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Sleep disorders:When things go bump and grind in the night

The sight of a sleepwalking child can be a frightening experience for any parent. Your first instinct may be to contact your pediatrician or child psychologist. But you may want to wait before you make that call. Sleep disorders are very common in young children and do not usually indicate significant psychiatric or psychological problems, though they can lead to sleep deprivation by disrupting sleep patterns. Sleep parasomnias are abnormal behaviors during sleep, such as sleepwalking, sleep talking, teeth grinding, and night terrors. According to Dr. Gary Zammit, director of The Sleep Disorders Institute at St. Luke’s-Roosevelt Hospital, 10 to 20 percent of children suffer from sleep parasomnias. Usually, children with parasomnias have only occasional episodes. Such disorders tend to run in families and might be made worse when a child is overly tired, has a fever, or is taking certain medications. However, when episodes occur frequently or interfere with the child’s daytime behavior, treatment by a professional may be necessary.

Somnambulism (Sleepwalking) According to the American Sleep Disorders Association, sleepwalking usually begins between ages 6-12 with the highest prevalence of incidence — at 16.7 percent — occurring at ages 11-12. Sleepwalking runs in families and affects boys more than girls. A typical episode lasts six minutes, but may last as long as a half-hour. During sleepwalking, a child is partly, but not completely awake. The only clue the child is actually asleep may be strange or unusual behavior. The child may wander around the house, mutter incomprehensible words, fall asleep in the closet or even urinate in inappropriate places. If you discover your child sleepwalking, she should be gently guided back to bed without waking her. Most children will outgrow sleepwalking, but until they do you should take safety measures to prevent harm. “The biggest concern with sleepwalking is what the child gets into,” says Dr. Thomas M. Kilkenny, director of Sleep Disorders Research at Staten Island University Hospital. Most injuries to sleepwalking children happen when they fall down stairs, out a window, or manage to go outside. The child’s bedroom should be on the ground floor with the doors and windows locked. Parents should remove anything hazardous from the child’s bedroom, and an alert mechanism such as bells should be placed on the child’s door. “Sleepwalkers can perform regular tasks, so it’s important to secure doors in an atypical fashion,” says Dr. Kilkenny. “Add a special lock or an extra lock that’s used only at night,” he suggests. Occasional incidents of sleepwalking are not a cause for concern, but if the sleepwalker is having frequent episodes and injuries or exits the house, seek professional help. In most cases,a doctor will only recommend securing the environment, but occasionally a very mild sedative will be prescribed.

Sleep-Related Bruxism (Tooth Grinding) Another problem that affects children is tooth grinding. The child doesn’t realize that it is happening, but the parents may hear the grinding, or the child may complain of a sore jaw or face in the morning. Sometimes the first indication of a problem occurs at a checkup when the child’s dentist notices a wearing down of the dental surfaces. “Bruxism in children usually occurs before the permanent teeth come in and goes away by the age of 8 or 9,” says Dr. Kilkenny. The causes of tooth grinding are unknown. However, sleep-related bruxism is more likely to occur during times of stress, and seems to run in families. The most common treatment is a mouth guard, fitted by a dentist, which is worn during sleep. It doesn’t prevent the grinding, but does prevent further damage to the teeth.

Solniloquy (Sleep Talking) Talking during sleep is a common occurrence among children, but is not something to be concerned about. Sleep talking rarely results in arousal from sleep or requires any treatment. Sleep talking occurs in young children primarily, and happens during the first few hours of sleep. It does not occur as part of a dream since dreaming occurs during the REM (rapid eye movement) stage of sleep, during the last third of the sleep period. Sleep talking is associated with fevers, obstructive sleep apnea and sleepwalking.

Night Terrors Night terrors differ from nightmares because they occur approximately 90 minutes into sleep during stage 3 or stage 4 non-REM sleep. “Night terrors are characterized by a bloodcurdling scream,” says Dr. Kilkenny. “The child may be sitting up in bed, staring off into space. They may be unresponsive to a parent’s attempts to wake or comfort them, but after about 20 minutes they usually go back to sleep and rarely remember the episode.” Like other parasomnias, children will outgrow night terrors.

Obstructive Sleep Apnea Sleep apnea is a breathing problem that occurs when the upper airway is blocked during sleep. It causes pauses in breathing during sleep and upsets normal sleep patterns. Though not a sleep parasomnia, obstructive sleep apnea is a serious sleep disorder and should not be ignored. “Any child who snores should be evaluated by a sleep specialist,” says Dr. Kilkenny. “Sleep apnea can result in sleep deprivation, failure to thrive, and even death in some cases. Luckily, most cases of pediatric sleep apnea can be resolved by removal of enlarged tonsils and adenoids.”


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