1.Overview and definition

Parasomnias and sleep-related movement disorders are included ICSD-3 2013. They are further divided into non–rapid eye movement (REM) sleep-related and REM sleep-related parasomnias according to the stage of sleep in which the symptoms occur (Table 1). The most common clinical problems include sleep terrors (also called night terrors, although this is not a formal diagnostic term) and sleepwalking (also called somnambulism) among non-REM sleep-related disorders. Sleep terrors can be very distressing for family members who witness them. They may be related to the immaturity of the brain and often improve spontaneously with age. Understanding the condition and responding calmly with a long-term perspective are important for management.

Table 1　 Subcategories of Parasomnias (partially abbreviated)

2.Symptoms

In children, non-REM sleep predominates during the first half of the night (from 10:00 p.m. to 1:00 a.m.), when sleep terrors typically occur during this period. These episodes are characterized by sudden awakening accompanied by intense fear and loud screaming. The child may appear flushed, with dilated pupils, rapid heartbeat, heavy sweating, and labored breathing. The person may jump out of bed and run in fear, posing a result of injury to themselves or family members. During this state, the child is unresponsive to calls and cannot recall them. Compared with other parasomnias, episodes are brief, typically lasting only a few minutes.

3.Diagnosis

Diagnosis is based on the patient’s history and observation of episodes, referring to the ICSD-3 diagnostic criteria for sleep terrors. To confirm the diagnosis and rule out comorbid sleep disorders, polysomnography with video monitoring may be performed, although the procedure is available only in limited facilities.

Table 2　Diagnostic Criteria for Sleep Terrors
All of the following A-C must be met:

4.Treatment and management

Attempting to awaken or speak to the child during an episode may worsen confusion and provoke unsafe behavior. Caregivers should instead focus on ensuring a safe environment to prevent injury.

In severe cases, measures such as locking windows and doors or removing dangerous objects from the surroundings may be necessary. If episodes are frequent, involve injury, or cannot be managed by environmental strategies alone, pharmacological treatment may be considered.

5.Complications and comorbidities

Parasomnias may be associated with other sleep disorders, such as obstructive sleep apnea. Recurrent nocturnal fears, wandering, or unusual movements may also be symptoms of epilepsy, restless legs syndrome, or attention-deficit/hyperactivity disorder.

SHIBATA, Mitsunori
Kawasaki-West Habilitation Center for chidren with disability