Terrors and Sleep Walking
By Richard M. Kravitz, MD and Dennis Clements, MD, PhD, MPH
Sleep walking and sleep terrors are two of the more commonly reported
sleep disturbances in children. They, along with confusional arousals,
belong to a class of sleep disorders called parasomnias.
disturbing to parents, these events are benign and self-limited,
usually resolving by adolescence.
Normal sleep is divided into two phases: rapid eye movement (REM)
sleep and non-rapid eye movement sleep (NREM).
people have heard of REM sleep. However, less-known NREM sleep makes
up the majority of sleep time (about 75 percent).
sleep predominates in the first third of the night and sudden shifts
out of its deepest portions (slow wave sleep) are when sleep walking
and sleep terrors can take place -- usually within a couple of hours
of the child falling asleep. REM sleep is recorded more in the early
morning hours, which is when dreams and nightmares arise.
are noted for having a strong family history. Ninety percent of
children with sleep terrors and 80 percent of children who sleep
walk have a family member who has exhibited similar behavior.
all cases, these parasomnias are notable for the patient not remembering
the event the next morning. Anything that fragments sleep, such
as inadequate sleep, illness, fever, or stress can increase the
number of these events.
general, sleep walking and sleep terrors are not associated with
any underlying psychological problems.
of Sleep Disorders
Confusional arousals are associated with what appear to be
sudden awakenings -- the child acts confused and disoriented. The
child will frequently sit up, look around the room, and possibly
moan or have inappropriate speech or behavior.
appearing awake, they are still asleep. Attempts to communicate
with the child will be unsuccessful (unless the child should fully
awaken). The events tend to last for several minutes. Afterward,
the child will lie back down and resume normal sleep. These events
are very common in children under five years old.
terrors can be very frightening events for the parents. They have
many aspects in common with confusional arousals, but they are associated
with the child screaming and looking terrified.
increased heart rate, rapid respirations, sweating, and dilated
pupils are frequently described. Despite appearances, the child
is still asleep.
will frequently push away family members who are trying to comfort
them; they might even become more agitated by this interaction.
with confusional arousals, the episodes will end as spontaneously
as they began. If the child should awaken from one of these events,
he or she will have no recollection of the episode and will not
be able to identify any precipitating dream.
is in contrast to nightmares (which originate from REM sleep and
occur later in the evening), for which the child can usually describe
their dreams in detail.
terrors can last for up to several minutes and may be associated
with sleep walking. The overall incidence is 3 percent in children.
They usually occur between four and 12 years old with a peak incidence
around age eight.
walking (somnambulism) is walking while asleep. Sleep walking
is frequently staggered and clumsy, with the child having a blank
expression on his or her face. The episode can be more than just
walking; patients have been noted to do complicated or bizarre maneuvers
such as opening doors and going outside, climbing out windows, or
turning on the gas in the kitchen.
with sleep terrors, trying to awaken the child can frequently be
associated with combative behavior. Episodes can last as long as
30 minutes but are usually shorter. Sleep walking is very common,
with an overall incidence of between 1 to 15 percent (15 to 40 percent
of children will do it at least once in their lifetime, and 3 to
4 percent of children will have frequent episodes).
incidence occurs between four and eight years old. There is also
an increased incidence of sleep talking reported in patients who
sleep walk (a 30 percent incidence in sleep walkers versus 5 percent
in the general population). Many children with sleep walking report
having had confusional arousals when younger.
No laboratory testing is warranted for any of these conditions;
the diagnosis is made by history alone. Sleep studies are usually
not useful unless other symptoms such as snoring or apneas are present.
Occasionally, an electroencephalogram (EEG) is indicated to assess
for seizures in unusual cases.
of these parasomnias is mostly supportive. That being said, there
are several things that parents can do to minimize the number and
severity of these events.
the events, it is best for the parents to let them run their course.
Trying to reassure or awaken the child can often lead to the event
becoming more severe.
sleep walkers, it is best to try and gently lead the child back
to their bed, where they will frequently continue their sleep. It
is imperative to have the child in a safe environment so that they
cannot hurt themselves. This would include keeping the floor clear
of obstacles, having a gate at any stairwell, and locking the doors
to the house and windows so that the children do not venture outside.
sleep deprivation can worsen the situation, make sure the child
has an adequate amount of sleep. Getting a good nights sleep
on a regular basis is imperative. Fevers can also worsen the situation,
so fever control is warranted during illnesses.
are not indicated for these conditions unless the conditions prove
problematic. Benzodiazepams such as diazepam (Valium) can decrease
the incidence and severity of sleep terrors and sleep walking and
may be especially useful if the episodes occur in clusters. Tricyclic
antidepressants may be tried when benzodiazepams are unsuccessful.
of these medications is usually not required and should only be
considered after discussion with a provider knowledgeable about
sleep disorders in children.
M. Kravitz, MD, is a Duke pediatrician certified in sleep medicine.
Dennis Clements, MD, PhD, MPH, is the chief medical officer of Duke
Children's Hospital. For more information, visit www.DukeHealth.org
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.