacks: Also known as sleep terrors, commonly occurs in children only. The attacks occur within the first 1-2 hours of the night. With a frightened scream, a child sits up in bed, agitated and petrified. There is accompanied sweating, increased heart rate and increase in respiration. The attack lasts for a few minutes only, before the child falls asleep again. There is generally no memory of the event the next morning. Sleep terrors are generally benign and time limited so that reassurance is both adequate and sufficient.
Nightmares: These occur much late at night. Screams are uncommon and arousals rapid. Vivid hallucinations and emotionally charged dreams are usually recounted. Recurrent nightmares reflect a psychological problem, which needs to be looked into.
Bed wetting: This occurs during the first third of the night. It is normally present in children up to seven years or so. Bed wetting after the age of seven certainly needs to be referred to a doctor. Most children generally grow out of it. More boys than girls are bed wetters. Hereditary factors playa strong role in determining whether a child will wet the bed or not.
Management
1. The child should not be traumatized for this habit by the parents. Do not humiliate the child since most parents have themselves been bed wetters.
2. Restrict intake of water before sleep.
3. Ensure the child passes urine before getting into bed.
4. Over a period of time, parents do get to know what time of the night the child will wet his bed. Ensure thus that the child is woken up and taken to the toilet before the bed wetting takes place.
5. Check out for any medical problems.
Examples of parasomnias are:
- Sleepwalking
- Teeth grinding
- REM sleep disorder
- Sleep-awake transition disorders, etc.
- Arousal disorders (presumed to be due to an abnormal arousal mechanism)
The best know parasomnia is sleepwalking, which is thought to afflict as much as 18% of the population. As is well know, sleepwalkers can venture out of the house into traffic and even walk through glass windows, harming themselves. When they wake up, the remember nothing.
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