Sleepwalking and other parasomnias in children
- Suresh Kotagal, MD
Suresh Kotagal, MD
- Professor of Neurology, Mayo Clinic
- Consultant in Neurology, Pediatrics, and Sleep Medicine
Parasomnias are episodic behaviors that intrude onto sleep. Sleep quality generally remains unaffected, but the events lead to significant worry for the parents or the patient. The events are most common in preschool-aged children, and they gradually decrease in frequency over the first decade of life . The events may mimic sleep-related epileptic seizures; thus, it is important to understand their clinical and sleep laboratory diagnostic features. Sometimes parasomnias are isolated symptoms in an otherwise healthy child, while on other occasions they coexist with neurologic, psychiatric, or medical disorders. This article provides an overview of common parasomnias of childhood.
Parasomnias involve relatively complex behaviors. Simpler and stereotyped movements are categorized as sleep-related movement disorders. These include restless legs syndrome, periodic limb movements of sleep, sleep-related bruxism, and sleep-related rhythmic movement disorder, and are discussed in separate topic reviews. (See "Sleep-related movement disorders in childhood" and "Restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in children".)
Most studies of parasomnias in childhood have provided cross-sectional data. There are few longitudinal studies.
Young children (aged 2.5 to 6 years) were evaluated in a large study in Quebec, Canada . Parasomnias were ubiquitous: 88 percent of the cohort manifested at least one parasomnia during the study period. Parasomnias or other sleep-related movements were noted at the following frequencies:
●Sleep terrors – 40 percentTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Furet O, Goodwin JL, Quan SF. Incidence and Remission of Parasomnias among Adolescent Children in the Tucson Children's Assessment of Sleep Apnea (TuCASA) Study. Southwest J Pulm Crit Care 2011; 2:93.
- Petit D, Touchette E, Tremblay RE, et al. Dyssomnias and parasomnias in early childhood. Pediatrics 2007; 119:e1016.
- American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
- Sheldon SH. Parasomnias in childhood. Pediatr Clin North Am 2004; 51:69.
- Petit D, Pennestri MH, Paquet J, et al. Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation. JAMA Pediatr 2015; 169:653.
- Bakwin H. Sleep-walking in twins. Lancet 1970; 2:446.
- Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Med Rev 2003; 7:413.
- Abe K, Amatomi M, Oda N. Sleepwalking and recurrent sleeptalking in children of childhood sleepwalkers. Am J Psychiatry 1984; 141:800.
- Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics 2003; 111:e17.
- Parrino L, Halasz P, Tassinari CA, Terzano MG. CAP, epilepsy and motor events during sleep: the unifying role of arousal. Sleep Med Rev 2006; 10:267.
- Kotagal S. Parasomnias of childhood. Curr Opin Pediatr 2008; 20:659.
- Rosen GM, Mahowald MW. Disorders of arousal in children. In: Principles and Practice of Pediatric Sleep Medicine, Sheldon SH, Ferber R, Kryger MH (Eds), Elsevier Saunders, Philadelphia 2005. p.293.
- Kotagal S. Sleep-Wake Disorders of Childhood. Continuum (Minneap Minn) 2017; 23:1132.
- Ekambaram V, Maski K. Non-Rapid Eye Movement Arousal Parasomnias in Children. Pediatr Ann 2017; 46:e327.
- Tinuper P, Provini F, Bisulli F, et al. Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev 2007; 11:255.
- Nobili L. Nocturnal frontal lobe epilepsy and non-rapid eye movement sleep parasomnias: differences and similarities. Sleep Med Rev 2007; 11:251.
- Aridon P, Marini C, Di Resta C, et al. Increased sensitivity of the neuronal nicotinic receptor alpha 2 subunit causes familial epilepsy with nocturnal wandering and ictal fear. Am J Hum Genet 2006; 79:342.
- Steinlein OK, Mulley JC, Propping P, et al. A missense mutation in the neuronal nicotinic acetylcholine receptor alpha 4 subunit is associated with autosomal dominant nocturnal frontal lobe epilepsy. Nat Genet 1995; 11:201.
- Díaz-Otero F, Quesada M, Morales-Corraliza J, et al. Autosomal dominant nocturnal frontal lobe epilepsy with a mutation in the CHRNB2 gene. Epilepsia 2008; 49:516.
- Vendrame M, Kothare SV. Epileptic and nonepileptic paroxysmal events out of sleep in children. J Clin Neurophysiol 2011; 28:111.
- Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28:499.
- Kotagal S, Nichols CD, Grigg-Damberger MM, et al. Non-respiratory indications for polysomnography and related procedures in children: an evidence-based review. Sleep 2012; 35:1451.
- Aurora RN, Lamm CI, Zak RS, et al. Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. Sleep 2012; 35:1467.
- Kotagal S, Silber MH. Childhood-onset restless legs syndrome. Ann Neurol 2004; 56:803.
- Simakajornboon N, Gozal D, Vlasic V, et al. Periodic limb movements in sleep and iron status in children. Sleep 2003; 26:735.
- Hopkins J, Isaacs C, Pitterle P. A developmental approach to sleep problems in toddlers. In: Clinical Handbook of Sleep Disorders in Children, Schafer CE (Ed), Aronson Inc, Northvale 1995. p.103.
- Tobin JD Jr. Treatment of somnambulism with anticipatory awakening. J Pediatr 1993; 122:426.
- Frank NC, Spirito A, Stark L, Owens-Stively J. The use of scheduled awakenings to eliminate childhood sleepwalking. J Pediatr Psychol 1997; 22:345.
- Nielsen TA, Laberge L, Paquet J, et al. Development of disturbing dreams during adolescence and their relation to anxiety symptoms. Sleep 2000; 23:727.
- Halliday G. Treating nightmares in children. In: Clinical Handbook of Sleep Disorders in Children, Schafer CE (Ed), Aronson Inc, Northvale 1995. p.149.
- Hauri PJ, Silber MH, Boeve BF. The treatment of parasomnias with hypnosis: a 5-year follow-up study. J Clin Sleep Med 2007; 3:369.
- Sadeh A. Cognitive-behavioral treatment for childhood sleep disorders. Clin Psychol Rev 2005; 25:612.
- Krakow B, Sandoval D, Schrader R, et al. Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. J Adolesc Health 2001; 29:94.
- Mahowald MW, Schenck CH. Insights from studying human sleep disorders. Nature 2005; 437:1279.
- Nevsimalova S, Prihodova I, Kemlink D, et al. REM behavior disorder (RBD) can be one of the first symptoms of childhood narcolepsy. Sleep Med 2007; 8:784.
- Lloyd R, Tippmann-Peikert M, Slocumb N, Kotagal S. Characteristics of REM sleep behavior disorder in childhood. J Clin Sleep Med 2012; 8:127.
- Schenck CH, Mahowald MW. Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol 1992; 32:3.
- Boeve BF, Silber MH, Ferman TJ. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003; 4:281.
- Gagnon JF, Postuma RB, Montplaisir J. Update on the pharmacology of REM sleep behavior disorder. Neurology 2006; 67:742.
- Schenck CH, Boyd JL, Mahowald MW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997; 20:972.
- Otto MW, Simon NM, Powers M, et al. Rates of isolated sleep paralysis in outpatients with anxiety disorders. J Anxiety Disord 2006; 20:687.
- Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006; 176:314.
- Bascom A, Penney T, Metcalfe M, et al. High risk of sleep disordered breathing in the enuresis population. J Urol 2011; 186:1710.
- Su MS, Li AM, So HK, et al. Nocturnal enuresis in children: prevalence, correlates, and relationship with obstructive sleep apnea. J Pediatr 2011; 159:238.
- Brooks LJ, Topol HI. Enuresis in children with sleep apnea. J Pediatr 2003; 142:515.
- Weissbach A, Leiberman A, Tarasiuk A, et al. Adenotonsilectomy improves enuresis in children with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 2006; 70:1351.
- Waleed FE, Samia AF, Samar MF. Impact of sleep-disordered breathing and its treatment on children with primary nocturnal enuresis. Swiss Med Wkly 2011; 141:w13216.
- DISORDERS OF AROUSAL FROM NON-RAPID EYE MOVEMENT (NREM) SLEEP
- Clinical features
- - Confusional arousals
- - Sleep terrors
- - Sleepwalking
- Differential diagnosis
- - Investigations
- - General strategies
- - Medical/surgical strategies
- - Behavioral measures
- PARASOMNIAS USUALLY ASSOCIATED WITH RAPID EYE MOVEMENT (REM) SLEEP
- Nightmare disorders
- - Management
- REM sleep behavior disorder (RBD)
- - Parasomnia overlap disorder
- Sleep paralysis
- OTHER PARASOMNIAS
- Sleep enuresis
- SLEEP-RELATED MOVEMENT DISORDERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS