Sleep walking, sleep talking, and night terrors are common in childhood. They occur in a deep sleep. Different stages of sleep are reviewed in Sleep 101.
Natural history of Non-REM Parasomnia (Somambulism, Somniloquy, Night Terror)
It is more common in childhood when SWS (Slow-Wave Sleep) is more abundant. Safety/Environmental measures is first line treatment. At times we do consider medication therapy, however we attempt to reserve this for cases where child may have been exposed to danger (walking out of house) or if the events are disruptive to others (healthy child needs a healthy well rested parent).
Are there treatments for these? Yes. Do you have to treat? My question to parents is generally what are we trying to accomplish. Let me explain.
I frequently have parents that are concerned that there child is not sleeping well. Remember, these occur in the deep stages of sleep. So deep that it is difficult to wake the kid up when this occurs. So if we are trying to accomplish good sleep, they are already in a deep sleep. Some of the medications used may actually blunt the deep sleep, which reduces the events.
There can be disorders of sleep fragmentation that cause brain arousals that trigger these events. Such examples include sleep apnea or periodic leg movement disorder. Those should be evaluated for and treatment of those conditions generally decreases the frequency.
Polysomnogram (PSG) should be considered if sleep fragmentation is suspected, as the fragmentation of sleep can provoke the episodes to be more frequent. Also, benzodiazepine may further provoke OSA if present, and TCA can have anticholinergic properties that can provoke PLMD (Periodic Limb Movement Disorder) if present.
Safety is number one. If the child has walked out of the house, or is turning on stoves, and such continues even after safety environmental measures then treatment should be considered.
If a parasomnia event does occur, gently attempt to bring child to bathroom first (urinary urgency is a top trigger), and then gently attempt to bring back to child’s place of sleep.
If it is opted to use medication in the future, generally Klonopin (clonazepam) is first line (assuming no OSA). Other consideration could be a TCA.
