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Excellent exploration of non-REM parasomnias with @GSTTnhs @guy_lesch @BBCRadio4
Partial arousal parasomnias like sleepwalking, or sleep terrors, are much more common in childhood.
#mysteriesofsleep http://www.bbc.co.uk/programmes/b09h34y9
Partial arousal parasomnias like sleepwalking, or sleep terrors, are much more common in childhood.
#mysteriesofsleep http://www.bbc.co.uk/programmes/b09h34y9
Up to 40% of children will sleepwalk at some point in their life.
About 20% will regularly sleepwalk, and just under 5% will do so frequently.
About 20% will regularly sleepwalk, and just under 5% will do so frequently.
The most common age for children to sleepwalk is during primary school years.
Sleep changes from birth to adulthood.
We see an increased proportion of deep (nREM) sleep - which these types of parasomnia arise from - during this time.
Sleep changes from birth to adulthood.
We see an increased proportion of deep (nREM) sleep - which these types of parasomnia arise from - during this time.
As @guy_lesch says, there is often a family member - mum, dad, aunt, uncle - who had similar episodes as children.
There is a definite genetic component to these episodes.
There is a definite genetic component to these episodes.
Older children, like adults, can start to do quite complex behaviours in sleep - all things they are used to doing on ‘automatic pilot’.
For kids this is often navigating to mum and dad’s bedroom, or the toilet.
For kids this is often navigating to mum and dad’s bedroom, or the toilet.
... sometimes they get it a bit wrong.
My sister, while sleepwalking, once opened the top drawer of our parent’s bedside table and happily peed all over the contents
My sister, while sleepwalking, once opened the top drawer of our parent’s bedside table and happily peed all over the contents
Sleepwalkers are still sound asleep.
The best thing to do is usually to calmly turn them around and guide them back to bed ... they’ll usually drift back to normal sleep, and won’t usually remember it the next day.
The best thing to do is usually to calmly turn them around and guide them back to bed ... they’ll usually drift back to normal sleep, and won’t usually remember it the next day.
Waking up a sleepwalker doesn’t itself cause harm, despite the old wives tales.
All it does do though is create a sleepy, confused child as to why they’re not in bed.
No benefit to doing this.
All it does do though is create a sleepy, confused child as to why they’re not in bed.
No benefit to doing this.
Sleepwalking itself is almost always harmless.
The risk comes from accidental injury, so attention to risk reduction is important - make sure windows and doors in particular are safely locked.
A bell tied to bedroom door often helps!
The risk comes from accidental injury, so attention to risk reduction is important - make sure windows and doors in particular are safely locked.
A bell tied to bedroom door often helps!
Because we get most of our deep (stage 3) sleep in the first third of the night, this is the most common time for sleepwalking episodes to occur.
They can occur at any point in the night though.
It’s less common to have more than one episode per night.
They can occur at any point in the night though.
It’s less common to have more than one episode per night.
Soundly sleeping sleepwalkers can usually safely navigate stairs.
What they *can’t* though is see things that they aren’t expecting to be there ... the roller skate left on the stair will cause them to fall
What they *can’t* though is see things that they aren’t expecting to be there ... the roller skate left on the stair will cause them to fall
This is why well-intentioned measures like putting up stair-gates can sometimes increase, not reduce, risk of accidental injury.
Brain is navigating its mental map of the house, not in real-time.
Brain is navigating its mental map of the house, not in real-time.
Sleepwalking episodes are more likely to happen if underlying sleep quality is worse for any reason.
This is why treatment of sleepwalking in kids focuses mainly on ensuring good core sleep routine and habits - and getting enough!
Top: good sleep
Bottom: fragmented sleep
This is why treatment of sleepwalking in kids focuses mainly on ensuring good core sleep routine and habits - and getting enough!
Top: good sleep
Bottom: fragmented sleep
Common childhood conditions which can affect sleep quality - like asthma, eczema, constipation, hay fever, reflux - can lead to poorer quality sleep, which then act as a trigger for sleepwalking episodes.
Treat those, episodes decrease.
Treat those, episodes decrease.
It means kids who are prone to sleepwalking are also more likely to do so if they are unwell for any reason, sleep deprived for any reason, or sleeping in an unfamiliar environment
We very very rarely use medication to treat sleepwalking in kids.
If very disruptive, we will try to treat with simple behavioural techniques first.
If very disruptive, we will try to treat with simple behavioural techniques first.
As well as physical health problems, daytime anxieties and stresses can also trigger parasomnias in susceptible kids.
... plus the Usual Suspects of poorer sleep: caffeine and electronic light!
Avoid talking about the episodes the next day, especially if your child has no recall.
Yes it might be funny ... but often just encourages kids to think about and be anxious about their sleep, which makes things worse!
Yes it might be funny ... but often just encourages kids to think about and be anxious about their sleep, which makes things worse!
Most primary school kids who sleepwalk grow out of it by teenage years.
About 10% will persist, and can then persist into adult years.
Understanding what’s going on, and simple precautions, are the key. And referral to @guy_lesch if still a major issue :)
About 10% will persist, and can then persist into adult years.
Understanding what’s going on, and simple precautions, are the key. And referral to @guy_lesch if still a major issue :)
Sleepwalking is a common problem in children, and can usually be diagnosed and managed by children’s GPs or paediatricians.
Very few need to see us, or need detailed sleep studies to confirm the diagnosis.
@NHSChoices info here: https://www.nhs.uk/conditions/sleepwalking/
Very few need to see us, or need detailed sleep studies to confirm the diagnosis.
@NHSChoices info here: https://www.nhs.uk/conditions/sleepwalking/
Sleep terrors are related to sleepwalking, and usually occur in younger pre-school problem. It’s usually parents who are terrified!
They represent a less developed response of the brain to the partial arousal state of sleepwalking.
They represent a less developed response of the brain to the partial arousal state of sleepwalking.
Where older kids and adults are developing a repertoire of automatic behaviours that their brain falls into during partial arousal, younger kids don’t have these yet. Their brain’s response is more primitive - similar to ”fight or flight” response
A child having a sleep terror will seem to suddenly wake from sleep:
Eyes open
Agitated
Screaming - often “help!” “Stop!” “Mum!”
Pale
Fast heart beat
Sweating
Inconsolable and unresponsive
They look terrified. Parents often convinced something awful happening
Eyes open
Agitated
Screaming - often “help!” “Stop!” “Mum!”
Pale
Fast heart beat
Sweating
Inconsolable and unresponsive
They look terrified. Parents often convinced something awful happening
Despite appearances, child is usually sound asleep still.
Episodes can last 5-60 minutes, with average being ~15-20 mins.
At end will usually settle back into sleep, or more fully wake, at which point can usually be settled.
Episodes can last 5-60 minutes, with average being ~15-20 mins.
At end will usually settle back into sleep, or more fully wake, at which point can usually be settled.
They are benign - no direct harm is caused to the child, and they will almost always not remember them.
If you wake them (I don’t advise it!) they will describe very primal fear, without the narrative content of a dream/nightmare.
If you wake them (I don’t advise it!) they will describe very primal fear, without the narrative content of a dream/nightmare.
Once the kids have settled, parents usually need a calming drink themselves!
This is Iain, son of @macpeteranna a good friend of mine ... first sleep terror I ever saw was his. Jo needed a bit of reassurance (and some wine!) after :)
This is Iain, son of @macpeteranna a good friend of mine ... first sleep terror I ever saw was his. Jo needed a bit of reassurance (and some wine!) after :)
In older times, parents believed children having sleep terrors were possessed by demons, and would hustle them down to the parish minister for exorcision.
Sadly these damaging beliefs about normal sleep events can still persist!
Sadly these damaging beliefs about normal sleep events can still persist!
Sleep terrors probably occur in about 5% (1 in 20) of all kids.
Again, treatment for vast majority is confident reassurance (essential!), explanation and good attention to core sleep routine and habits https://www.nhs.uk/conditions/night-terrors/#night-terrors
Again, treatment for vast majority is confident reassurance (essential!), explanation and good attention to core sleep routine and habits https://www.nhs.uk/conditions/night-terrors/#night-terrors
Like @guy_lesch in adult clinic we do see other non-REM parasomnias in @EvelinaLondon sleep clinic, but majority are sleep terrors/sleepwalking (can have mixed elements of both)
As with many #mysteriesofsleep, a little bit of knowledge of sleep physiology makes sense of all
As with many #mysteriesofsleep, a little bit of knowledge of sleep physiology makes sense of all
... in my clinic, explaining sleep terrors and sleepwalking is an excuse to get my Sharpies out
