Confusional arousals are most common in infants and toddlers, but are also seen in adults. Evidence of confusional arousals includes:
- crying in bed
- thrashing around in bed
- sleeper appearing to be awake
- once awake, sleeper appears confused and upset
- resists attempts to comfort or console
It is difficult to awaken a person in the grips of a parasomnia episode. The confusional arousal can last up to half an hour and usually ends when the agitation subsides and the sleeper awakens briefly, wanting to return to sleep.
This disorder is commonly seen in older children and can range from simply getting out of bed and walking around the bedroom to prolonged and complex actions, such as going to another part of the house or even outdoors. A sleepwalker will sometimes speak, but is unlikely to be clearly understood.
Sometimes complicated behaviours take place during a sleepwalking episode (such as rearranging furniture), but these activities are usually not purposeful. While injuries during sleepwalking are uncommon, sleepwalkers may put themselves in harm’s way – such as walking outside in bedclothes during the winter. Simple precautions enhance safety.
In most cases, no treatment is necessary. The sleepwalker and family can be assured that these events rarely indicate any serious underlying medical or psychiatric problem. In children the number of events tend to decrease with age, although they can occasionally persist into adulthood or even originate during the adult years.
A rare variation of sleepwalking is “sleep-related eating”. This disorder manifests itself as recurrent episodes of eating during sleep, without conscious awareness.
Sleep related eating can occur often enough to result in significant weight gain. Although it can affect both sexes and all ages, it is most common in young women.
These are the most extreme and dramatic of the arousal disorders and the most distressing to witness.
A sleep terror episode often begins with a “blood curdling” scream or shouts and can produce signs that suggest extreme terror, such as dilated pupils, rapid breathing, racing heart, sweating and extreme agitation.
During a sleep terror episode the victim may bolt out of bed and run around the room or even out of the house. In the course of the frenzied event, sleepers can hurt themselves or others.
As disturbing and frightening as these episodes are to an observer, the sleeper usually has no conscious awareness of the event and generally does not remember it upon awakening.
Unlike typical nightmares or bad dreams, sleep terror episodes are not usually associated with vivid dream images that are recalled after awakening.
HOW ARE AROUSAL DISORDERS EVALUATED?
In typical childhood occurrences of arousal disorders, medical evaluation is not likely to be needed.
You should, however, contact a healthcare professional if a child’s disturbed sleep causes:
- Potentially dangerous behaviour, such as that which is violent or could cause injury;
- Extreme disturbance of other household members;
- Excessive sleepiness during the day.
In these cases formal evaluation and a sleep centre study is warranted.
Because disorders of arousal are relatively uncommon after childhood, adults suffering from these disorders should seek evaluation.
In some cases, these disorders can be triggered by other conditions such as sleep apnoea, heartburn or periodic limb movements during sleep.
A sleep specialist should evaluate the patient’s behaviours and medical history.
ARE THERE TREATMENTS FOR AROUSAL DISORDERS?
Simple precautions should be taken to ensure safety for people with arousal disorders. Clearing the bedroom of obstructions, securing windows, sleeping on the ground floor and installing locks or alarms on windows and doors can add a degree of security for the individual and the family.
In cases severe enough that the sleep disorder leads to injury or involves violence, excessive eating or disturbance to others, treatment may be warranted. Therapy can include medical intervention with prescription drugs or behaviour modification through hypnosis or relaxation/mental imagery.