The most common non-rapid eye movement (NREM) parasomnias in children are the disorders of arousal (e.g., sleepwalking, night terrors, and confusional arousals), which occur most commonly in the first half of the night.
Rapid eye movement (REM) parasomnias occur later during the night and consist of experiences such as nightmares, recurrent isolated sleep paralysis, and REM sleep behavior disorder (RBD). The latter is extremely rare in children.
The differential diagnosis includes seizures.
The three most common modifiable triggers for parasomnias in children include sleep deprivation, restless legs syndrome and obstructive sleep apnea. Treatment of these disorders may significantly reduce or resolve parasomnias in affected children.
Parasomnias are diagnosed on clinical grounds, based on descriptions from an observer, such as a parent or sibling who may share the bedroom. Ordinarily, a sleep study (diagnostic polysomnogram) is not necessary to establish the diagnosis. However, this test may be ordered when other comorbid primary sleep disorders, such as sleep apnea, are suspected.
Management consists of treatment of the underlying cause of the parasomnia, reassurance, modification of the sleep environment, and, in adolescents, avoidance of substances such as caffeine and alcohol. When parasomnias become frequent and more problematic, occasionally pharmacologic agents may be helpful.
The home environment needs to be modified to increase safety. This includes removal of any potentially dangerous items and sharp objects, locking doors, arranging for a sleeping space on the ground floor, and installation of door alarms.