Parasomnias

Key Features

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

• Sleep terror

  • Abrupt, terrifying arousal from sleep

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

  • Distinct from sleep panic attacks

• Nightmares occur during REM sleep, unlike sleep terror, which occurs in stage 3 or 4

• Sleepwalking

  • Includes ambulation or other intricate behaviors while asleep, with amnesia for the event

  • Mostly affects children ages 6–12 years

  • Episodes occur during stage 3 or 4 sleep in the first third of the night and in REM sleep in the later sleep hours

  • In the elderly, may be a sign of dementia

  • May be an idiosyncratic reactions to drugs (eg, marijuana, alcohol) and medical conditions (eg, partial complex seizures) in adults

• Enuresis

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

  • More common in children, usually in the 3–4 hours after bedtime, but not limited to a specific stage of sleep

Clinical Findings

• Sleep terror

  • Abrupt, terrifying arousal from sleep

  • Fear, sweating, tachycardia, and confusion for several minutes

  • Confusion during the event and amnesia after it

Diagnosis

• Sleepwalking is confirmed by a sleep study

Treatment

• For sleep terrors and sleepwalking: benzodiazepines (diazepam, 5–20 mg orally at bedtime, suppresses stage 3 and 4 sleep)

• For enuresis

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

  • Imipramine, 50–100 mg orally at bedtime

  • Behavioral approaches (eg, bells that ring when the pad gets wet) have also been successful