Sleep Disorders

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Two general categories of sleep disorders are recognized. Dyssomnias are problems with the initiation or maintenance of sleep, or with sleep that is inefficient. These include common sleep timing problems such as frequent night wakings and difficulty falling asleep at night or difficulty waking in the morning. Dyssomnias also include relatively rare problems such as obstructive sleep apnea (associated with enlarged tonsils and adenoids) and narcolepsy (sudden daytime sleep attacks).

Parasomnias occur during sleep but are not associated with insomnia or excessive sleepiness. Common parasomnias in children include head banging or rocking (exhibited by about 58% of children) and nightmares (most commonly of being attacked, falling, or dying). Nightmares are not the same as the rarer sleep terrors, a disorder in which a child, although asleep, appears to be awake and terrified. In sleep terrors, the child is screaming and incoherent with a glassy-eyed stare, profuse sweating, and rapid heart rate and respirations. The child is difficult to rouse and calm, and in the morning retains no memory of the episode. Both nightmares and sleep terrors occur during the transition from NREM sleep to REM sleep. They generally resolve with age. Other para-somnias are teeth grinding (bruxism), sleepwalking, and sleep talking. Bed-wetting (enuresis) is also considered a parasomnia if it continues after the age of five in the absence of physical or psychiatric pathology.

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