Non-Rapid Eye Movement Sleep Arousal (NREM) Disorder in Children and Adolescents

Although parasomnias can take several forms, a child is typically diagnosed with a NREM sleep arousal disorder when he or she experiences one of the following on a regular basis:

• Sleepwalking (somnambulism), in which the child rises from bed and moves around while still asleep.  Individuals who are sleepwalking typically cannot communicate and are awakened only with significant difficulty.
• Night terrors, in which the child awakes abruptly from sleep in a panicked, intensely fearful state, sometimes with a panicked scream.  

Individuals who experience sleepwalking or night terrors remember little or nothing of these episodes, including any dreams that may have occurred.

Occasional parasomnias are very common in young children and are often outgrown by middle childhood.  Therefore, NREM sleep arousal disorders are diagnosed and treated only when the parasomnias occur repeatedly and cause clinically significant distress or impairment.

NREM sleep arousal disorders can also lead to sleep avoidance (particularly in the case of night terrors) or impaired concentration during the day.  NREM sleep arousal disorders often occur in isolation, but can co-occur with other psychological disorders, including major depressive disorder and obsessive-compulsive disorder.

NREM sleep arousal disorders are thought to stem from abnormalities in sleep architecture, including deeper sleep, greater occurrence and fragmentation of slow-wave sleep, and alterations in delta activity during sleep, which give rise to the disorder.  Parasomnias are thought to increase in frequency following the consumption of alcohol and other substances, in response to lights or noises, and when the individual is experiencing stress.  Parasomnias appear to have a genetic component, although having a genetic predisposition toward parasomnias does not necessarily mean that the individual will develop a parasomnia.

However, the following treatments have shown some promise for reducing the occurrence of one or more parasomnias in children:

• Benzodiazepines, specifically diazepam and clonazepam, have shown promise in several case series.  
• Cognitive-behavioral therapy including scheduled awakenings showed positive effects in several case series.
• Antidepressant medications, specifically imipramine, have shown some benefit in case studies.
• Hypnosis has shown some positive effects in several case series.