SLEEPWALKING AND SLEEP TERRORS

Sleepwalking. Almost half of all children have had at least one episode of sleepwalking. It is often seen in older children, peaking in children between the ages of 4 and 8. The sleepwalker may return to bed or awaken in the morning in a different part of the house, such as in a closet or someone else's room. Sleepwalkers can even carry on conversations, which are difficult to understand and make little or no sense. Children who are sleepwalking are capable of acting out complicated behaviors, such as rearranging furniture, but usually the activities make little sense. It is quite common for children to urinate in closets, or other strange places, while sleepwalking. When your child sleepwalks, his eyes will be open but they may appear "glassy."

Sleep terrors. Sleep terrors, or night terrors as they are often called, are usually dramatic and the most distressing to witness. Sleep terrors almost always begin with a "bloodcurdling" scream or shout. During one of these events, your child will look like she is experiencing extreme terror. Overall, she will look extremely agitated. During the frenzied event, children may hurt themselves or someone trying to calm them. As disturbing and frightening as these events appear to the observer, children having them usually are totally unaware of what they are doing. In fact, sleep terrors are much worse to watch than to experience. For the child, a sleep terror is less traumatic than a typical nightmare or bad dream. An easy way to distinguish between sleep terrors and nightmares is to determine who is more upset. If your child is more upset, then it was a nightmare. If you are more upset, then it was a sleep terror. About 5% of children have sleep terrors, with most sleep terrors occurring when the child is between 5 and 7 years, although younger children can also have them. And, sleep terrors runs in families. Studies find that 96% of children who have sleep terrors have another family member who has experienced a disorder of partial arousal.

CRUCIAL FEATURES

Time of night. Sleepwalking and sleep terrors usually occur within one to two hours of falling asleep.

Amnesia. Your child will probably have no memory of these events.

Avoid comfort. Most children avoid being comforted. They may get more upset and scream more if you talk to them and try to calm them down.

WHAT PARASOMNIAS ARE AND ARE NOT

A child who is sleepwalking or experiencing a sleep terror is basically stuck halfway between asleep and awake. These behaviors are not:

Not a Nightmare. Sleep terrors are not nightmares. Your child is NOT dreaming during these events, although it may look it.

Not a Psychological Problem. Sleep terrors and sleepwalking are not an indicator that your child has some serious psychological problem.

CAUSES

There are certain things that make these two sleep disorders worse or more likely to occur.

Sleep deprivation. Not getting enough sleep is the number one reason that a child has a sleep terror or walks in his sleep. If your child doesn't get enough sleep on Wednesday night, on Thursday night he is more likely to have a sleep terror.

Fevers or illness. A high fever or being sick can cause sleepwalking and sleep terrors. The higher the fever, the more likely an event will happen.

Strange places. Sleeping at grandma's house, a friend's house, or any strange place can lead to a sleep terror or sleepwalking.

Stressful times. Parasomnias often occur during periods of stress. It is not the stress itself that causes the sleep problems, but the sleep deprivation that often goes along with stressful times. If you are moving, going through a divorce, or there has been a death in the family, your child may not be getting to bed as early as you would like and may not be getting enough sleep. If your child is worrying before falling asleep, he may not be getting the sleep he needs. Whenever this happens, unusual sleep behaviors are more likely to occur.

KEEP YOUR CHILD SAFE

The most important thing that you can do is keep your child safe.

Gates. Put up gates at the door of your child's bedroom and at the top of stairs. For younger children, the gates will stop them from leaving their room or going downstairs. For older children, the gate may not stop them but it will hopefully slow them down enough for someone to hear them.

Alarms. An alarm can be very helpful in making sure that your child is safe and doesn't leave the house. These are not intended to wake your child, but to wake you. Any type of alarm will do, from the fancy and expensive burglar alarm to the simple.

Lock windows. Ensure that windows, especially second story or higher, do not open wide enough that your child can jump out of them.

Remove things that are in the way. If your child walks in his sleep, clear away anything that he can step on or trip over during the night.

WHAT TO DO

There are a number of things that you can do to deal with these behaviors.

Don't wake your child. It is best not to try and wake your child as it will often prolong the event.

Guide your child back to bed. To encourage return to normal sleep, guide your child gently back to bed. If he resists, let him be.

Try not to interfere too much. The normal response of parents is to try and comfort their child during one of these episodes. Try to resist doing this. Most children will just get more agitated, especially if you try to hold an already upset-looking child. If your child is about to come to harm, though, be sure and keep your child safe even if he fights you.

Increase sleep. Increase the amount of sleep that your child is getting and try to let not let him become sleep-deprived. These behaviors are much more likely to happen when your child is sleep-deprived.

Maintain a regular sleep schedule. Parasomnias are more likely to happen on nights that your child goes to sleep at a time that is different than usual.

Don't discuss them the next day. The morning after an event, don't discuss the problem with your child. Discussing the event is likely to worry your child. This can lead to your child becoming anxious about sleeping, being less likely to fall asleep at night, and therefore become more sleep-deprived.

Allay your child's fears. For older children, it may be helpful to discuss how common these behaviors are and to allay your child's fears or concerns that she is different or that something is wrong with her.

TREATMENT OPTIONS

In most cases, parasomnias require no treatment. In severe cases, however, when these behaviors involve injury, violence, or disruption of others, treatment may be necessary. Treatment may include medical intervention with prescription drugs or behavior modification techniques. Speak to your child's doctor if you are concerned about her behavior during the night.

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