Parasomnias

Sleep terror, nightmares, sleepwalking, and enuresis more common in children than in adults

Distinct from sleep panic attacks

Usually seen in preadolescent boys, although it may occur in adults

Occur during REM sleep, unlike sleep terror, which occurs in stage 3 or 4

Includes ambulation or other intricate behaviors while asleep

Episodes can occur during stage 3 or 4 or REM sleep

Causative factors include medical conditions and drugs of abuse

Involuntary micturition during sleep occurring in a patient who usually has control

Most common 3–4 hours after bedtime, but not limited to a specific stage of sleep

Fear, sweating, tachycardia, and confusion for several minutes

Abrupt, terrifying arousal in sleep

Amnesia for the event

Confusion during the event and amnesia after it are common

Sleep walking is confirmed by a sleep study

Benzodiazepines (diazepam, 5–20 mg orally at bedtime, suppresses stage 3 and 4 sleep)

Desmopressin nasal spray is likely the treatment of choice for nocturnal enuresis

Alternatively, imipramine, 50–100 mg orally at bedtime

Behavioral approaches (eg, bells that ring when a pad is wet) have been successful