Primary Sleep Disorders: Parasomnia

Types of parasomnias

Types of common parasomnias:

• Nightmares and nightmare disorder

• Bedwetting

• Disorders of arousal: sleepwalking, sleep terrors, and confusional arousals

• Sleep-related behavior disorder (SRED)

• Nocturnal sleep-related eating disorder

• REM sleep behavior disorder (RBD)

Other types of parasomnias include sleep paralysis, sleep aggression, and sexsomnia.

Nightmares and nightmare disorder

Nightmares are frightening dreams that jolt the sleeper awake suddenly. People usually remember vivid details about their nightmares. Having the same nightmare over and over is called a nightmare disorder.

In adults, nightmares are often connected with other conditions. These include posttraumatic stress disorder, depression, and schizophrenia. Nightmares can happen more often during stressful life situations. These could include the death of a loved one, a breakup or divorce, or loss of a job. They can also be linked to certain medicines, such as antidepressants, narcotics, or seizure medicines.

Sleep terrors

Sleep terrors, also known as night terrors, are episodes of fear, confusion, and screaming during sleep. Toddlers who have sleep terrors may try crawling or walking in their sleep. If this happens, parents will need to watch them closely so that they don't hurt themselves. Sleep terrors usually last a few seconds to a few minutes. They often occur with sleepwalking. Unlike a nightmare, a person having a sleep terror won't wake up and won't remember anything the next morning. Although often short, sleep terrors can last up to 45 minutes.

Nightmares and sleep terrors are more common in children than adults. In children, they are rarely caused by a physical or mental illness. Both nightmares and sleep terrors are more common in people with other sleep problems, such as obstructive sleep apnea.

If your child has nightmares, they will often wake up suddenly and may come to you for comfort. You can explain to your child that they've had a bad dream.

Children with sleep terrors might have their eyes open and seem to be awake. Yet they may be confused, glassy-eyed, and unable to communicate. The child is often inconsolable. Your child might also:

• Sit up in bed

• Scream or shout

• Kick or thrash around frantically

• Breathe heavily and sweat

• Be hard to wake up or hard to calm down

• Stare wide-eyed

• Get out of bed and crawl or run around the house

If your child has a sleep terror, talk to them calmly and gently. Try to get them back into bed without shouting, shaking them, or trying to wake them.

Diagnosis

Nightmares and sleep terrors are often diagnosed by history alone. Some adults might need to undergo more evaluation, such as psychiatric testing. This is to make sure they don't have an underlying problem related to the sleep terrors.

Treatment

Nightmares and sleep terrors can be frightening. But they're usually nothing to worry about. Most children will outgrow them by the time they are teens. But it's important to make sure your child or family member is safe from harm during the night. 

If your child has sleep terrors, you may need to place gates on staircases to prevent injury and remove dangerous objects from your home. Children who have frequent sleep terrors shouldn't sleep in bunk beds. Be sure to talk with your healthcare provider if you or a family member ever gets hurt while sleeping.

Adults who have frequent nightmares and sleep terrors may benefit from cognitive behavioral therapy (CBT). CBT can be done with a counselor or at a sleep medicine center. It can be effective after only a few sessions. Some medicines can help reduce the frequency of nightmares linked to posttraumatic stress disorder.

Bedwetting

Healthcare providers refer to nighttime bedwetting as nocturnal enuresis. This condition is fairly common in children. It's not unusual for children younger than 6 to wet the bed. It tends to affect boys more than girls. Bedwetting is also much more common in children whose parents both wet the bed as children. 

Bedwetting often occurs when a child makes too much urine for the amount that their bladder can store. Children with the condition don't wake up when their bladder is full.

Diagnosis

Take your child to their healthcare provider if they're still wetting the bed after age 6. The provider may ask you about your child's bathroom habits during the day and night. They may do a physical exam. The provider will also do a urine test called a urinalysis. This is to see if there is an obvious cause for the bedwetting, like a urinary tract infection or diabetes.

The healthcare provider might ask you about how things are going at school and at home for your child. Your child's bedwetting might be concerning to you. But children who wet the bed are usually not more emotionally upset than other children.

If the provider finds no underlying cause, the bedwetting is called primary nocturnal enuresis. If a separate medical condition is causing the bedwetting, it's called secondary nocturnal enuresis. These separate conditions may include a urinary tract infection, diabetes, spinal cord problems, or defects of body parts, like the urethra.

Treatment

Most children don't need treatment for bedwetting. If your child's healthcare provider decides to treat them, it will likely be with behavioral therapy or medicine. These are possible behavioral therapy treatments:

• Limit fluids before bedtime.

• Have your child go to the bathroom at the beginning of the bedtime routine. Then have them go again right before getting into bed. Sometimes, waking them up in the middle of the night to use the bathroom is advised.

• Reward your child for dry nights. On wet nights, don’t punish or embarrass them.

• Have your child help you change the sheets when they wet the bed. This is not meant as a punishment. It's to help them become responsible. It can also help decrease your child's embarrassment. If you find yourself using it as a punishment, stop using this technique.

• Ask your child's provider about bladder training programs. Bladder training involves a specific structure. Your child practices holding their urine at certain times during the day. This helps the bladder stretch to accommodate more urine.

• Know your child’s daily urine and bowel habits.

• Talk to your child about bedwetting. Let them know it's not their fault and that most children stop bedwetting as they get older. Your child won’t think bedwetting is a big deal if you don’t. Remind your child that other children wet the bed.

• Create a no-teasing rule in your family. This is especially important with your child’s siblings. Teach people that bedwetting isn't your child’s fault.

• Think about waking up your child 1 to 2 hours after going to sleep to use the toilet.

• Use a pad with an alarm that sounds when it gets wet (bell and pad method or alarm therapy).

If behavioral therapy doesn't work for your child, and they're at least 7 years old, their healthcare provider might prescribe medicine. One type of medicine helps the bladder hold more urine. The other causes the kidneys to make less urine. These medicines can have side effects like flushing of the cheeks and dry mouth. They're not a cure for bedwetting. 

Helping your child cope

It's important to remember that bedwetting isn't a child's fault. It's not a mental or behavioral problem. And it doesn't happen because a child is too lazy to get out of bed. Don't make your child feel guilty or ashamed. Don't punish them for wetting the bed. Listen to your child. Unfortunately, even young children can be bullied. Take constructive action if that occurs.

Encourage your child to use the bathroom during the night. Place nightlights in hallways and rooms to make this easier. It may be helpful to use a waterproof mattress pad.

Sleepwalking

Sleepwalking, also known as somnambulism, is a disorder in which a person partially wakes up during the night and walks around without realizing it. The sleepwalker might make repetitive movements, such as fumbling with clothing, getting out of bed and strolling around, or even talking to you. Sleepwalking is usually not something to worry about. Most children will outgrow sleepwalking by their teens. 

If your child is sleepwalking, try to guide them gently back to bed. Don't shake them or yell at them to try to wake them up. It's also important to think about their safety. As with sleep terrors, remove dangerous objects from the home and place gates on stairs to prevent falls. Keep doors and windows locked. 

Most children won't need treatment for sleepwalking. If your child sleepwalks for a long time or is having problems during the day due to lack of sleep, talk with their provider. You might want to keep a sleep diary for a few weeks and record when your child sleepwalks. One method sometimes used to treat sleepwalking is waking your child up 15 minutes before they normally sleepwalk. But talk with their provider before doing this.