Parasomnias

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

Diagnosis

• Sleep walking is confirmed by a sleep study

Treatment

• 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