Sleep terrors and confusional arousals in children and adolescents

Confusional arousals and sleep terrors are common parasomnias and fall on the opposite ends of arousal parasomnia spectrum. Confusional arousals begin with moaning and proceed to movements which may sometimes be complex. Sleep inertia and sexsomnia are considered subtypes of confusional arousal. Sleep terrors are intense and most dramatic of the parasomnias and are associated with loud scream, cry, complex motor movements, and intense autonomic activation. In both the parasomnia, inability to arouse the child, amnesia for the event, and worsening of agitation with attempt to awaken the child are seen. Both the disorders are common in children and resolve by adolescence. There is a strong family history of parasomnia in most cases. Obstructive sleep apnea, restless leg syndrome, and periodic limb movements are precipitating factors. Separation anxiety is associated with sleep terrors, whereas mental disorders are sometimes associated with adolescent and adults with confusional arousal. Dissociation of wakefulness and sleep, and nonrapid eye movement (NREM) instability are suggested as pathophysiological mechanisms. Differentiation from nocturnal seizures is important. Video EEG and polysomnography facilitate differential diagnoses and rule out precipitating factors. Behavioral therapies as well as improving sleep quality are essential in controlling the events. There is limited evidence on pharmacological treatments, but benzodiazepine and tricyclic antidepressants are commonly used. Legal and societal implications are vital to note due to complexity of the motor movements involved with the parasomnia.