REASSURE, MAKE THE BEDROOM SAFE, AND RULE OUT A NOCTURNAL SEIZURE
Parasomnias in Adults - StatPearls (NCBI Bookshelf NBK560524) - https://www.ncbi.nlm.nih.gov/books/NBK560524/
Night terrors frighten the parents far more than the child, who remembers nothing. The two jobs are to separate them from a nocturnal seizure and to stop the child getting hurt while sleepwalking. No drug is offered: the article's drug list is adult, unquantified for children, and aimed at a problem that resolves on its own.
- SOURCE LIMIT, STATED UP FRONT - the cached article is titled Parasomnias in Adults. It is used here because it carries the paediatric epidemiology and the clinical description of sleep terrors, and because no dedicated paediatric parasomnia chapter exists on the Bookshelf. Everything below is drawn from it; nothing paediatric has been extrapolated beyond what it says.
- WHAT A NIGHT TERROR IS - sleep terrors, which most people call night terrors, also happen in the sleep cycle's first third. What happens is an abrupt, partial arousal out of delta-wave sleep, with frantic movement and screaming; and that burst of activity is followed by a stretch of intense anxiety and hyperarousal.
- THE CHILD WILL NOT REMEMBER, AND THAT IS THE CLUE - the NREM arousal disorders come with amnesia, confusion and disorientation. A child who describes the dream in the morning had a nightmare, not a night terror: nightmares sit in the sleep cycle's second half, and the memory of them survives waking. And because a nightmare belongs to REM, movement and vocalisation do not occur.
- TIMING SEPARATES THEM - the NREM events come early in the night, inside three hours of the child falling asleep, while the REM events start more than 90 minutes after sleep begins and cluster in the second half. Ask what time it happens before asking anything else.
- MAKE THE HOUSE SAFE - the episodes repeat: the child gets up and walks, often to no purpose, after falling asleep, in a trance with a blank stare, not answering anything around them. The danger the article names is that a sleepwalker can still work a door or a window handle. Locks on the balcony door and the stair gate are the treatment.
- IT IS COMMON AND IT RUNS IN FAMILIES - sleepwalking happens more in children than in adults; the estimate is that about 15% of children will sleepwalk at least once, and that most grow out of it by adolescence. One study found 47% of children with a sleepwalking parent sleepwalked themselves, rising to 61.5% where both parents did. Sleep terrors are far rarer in childhood - estimates go as low as 3%.
- DEAL WITH WHAT FRAGMENTS DEEP SLEEP - the things that break up slow-wave sleep, on the article's list: a genetic susceptibility, restless legs, too little sleep, periodic limb movements, noise, touch, alcohol, stress, a sleep-related breathing disorder, medicines, and fever. In a child that usually means a late bedtime, a hot noisy room, or snoring - and snoring with witnessed pauses belongs on the paediatric obstructive sleep apnoea pathway.
- ASK WHAT THE CHILD IS TAKING - the drugs reported to bring on a parasomnia or make one worse: the SSRIs, the tricyclic antidepressants, venlafaxine, the monoamine oxidase inhibitors, the beta-blockers, zolpidem and zopiclone.
- THE EVENT THAT IS NOT A PARASOMNIA - where sleepwalking begins for the first time in an adult, that should send you looking for nocturnal seizures, for a breathing-related sleep disorder, and through the drug list. Stereotyped movements repeating identically night after night, several events in one night, tongue-biting, incontinence, or drowsiness the next morning point to epilepsy and need a paediatric neurology opinion and an EEG.
- EYES OPEN OR SHUT IS A USEFUL QUESTION - as a rule the eyes stay open through an NREM sleep disorder, and stay closed in a REM one.
- WHAT TO DO IN THE MOMENT, AND WHAT IT LEADS TO - the non-drug measures the article names are psychotherapy, scheduled awakenings, hypnosis and relaxation exercises. Scheduled awakening - waking the child briefly about fifteen minutes before the usual time of the event - is the one parents can do. Prognosis: most parasomnias either settle by adolescence or turn up only as isolated events.
- NO SEDATIVE IS OFFERED HERE - the article's drug paragraph is adult, and it states its own objection: benzodiazepines give way to alternatives, on account of the side effects they carry and the addiction they can cause. It gives no paediatric amount for any of them. Against a disorder that resolves with age and a child who is not distressed by it, that is a specialist decision, and no prescribing row is written.
- TREAT THE THING UNDERNEATH IF THERE IS ONE - sleep terrors keep company with anxiety, with depression, and with obsessive-compulsive and phobic disorders. Where a parasomnia is the outward sign of some other condition alongside, treating that condition is what makes the parasomnia follow.