Sleep Disorders in Kids are Common

Differentiating the usual from the unusual.

All parents are familiar with the stress of trying to get kids to sleep—as well as the worry that comes when that sleep isn’t sound. Children often experience more sleep disturbances than adults, but parents may still be surprised to see their child walking around the house at night, or frightened when a child screams during a sleep terror. We spoke with pediatric neurologist and sleep specialist Shelly Weiss, MD, FRCPC, to better understand the common sleep disorders known as disorders of arousal.

WHAT ARE DISORDERS OF AROUSAL?
Also known as non-rapid eye movement (NREM) parasomnias, these are abnormal episodes that occur during a stage of sleep known as N3, and are more common in children. The episodes include confusional arousals, sleep terrors and sleep walking. They can occur during any period of sleep, including naps. According to Dr. Weiss, they have three factors in common—they occur during non-rem sleep, children are not aware of their behavior during them, and children do not remember them in the morning.

CONFUSIONAL AROUSALS
Confusional arousals are just what they sound like—your child may appear to be awake, but have unusual behavior, such as speaking slowly, or saying nonsense. These events are very common, and are most frequent between the ages of two and five. Dr. Weiss says that parents should not be concerned about these types of awakenings.

SLEEP TERRORS
Pediatric sleep terrors (also known as night terrors) can be extremely distressing for parents. Dr. Weiss says that a parent will observe what seems like an abrupt awakening, though the child will not actually be awake or responsive. He or she may seem terrified, may scream out loud and may be sweaty and have a fast heart rate. Parents will be unable to soothe the child, and trying to calm the child might actually make him or her become more agitated. Episodes typically last between 5 and 30 minutes. Although frightening for parents, children do not remember these terrors in the morning. According to Dr. Weiss, about 30% of young children experience sleep terrors, and almost all outgrow them by their teenage years.

SLEEPWALKING
Sleepwalking is also quite common, occurring in about 15% of children aged 5-12. Dr. Weiss says that sleepwalking is the most likely disorder to persist into adulthood, with about 1% of adults continuing to sleepwalk. Sleepwalking can appear to be purposeful to parents, but just like the other parasomnias, the child will not respond normally and will not remember the incident in the morning. Children may injure themselves by leaving their bed and can even fall off of landings or out of windows. Sleepwalking can be associated with bedwetting or rising to use the wrong area as a toilet. Though they may be distressing to parents and to children, they are not signs of serious illness, and most children eventually outgrow them.

SAFETY FIRST
Non-rem parasomnias are not dangerous in and of themselves and rarely signify any underlying illness, but Dr. Weiss emphasizes that it’s important for parents to take steps to keep kids safe. Doors and windows should be secured (though a child should never be locked in a bedroom due to risks such as a house fire), and parents should remove dangerous objects from reach if needed.
Parents can purchase systems which alert them if a child has left the bed so they can observe and intervene if necessary. Usually, caregivers should not try to wake up the sleeping child.

WHEN TO SPEAK TO A PEDIATRICIAN
Dr. Weiss explains, “If your child experiences a dramatic change in their sleep, begins having these disorders at an unusual age or more frequently, or simply isn’t doing well during the day by feeling too sleepy or having emotional problems, then it’s a good idea to speak to your child’s care provider.”

Pediatric non-rem parasomnias can almost always be diagnosed, and primary care providers are well-versed in their management. Only very rarely would a child need to be seen by a specialist since children do not need to be evaluated via sleep study for non-rem parasomnias. Reassurance and simple behavioral steps are generally the most effective treatments.

Because disorders of arousal are affected by stress levels and sleep deprivation, Dr. Weiss recommends setting a consistent bedtime routine and sleeping environment. Ask your child about emotional stressors, and provide reassurance as needed. Be aware that these disorders tend to be worse while traveling (especially across time zones), and be prepared for more episodes when sleeping away from home. Parents can help by preparing friends and family for the possibility of sleep issues. With time, your child’s sleep should become more regular, and everyone will be getting a better night’s rest.
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Rosei Skipper, MD completed her Psychiatry residency and Child fellowship at the Mayo Clinic in Rochester, MN. She is currently pursuing further training in psychoanalytic therapy.


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