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For further information, see CMDT Part 25-15: Sleep-Wake Disorders

Key Features

  • 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

Clinical Findings

  • 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

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