Disorders sleep in children

These disorders are diverse and differ significantly in structure from sleep disorders in adults. Their prevalence at the age of 1-5 years is 25%. Most often, children have PARASOMNIES (various phenomena that occur during sleep) and INSOMNII (sleep initiation and maintenance disorders). The most interesting and more common are parasomnias .

Dreaming It is the uttering of words or sounds during sleep in the absence of subjective awareness of the episode. Sleep-talking episodes occur at any stage of sleep, more often during shallow slow-wave sleep (stages 1 and 2). It is known that they are a benign phenomenon that occurs in most people throughout life, but in childhood it is much more common than in adulthood. Thus, in the “often or every night” category, sleep-speaking occurred in 5-20% of children and in 1-5% of adults in the general population. There is no special treatment. 

Bruxism. Bruxism refers to episodes of teeth grinding during sleep. Teeth grinding usually occurs once per second and lasts 5 seconds. or longer. These episodes are then repeated throughout the night. They can occur at any stage of sleep; typical motor artifacts are recorded on the EEG and EMG at this time. The reason for the grinding of teeth is unknown. The family character of the inheritance of this disorder is noted – according to our data, 18% of the patients’ relatives had such episodes in childhood or are currently having such episodes. As in the case of dreaming , this phenomenon was more often observed in boys. The association of increased frequency of teeth grinding episodes with daytime emotiogenic situations is also traced . There was no connection between bruxism and the presence of helminthic invasion in a child (a common myth). In children, bruxism very rarely leads to damage (tooth abrasion), so special treatment is usually not given. Nootropics and sedatives are used. Sometimes you have to choose a special dental splint. 

Nocturnal enuresis. A disorder characterized by frequent (for boys after 5 years more than 2, for girls – 1 episode per month) cases of involuntary urination during sleep. The prevalence of NE at the age of 12 reaches 3%, more often in boys. Children with this disorder often have very deep sleep (increased delta sleep), but NE episodes occur in all stages. There are primary (enuresis from birth without “dry gaps”) and secondary (interrupted for 3-6 months) forms of the disease. It is assumed that congenital or acquired dysfunction of the autonomic apparatus that control the bladder plays an important role in the development of this condition. There is a fairly close hereditary predisposition. The genes of the familial forms of NE – enur1 and enur2 – were isolated. Treatment uses behavioral techniques (fluid restriction, reward, bladder training), psychotherapy, physiotherapy, nootropics, antidepressants ( Melipramine ), and pituitary hormones ( Minirin ). 

Sleepwalking. Sleepwalking is a series of episodes of complex behavior that occur during sleep and are manifested by performing various actions, most often walking. Most often it is just a “trip” to the corridor, to the kitchen or to the parents’ bedroom. More complex motor acts can also be carried out, imitating habitual actions: searching for toys, trying to open a door with a key. Actions are performed with open eyes, with an expressionless gaze. The child does not respond to questions addressed to him. Such an episode lasts from several seconds to several minutes, on average about 6 minutes. The amnesia of the episode that happened the next morning is characteristic. The prevalence of sleepwalking in the child population is 10-30%. Most often they occur in the first third of the night, when delta sleep is most prevalent. Heredity for these parasomnias was noted in 20% of patients. The plan of therapeutic measures includes conducting a conversation with parents on the organization of sleep patterns and behavior during an attack, courses of sedative and nootropic therapy, psychotherapy. According to the literature, 5-7% of cases of sleepwalking are epileptic in nature, however, most likely, these data are overestimated. 

Night terrors. These include episodes of awakening with a loud cry and behavioral and vegetative manifestations of fright. The parents’ attention can be attracted by the cry of the child, when they approach, they find him sitting in bed with an expression of fear or confusion on his face. Breathing and palpitations are rapid, and profuse sweating may occur. At the same time, the child does not respond to words addressed to him, and attempts to calm him down can lead to increased fear or resistance. In the morning amnesia of what was happening is observed. Night fears are less common than sleepwalking, their prevalence in children is 1-4%, reaching a peak at the age of 4-12 years. More common in boys. These episodes can be provoked by daytime emotional situations, fever and prolonged lack of sleep. Polysomnographic examination does not reveal a specific pathology. Therapeutic measures include psychotherapy, nootropic and sedative therapy. 

Nightmares. Nightmares are terrifying dreams. The content of dreams scares the child, he dreams that he is being threatened, hurt, harassed or attacked. From this he wakes up in excitement, cries or calls out to his parents. Unlike night fears, nightmares more often occur in the morning and are confined to the phase of REM sleep. Nightmares differ from nightmares in that the night awakening is complete, the child is available to contact, tells that he was frightened and in the morning continues to remember about it. The prevalence of nightmares in the child population is 5-30%. The appearance of nightmares in a child can be triggered by stressful situations, feverish conditions, taking psychotropic drugs. An increase in nightmares can be evidence of a distress in the psycho-emotional sphere of a child, a manifestation of an internal conflict that he has. Among the therapeutic measures, psychotherapy with the possible addition of sedatives and nootropics plays a dominant role. 

Rhythmic movement disorder. It manifests itself in stereotypical, repetitive movements involving large muscles, usually the neck and head. The pattern of these movements can be quite varied: the child can “butt” the pillow or the headboard with his head, or, standing on his hands and knees, rhythmically sway back and forth. The prevalence of this phenomenon in children under 4 years of age, according to the literature, is 6-10%. It is believed that in this way, through a rhythmic effect on the structures of the vestibular apparatus, children “calm down” and “rock” themselves. Indeed, the development of such episodes can be triggered by emotional overexcitation. 

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