Duke Medicine: Sleep terrors and sleep walking

What should you do when your child screams out at night? Richard M. Kravitz, MD, a Duke pediatrician certified in sleep medicine, tells us what we need to know and why not to worry:

Posted 1:38 a.m. Sep 14, 2010 — Updated 1:53 a.m. Sep 14, 2010

Duke Medicine

What should you do when your child screams out at night? Richard M. Kravitz, MD, a Duke pediatrician certified in sleep medicine, tells us what we need to know and why not to worry:

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. While disturbing to parents, these events are benign and usually resolve by adolescence.

Normal sleep is divided into two phases: rapid eye movement (REM) sleep and non-rapid eye movement sleep (NREM).

Most people have heard of REM sleep. However, less-known NREM sleep makes up about 75 percent of sleep time.

NREM sleep predominates in the first third of the night and sudden shifts out of its deepest portions 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.

Parasomnias 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.

In all cases, the child does not remember the event the next morning. Anything that fragments sleep, such as inadequate sleep, illness, fever, or stress can increase the number of these events.

In general, sleep walking and sleep terrors are not associated with any underlying psychological problems.

Types 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.

Despite 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.

Sleep 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.

An increased heart rate, rapid respirations, sweating, and dilated pupils are frequently described. Despite appearances, the child is still asleep. Children will frequently push away family members who are trying to comfort them; they might even become more agitated by this interaction. They usually occur between four and 12 years old with a peak incidence around age eight.

Sleep walking 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.

As 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).

Most incidents happen between four and eight years old.

What can parents do to minimize these sleep disorders? Read more about the different types of sleep disorders and diagnosis and management in the full article on the Your Child's Health section of dukehealth.org.

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