Parasomnias during NREM sleep include confusional arousal, night terrors and sleepwalking. They appear within two to three hours of a child falling asleep.

Confusional arousals are most common and often go unnoticed. Your child may sit up in bed, call out, cry, and be very difficult to comfort. The episode may last for up to 30 minutes, but in the morning she has no memory of the event.

A night terror is a similar but more dramatic disturbance. The child will be more agitated, may try to run or escape and may scream. She may sweat and have a fast pulse. Settling her may not be easy, and in the morning she will not remember what happened. Children with confusional arousals and night terrors are usually as rested and refreshed as if their sleep had not been interrupted.

Sleepwalking generally occurs in children older than age five. Some children walk quietly around the house. Others become agitated and run about, and so are at risk of injury. These NREM behaviors are normal and are only dangerous if the child is hurt during an episode.
In general, none of these behaviors needs to be treated. Fever and being overtired (sleep deprivation) are common triggers. Ensuring adequate naps and sleep can help reduce these incidents. If you have a sleepwalker in your family, ensure doors are locked and the house is safe.

Sleep events may be frequent enough that you can anticipate them. In this case, briefly waking your child just before an expected disturbance can prevent an arousal or night terror. Do not wake your child during an event, as this may make it worse.

Rapid eye movement (REM) sleep concerns

REM parasomnias include nightmares and sleep paralysis. These usually occur early in the morning and during waking.

Nightmares are upsetting dreams that wake a person from sleep and are often vividly remembered. Unlike night terrors, the child will be fully awake after the nightmare, often too afraid to go back to sleep. Nightmares are common in all children, but can also be caused by medications like anti-depressants, blood pressure medication and antihistamines.
Sleep paralysis can occur while falling asleep and also while wakening. The child may experience a brief period when he cannot move his body or limbs, or cannot speak. These episodes are usually stopped by sound or by touch. Although it is not dangerous, sleep paralysis can be very frightening for children and parents. It is most commonly caused by sleep deprivation. In older teens and young adults, it can be associated with anxiety as well as narcolepsy. (Narcolepsy is a sleep disorder that causes excessive sleepiness and sleep attacks at the wrong time, such as at school or work.)

Talking about the nightmares or sleep paralysis with your child may help him feel less scared.

Other sleep disturbance concerns

Some parasomnias in children are not related to the two types of sleep.

Hypnic jerks occur during sleep or just as a person is falling asleep or waking from sleep. A child may feel like he is falling when he has these involuntary muscle contractions. Like many other parasomnias discussed here, these jerks are often related to sleep deprivation. They are harmless, unless someone sharing the bed is kicked or injured.

Bruxism occurs in two to three children in ten. It is an involuntary and forceful clenching or grinding of teeth. Young children who are teething may grind to reduce teething pain, just as one might rub a sore muscle. Stress can also cause nighttime teeth grinding, as can certain medical conditions like cerebral palsy and Down syndrome. Most children outgrow it. For some, it can be a cause of headaches and pain in the jaw joint (temporo-mandibular joint or TMJ). In severe cases, there can be damage to tooth enamel, increased tooth sensitivity, and severe jaw or facial pain. Some children may benefit from wearing a nighttime mouth guard.

Medical conditions that interfere with sleep

While many children have these common sleep experiences, some more serious medical conditions also have nighttime symptoms.

After seeing a hypnic jerk, night terror or confusional arousal, many parents worry that a child is having a seizure. Seizures are like electrical storms in the brain and require proper diagnosis and treatment. Discuss this possibility with your doctor if your child is older than eight or nine years when the behavior starts. Tell your doctor if your child has more than one event per night or has other unusual movements or behaviors during the day.

Obstructive sleep apnea (OSA) is another medical condition that can cause unusual sleep behavior in children. Parents of children with OSA notice their child may snore regularly, pause in breathing, and have difficulty breathing during sleep. Caregivers may also notice that the child snorts, gasps or chokes during sleep. Bedwetting may also become a problem. The child may toss and turn through the night, sweat during sleep and breathe through the nose. OSA can significantly affect daytime behavior and attention, so it is important to diagnose it correctly. A sleep study, known as polysomnography, can help confirm this problem. A consultation with an ear, nose and throat surgeon may follow, if needed.

Children with restless legs syndrome (RLS) feel an uncomfortable sensation in their legs at rest and need to move their legs. The uncomfortable feeling goes away after the child moves. Children sometimes describe this sensation as pain in their legs. These pains are often called ‘growing pains’ by parents, but in fact are RLS. The condition can affect how well children sleep by keeping them awake at night. Some children with RLS lack iron, so discuss this symptom with your child’s doctor.

Parasomnias are really common in preschool-aged children and appear less over time, usually disappearing completely by age ten. The best way to prevent a parasomnia is to make sure your child gets enough sleep. Waking your child up just before an expected arousal can also prevent an event. For most children who occasionally have an upsetting sleep experience, a visit to your family doctor is usually enough to reassure you that nothing dangerous is happening. If seizures, OSA or RLS are suspected, or if nighttime behavior disturbs other members of the family, more investigation may be needed. A sleep study may help determine what is happening during sleep. Some simple blood work may also be required.

A good night’s sleep helps all family members have a full and productive day at home, school and work. While some sleep behavior may be scary to see, knowing that it is usually harmless will help children and caregivers rest easier.

Sleep Struggles Does your child have disrupted sleep?

The best way to prevent a parasomnia is to make sure your child gets enough sleep.

Once a healthy bedtime routine is established for your child, it can feel like the sleep ‘work’ is done. Then you hear a scream in the night or awaken with your child standing at the end of your bed, confused.

As children grow, their sleep patterns change. Most people can recall the feeling of nightmares, which are more common for children than adults. In addition to nightmares other normal sleep behaviours, called parasomnias, may not be as familiar to parents and even seem frightening. They include:

Non-rapid eye movement (NREM) sleep concerns

Rapid eye movement (REM) sleep concerns

Other sleep disturbance concerns

Medical conditions that interfere with sleep

Sleep Struggles
Does your child have disrupted sleep?