It is often hilarious to hear children talking in their sleep. However, it could be an alarming event if you are awakened to their shrill cry in a full-blown sleep terror. These behaviors are called parasomnias, a term used to describe unusual behaviors occurring during sleep.

These events disturb parents’ sleep more than the kids, as most children do not recall the episodes. Parasomnias are experienced before falling asleep, during sleep, and at periods of arousal from sleep. These events are seen frequently in children and can be seen in up to 17% of young children aged 3 to 13 years. Older children experience parasomnias less often, although some may persist into adulthood.

What are the types of parasomnias?

There are several types of parasomnias, classified based on the stage of sleep a child is in. We cycle through different stages of sleep, broadly non-rapid eye movement sleep (non-REM) and rapid eye movement sleep (REM). Non-rapid eye movement sleep is the first stage of our sleep cycle and contains light sleep (stages one and two) and deep sleep (stage 3). These sleep cycles last about 90 minutes and tend to get deeper as sleep progresses. The most common parasomnias in children occur during this stage of sleep and are broadly called disorders of arousal. These disorders include confusional arousals, sleep terrors, and sleepwalking. In addition, children tend to have more parasomnias because they have more slow-wave sleep than adults.

REM sleep, also known as dream sleep, usually occurs after non-REM sleep. The first period of REM sleep lasts a few minutes, and each of the later stages gets longer. During REM sleep, some parasomnias are nightmare disorders, sleep paralysis, and a rare condition in children called REM behavior disorder. Different from non-REM parasomnias, children tend to remember their nightmares.

This blog is mainly focused on types, features, and triggers of non-REM parasomnias as they are more common.

Non-REM parasomnias

These children are in a wake-like, sleep-like state. There is an inappropriate or lack of response when parents try to intervene. They typically don’t remember the episode or sometimes have a partial recall. The duration of these parasomnias is usually brief, typically less than one minute. Still, some can last as long as 40 to 60 minutes. Attempts to wake a child or console them may prolong the episode or worsen their agitation. Most of the episodes end abruptly, with the child returning to deep sleep. Children have amnesia of the event, meaning they have no recollection of what happened in the morning.

Confusional arousals

The child may show mental confusion or chaotic behavior in bed. They may sit up, look around, appear disoriented, mumble a few words and go back to sleep. They typically don’t seem scared, as seen in sleep terrors.

Sleepwalking

This is also known as “somnambulism.” Children show abnormal behaviors out of bed while still asleep, can engage in complex behaviors like opening doors and going down the stairs, and may wander around the house including the kitchen. They may even end up by your bed, standing quietly and staring blankly. In some instances, children have walked out of the house as a safety risk.

Sleep terrors

Sleep terrors are also referred to as night terrors and are typically seen as increased nervous system activation during sleep. Usually, children can suddenly wake up looking agitated, tense, have an increased breathing rate, excessive sweating, and tremors. They have expressions of terrors or intense fear. You may hear a shrill cry, screaming, or agitation. At times they may sit upright in bed with their eyes open. Attempts to wake a child out of the sleep terror or console them can increase their agitation or prolong the episode.

What are some triggers of parasomnias?

Some factors increase the likelihood of these parasomnias, such as:

• Sleep deprivation: If sleep is disrupted, or if there has been inadequate sleep, the body tries to make up with a stronger drive for slow-wave sleep (remember, more parasomnias occur in slow-wave sleep). Children may have more parasomnias if their sleep has been restricted. It is essential to ensure your child gets the right amount of sleep. Sometimes just increasing the amount of sleep decreases the frequency of sleep parasomnias.

• Acute stress: stressful family dynamics, a recent move, or sudden disruption can trigger episodes.

• Fever: Acute illnesses with fever can make parasomnias more likely to occur.

• Medications: Some medications can trigger parasomnias, including stimulants, allergy medications like antihistamines, sedative medications. If your child has frequent sleep terrors, you should provide your doctor with a list of medicines they are taking. This should include prescription drugs and over-the-counter medications as well.

• Sleep disorders: Sleep disorders are a common trigger for parasomnias. Examples include obstructive sleep apnea and restless legs syndrome. Children who have frequent parasomnias may need a sleep study to rule out these disorders.

• Medical conditions: Some medical conditions can trigger parasomnias. This occurs because they can cause sleep fragmentations and lead to sudden arousals from sleep. Examples of these conditions are asthma, reflux, and pain.

• Family history: Studies show a genetic risk factor for terrors. Children can be 10 times more likely to have parasomnias if their parents have a similar history. This risk is even higher if both parents have a history.

If your child has any history of post-traumatic stress disorder, depression, or other mood disorder, or if they have any developmental conditions, they should be evaluated by your medical team.

There are rare conditions where children have seizures in their sleep. They can occur anytime during the night and may mimic parasomnias. Differentiating them from parasomnias may be challenging. If you have concerns your child has seizures, they should be evaluated by a neurology specialist.

This list of parasomnias is not an exhaustive one. I highlighted the most common parasomnias in children. If you believe your child has a parasomnia, consult with their physician to evaluate and discuss treatment options.

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