Confusional arousals in children do not necessarily warrant treatment. In adults who exhibit aggression towards

others or self-injury, room safety precautions need to be implemented and conditions facilitating or triggering attacks need to be avoided. The attacks should be allowed to terminate spontaneously. Benzodiazepines or tricyclic medications may be useful as short-term therapy for a few days or weeks during periods when attacks are more common. Sleep terrors The peak prevalence of sleep terrors is between 5 and 7 years of age. Inhibitors,research,lifescience,medical By age 8, half of the children are attack-free, while 36% continue to have attacks until adolescence. Episodes of sleep terror occur during the first third of the night and also during daytime naps. The child sits up, emits a piercing Inhibitors,research,lifescience,medical scream, and appears frightened, with increased pulse and respiratory rates and profuse sweating. The episodes last from 30 s to 5 min, and the child is amnesic for the events during the episode. PSG shows explosive arousal with marked increases in muscle tone,

heart rate, and respiratory rate, and a rapid decrease in skin resistance. Facilitating and precipitating factors need to be avoided. Treatment may Inhibitors,research,lifescience,medical include either a short-acting benzodiazepine, such as midazolam (10-20 mg), oxazepam (1020 mg), or clonazepam (0.5-2 mg). Patients unresponsive to benzodiazepines may benefit from tricyclic antidepressants such as clomipramine, desipramine, or imipramine (10-50 mg at hour of sleep). If total control of the episodes occurs and is sustained over several months, a slow and progressive withdrawal of medication may be performed.

Sleepwalking (somnambulism) The patient ambulates during sleep, Inhibitors,research,lifescience,medical is difficult to arouse during an episode, and is usually amnesic following the episode. Guilleminault et al indicated that children over the age of 4 Inhibitors,research,lifescience,medical reported vague memories of having to act, run away, escape or defend themselves against monsters, animals, snakes, spiders, ants, intruders, or other threats, and that they felt completely isolated and fearful.143,144 Episodes usually occur in the first third of the night during SWS.4,143,144 This disorder all has a peak age of onset at 5 years of age and peak prevalence at about 12 years. Most children outgrow the episodes by age 15. PSG recordings demonstrate 2 abnormalities during the first sleep cycle: frequent, brief, nonbehavioral EEG-defined arousals prior to the somnambulistic episode and abnormally low 8 (0.75-2.0 Hz) EEG power on spectral analysis, correlating with high-voltage “hypersynchronic δ” waves lasting 10 to 15 s occurring just prior to the movement.140,142-145 This is selleck screening library followed by stage I NREM sleep, and there is no evidence of complete awakening. REM behavior sleep disorder In REM behavior sleep disorder (RBD), the patient complains of violent or injurious behavior during sleep with disruption of sleep continuity and excessive motor activity during dreaming, accompanied by loss of REM sleep EMG atonia.