Which clinical history findings are characteristic of parasomnias?

Updated: Oct 09, 2018
  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Nightmare disorder affects 10–50% of children aged 3–6 years. Nightmares occur during rapid eye movement (REM) sleep, usually in the second half of the night, and are well remembered in the morning. After a nightmare, the child is alert and can clearly describe scenes and frightening images in detail.

Nightmares are common during stressful times or after frightening events, such as frightening movies. If nightmares are severe and frequent, they may affect daytime functioning. In posttraumatic stress disorder (PTSD), nightmares may be associated with flashbacks, numbing, reenacting the events, and avoidance.

Night terrors, also known as sleep terrors, typically occur in the first 3 hours of sleep. The child is not awake but appears agitated. Abrupt, usually agitated, arousal from slow-wave sleep takes place. Night terrors are associated with autonomic arousal (eg, tachypnea, tachycardia, and diaphoresis) and screaming. The child is often inconsolable during the episode. After about 3–5 minutes, the episode terminates spontaneously, and the child quickly returns to sleep. Recall of the event in the morning is poor. This type of disturbance may be associated with an ongoing illness or fever.

In sleepwalking disorder (somnambulism), the patient is difficult to arouse and usually has no recollection of the event in the morning. Actions taking place during sleepwalking frequently vary. Sleep eating occurs more frequently in females.

In primary nocturnal enuresis (bed wetting), no period of nighttime dryness occurs for more than 6 months. In secondary enuresis, a relapse of bed wetting occurs after a period of at least 6 months of dryness. This sleep disturbance may be associated with shame and low self-esteem and therefore should prompt a review for other psychiatric disorders. Secondary enuresis may be precipitated by emotional and physical trauma.

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