Sleep Disorders

Parasomnia

Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or arousal from sleep. Typically people suffering from a parasomnia disorder experience unpleasant or undesirable behavior or experiential phenomena that occur predominantly or exclusively during the sleep period.

The following is a brief description of the more common parasomnias.

Sleepwalking is also called “somnambulism.” Sleepwalking occurs when a person gets up from bed and walks around even though he or she is still asleep. These events can be either calm or agitated, with varying degrees of complexity and duration. A new onset of sleepwalking in an adult typically signals sleep apnea or another sleep disorder. Somnambulism can also involve a series of other complex actions. Individuals may sit up and look around in a confused manner or bolt from the bed and walk or run away. At other times a sleepwalker might talk or shout as they walk or perform routine daily actions that are not normally done during the day. Symptoms of sleepwalking are as follows:

  • Sitting up in bed and repeating movements.
  • Looking dazed (sleepwalkers’ eyes are open but they do not see the same way they do when they are fully awake)
  • Difficult to wake up
  • Urinating in undesirable places, moving objects around or climbing out of a window
  • Indecent exposure and other sexual behaviors
  • Hostile or violent behavior
  • Likely to have no clear memory of the event therefore creating lots of confusion
  • Episodes can occur rarely, or very often, happening multiple times a night for a few nights in a row
  • Injury to self, the bed partner, or others in the same home

Children suffer from sleep walking too, with arousals peaking at eleven to twelve years of age. However, ninety percent will outgrow it. Typically, no specific treatment for sleepwalking is needed.

Strategies for Parents with Children who Sleepwalk:

  • Prevent injury by removing dangerous objects from areas that your child has access to such as open doors and windows, sharps objects etc.
  • When you find your child sleepwalking, you should gently guide your child back to bed.
  • You shouldn’t yell or shake your child to wake them up during their sleepwalking.
  • You should never make your child feel ashamed about sleepwalking.
  • Keep a “sleep diary” for your child to monitor and record the times when he or she sleepwalks.
  • If your child sleepwalks for a long period of time you should see a sleep physician. Some medicines can be used to treat sleepwalking.

Sleep Terrors are the most dramatic disorder of arousal. An adult or child will sit up in bed and pierce the night with a “blood-curdling” scream or shout. This scream or shout may be incoherent to others. Kicking and thrashing usually accompany this scream, as well as a look of intense fear with eyes wide open and heart racing. Sweating, breathing heavily and very tense muscles are also common body responses to sleep terrors. Although the person appears to be awake, he or she usually misperceives the environment and attempts at consolation are fruitless and may serve only to prolong or even intensify the state of confusion. Complete amnesia for the activity is typical, however partial recall is possible. The universal feature of sleep terrors is inconsolability, so parents and bed partners should use caution and be patient in comforting the person once the episode is over.

Strategies for Parents with Children who have Sleep Terrors:

  • Consult with your child’s physician. Night terrors occasionally result from underlying psychological or physical issues, such as fatigue, psychological stress, fever or certain medications. Ruling out these underlying causes is the first step.
  • Obtain treatment from a counselor or psychologist if your child’s night terrors result from underlying psychological stress.
  • Establish a regular bedtime routine to ensure that your child gets proper sleep. Night terrors often result from insufficient amounts of sleep.
  • Wait out night terrors whenever possible. Most physicians advise that night terrors will not cause harm, and they do not recommend specific treatment.
  • Gently restrain your child if he is thrashing too much and becomes a danger to himself or others. Talk to your child in a soft and relaxed voice.
  • Guide your child back to bed once he is calm and accepts your assistance. If he resists, continue gently talking until he accompanies you.
  • Don’t shake your child awake or shout at him during a night terror. This could make things worse.
  • Keep a sleep diary on your child to look for patterns in the timing of your child’s night terrors. If you notice that the terrors occur regularly, say one hour after going to sleep, wake your child just before the hour arrives. This may interrupt the sleep cycle and offset the night terror.
  • If the problem persists for a lengthy period of time you should consult a sleep physician.

Sleep Enuresis, the more common name for sleep enuresis is bedwetting. Bedwetting occurs when a person urinates in his or her sleep. It results from a failure to wake up from sleep when the bladder is full or from a failure to prevent a bladder contraction. Most children should be able to control their bladders during sleep by the time they are about five years of age. Therefore, bedwetting is not considered a sleep disorder unless it occurs at least twice a week in a person at least five years old.

Bedwetting can be primary or secondary. A child with primary bedwetting has never regularly stayed dry during sleep for six straight months. A child or adult with secondary bedwetting had earlier stayed dry for at least six straight months. Then he or she began bedwetting at least twice a week for a period of at least three months. The main risk involved with primary bedwetting is the damage that can be done to the child’s or to the adult’s self-esteem. How well the person’s family deals with the incident is very important. Their reaction will determine to a great extent how severe the problem becomes.

Strategies for Parents with Children who have Sleep Enuresis:

  • Reduce evening fluid intake 2 to 3 hours before bedtime.
  • Have your child go to bathroom before getting into bed.
  • Set a goal for your child of getting up at night to use the toilet.
  • Make sure the child has easy access to the toilet.
  • Reward your child for remaining dry.
  • Consider using diapers or pull-ups at night.
  • Keep a record of dry and wet nights.
  • Do not blame or punish the child for wetting the bed. Be supportive and encourage your child.
  • Avoid giving food or soft drinks which contain caffeine as they cause more urine production.

Sleep Related Eating Disorder (SRED) consists of frequent episodes of nocturnal, compulsive binge eating and drinking, generally with out full conscious awareness. Episodes tend to occur in an “out of control” manner, when the person is only partially awake. Some people are very alert as they eat while others have only a partial memory or no memory of the event afterward. This recurrent and involuntary consumption commonly has adverse consequences. Trying to stop a person during an episode tends to provoke anger and resistance.
A majority of people with SRED have an episode of eating nearly every night. Some eat more than once each night. These episodes take place even though feelings of hunger and thirst are absent. The episodes can happen at any time in the night. Foods that are high in calories tend to be eaten the most. It is common to eat thick and sugary foods such as peanut butter or syrup. While these foods are typically not preferred during the day, they are consumed very rapidly during the episode. An entire event may last for only ten minutes, consisting of the time it takes to get from the bed to the kitchen and back to bed again.

Problems resulting from SRED include the following:

  • Eating strange forms or combinations of food, such as raw bacon, buttered cigarettes or coffee grounds
  • Eating or drinking toxic substances, such as cleaning solutions
  • Eating foods to which you are allergic
  • Suffering from insomnia due to sleep disruption
  • Sleep-related injury
  • Loss of appetite in the morning
  • Stomach pain
  • High cholesterol
  • Excessive weight gain and obesity

SRED may develop slowly over time. It may also begin quickly with nightly episodes of eating from the start. It is long lasting and does not seem to ease up. It may be a factor in causing depression. This can result from a sense of shame and failure to control the eating. Some people with SRED may avoid eating during the day. They may also get too much exercise in an attempt to prevent obesity.

 
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