Parasomnia: Night Terrors Outline Parasomnias Night terrors
Ionescu, Daniel, Contributing Writer has reference to this Academic Journal, PHwiki organized this Journal Parasomnia: Night Terrors Kelsey Carrio, Megan Preovolos Christian Wilbur, Marjan Amiridavani COGS 175 June 1, 2007 Outline Intro to Night TerrorsKelsey REM/ n-REMMJ CausesChristian TreatmentsMegan Conclusions
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Parasomnias Parasomnias are disruptive sleep-related disorders that can occur during arousals from REM sleep or partial arousals from Non-REM sleep. Parasomnias include nightmares, night terrors, sleepwalking, confusional arousals in addition to many others.
Night terrors A person experiencing a night terror or sleep terror abruptly awakes from sleep in a terrified state. The person may appear to be awake, but is confused in addition to unable to communicate. They do not respond to voices in addition to are difficult to fully awaken. Night terrors last anywhere from a few seconds up to 30 minutes, after which time the person usually lies down in addition to appears to fall back asleep. People who have sleep terrors usually don’t remember the events the next morning. People experiencing sleep terrors may pose dangers to themselves or others because of limb movements. Night terrors are fairly common in children occurring in approximately 5% of them mostly between the ages of three to five.
N-REM vs. REM Non-REM Slow EEG Muscular activity Dreaming rare 80% of sleep time REM (paradoxical) EEG similar to awake person No movement Dreaming common Hard to arouse easily 20% of sleep time Onset of Night Terror – EEG Spontaneous attack during stage 3 of NREM sleep 2 s of diffuse hypersynchronous high voltage delta wave arousal Brief EEG delta discharge immediately preceding the clinical episode Increased heart rate (shown from EKG) Causes of Night Terrors Genetic Factors Sleep Disordered Breathing (SDB) Acute Triggers
Genetic Factors Guilleminault et. al. 2003 – 35% of children with both NT in addition to SDB have at least 1 immediate relative with parasomnia. Kales et. al. 1980 – 96% had 1 or more relatives in the pedigree with NT or Sleepwalking. Owens et. al. 1999 – 60% risk if both parents were affected. Sleep Disordered Breathing Guilleminault et al. 2003 – 51 of 84 children had BOTH NT in addition to an additional sleep disorder. – If the SDB is treated, then the NT symptoms disappear. Owens et al. 1997 – Parasomnias are more common in children with Obstructive Sleep Apnea (OSA) than in a normative age-matched sample. How SDBs Sleep fragmentation due to sleep-disordered breathing may elicit an increase in slow-wave sleep as a recovery mechanism. This could be an increased risk factor as long as night terrors because they occur in stage 3/4 of sleep.
Acute Triggers Mild increases in psychosocial stress in addition to relative sleep deprivation are known to trigger night terrors in affected individuals. These triggers most likely play a synergistic role in evoking the night terror, in addition to are not the primary source when they Treatments Education Behavioral Hypnosis Medication
Educate Make sure parents underst in addition to Transitory: Usually end on their own Regular sleep pattern Safe environment No bunk beds, safety gates, etc Remove sleep disturbances Night lights, sounds, etc Protect but dont awaken Behavioral Intervention Waking Treatment Usually occur around same time each night Track timing of night terrors as long as a couple of nights Fully wake up 15-30 mins be as long as e usually occur Allow to sleep again after 5 minutes After week, stop waking. If terrors return, repeat waking as long as one more week 90% effective in study of 50 children (Oakey) Hypnosis Stress reduction In adults: Mild night terrors: self-hypnosis Deep breathing, concentrate on relaxing imagery Severe night terrors: Professional hypnotism Suggestions to reduce awareness of nocturnal sensory stimuli
Medication Tricyclic Antidepressants Ex: Imipramine, Trazodone Often used as temporary treatment in conjunction with hypnosis Benzodiazepines Ex: Diazepam Suppress slow-wave (stage 3/4) sleep Disadvantages Addictive Growth hormone secreted in slow wave sleep Also studies stating DOESNT work (Cooper) Melatonin Therapy Neurohormone produced by pineal gl in addition to Therapy as long as sleep-phase onset delay Take controlled release 30 mins be as long as e bedtime Study: Abrupt disappearance of parasomnias in 12 year old boy (within 2 days) -Smits et al. L-5-Hydroxytryptophan (Bruni et al, 2003) Pre-cursor of serotonin Serotonin may cause production of sleep-producing factors Resolves conflict between slow-wave sleep in addition to arousal 45 children: 34 given L-5-HTP, 14 take placebo Episode recurrence after 6 months 2 in L-5-HTP (6.4%) 9 in placebo group (64.3%)
Case Study Self-Hypnosis in Management (Kohen et al, 1992) Four children, 8-12 yrs old Treatment: 20-60 mg of imipramine at bedtime followed by self-hypnosis Strategy: Demystify through education Establish prompt control through imipramine Train in self-regulation through self-hypnosis Discontinue medication but continue hypnosis Conclusion Unanswered questions What causes the sudden occurrences to stop Exact causes in addition to remedies Alternate State of Consciousness Is it even conscious Are they aware References Bruni, et al. L-5-Hydroxytryptophan treatment of sleep terrors in children. Eur J Pediatrics. 2004; 163:402-407 Cardoso, Silvia PhD in addition to Sabbatini, Renato PhD Night Terrors www.cerebromente.org.br/ /terror/terror1-i.htm Copyright 1998 by State University of Campinas, Brazil Chiba, A. Circadian Rhythms 4-19-2007 http://www.cogsci.ucsd.edu/~chiba/circadian-rhythms-07.pdf Di Gennaro, et al.Night terrors associated with thalamic lesion Clinical Neurophysiology, Volume 115, Issue 11, November 2004, Pages 2489-2492 Dur in addition to , Mark in addition to Jodi A. Mindell. Behavioral intervention as long as childhood sleep terrors. Behavior Therapy. 1999;40(30): 705-715. Guilleminault C, Palombini L, Pelayo R, Chervin R. Sleepwalking in addition to Sleep Terrors in Prepubertal Children: What Triggers Them PEDIATRICS Vol. 111 No. 1 January 2003, pp. e17-e25. Haley, Carma. Terror in the Night http://childrentoday.com © 1999-2003 iParenting, LLC Kales A, Soldatos CR, Bixler EO, et al. Hereditary factors in sleepwalking in addition to night terrors. Br J Psychiatry. 1980;137:111-118. Kohen, et al. Sleep-terror disorder in children: the role of self-hypnosis in management. American J Clinic of Hypnosis. 1992 April; 34(4):233-244. Lask,B. A novel in addition to non-toxic treatment as long as night terrors. BMJ 1988; 297(6648):592. Matthews, B in addition to M. Oakey. Triumph over terror. BR Med Journal. 1986; 292:203. Not Such Sweet Dreams http://www.talaris.org/spotlight-dream.htm Talaris Research Institute © 2005 Owens J, Millman R, Spirito A. Sleep Terrors in a Five Year-old Girl. Arch Pediatr Adolesc Med. 1999;153:309-312. Owens J, Spirito A, Nobile C, Arrigan M. Incidence of parasomnias in children with obstructive sleep apnea. Sleep. 1997;20:1193-1196. Rosen, et al. Sleep walking, confusional arousals in addition to sleep terrors in the child. Principles in addition to Practice of Sleep Medicine in the Child. Philadelphia, PA: Saunders. P 99-106. Sleep Disorders: Parasomnias www.webmd.com/sleep-disorders/guide/parasomnias ©2005-2007 WebMD, Inc
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