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Most childhood sleep disturbances occur only at certain ages, are temporary, and disappear as the child grows older. While annoying or frightening, they usually are not serious. In some cases, however, abnormal sleeping habits can be a sign of more serious problems requiring medical consultation.

Sleepwalking (somnambulism) is fairly common, especially among children. An estimated 15 percent of all children between the ages of 5 and 12 have walked in their sleep at least once, and most outgrow the disorder. Typically, the child (or adult) sleepwalker sits up, gets out of bed, and moves about in an uncoordinated manner. Less frequently, the sleepwalker may dress, open doors, eat, or go to the bathroom without incident and usually will avoid obstacles. But sleep-walkers don't always make their rounds in safety. They sometimes hurt themselves, stumbling against furniture and losing their balance, going through windows, or falling down stairs.

In children, sleepwalking is not believed to be influenced by psychological factors. In adults, it could indicate a personality disturbance.

Usually, it is enough for parents of sleepwalkers to provide their children with emotional support. They should also lock windows and doors and make sure the child does not sleep near stairways and potentially dangerous objects. For severe cases, a doctor may prescribe drugs.

Night Terrors versus Nightmares

Night terrors (known as pavor nocturnus in children) are relatively short nocturnal episodes during which the child sits up in bed, emits a piercing scream or cry, looks frightened, and sweats and breathes profusely. Episodes usually occur between the ages of 4 and 12, are more common in boys than girls, and can be expected to disappear as the child grows older. Typically, they occur during the first third of the night. The disorder may progress to sleepwalking, but generally that only happens when the child is made to stand up. Later the child will forget the entire episode. Parents should comfort and provide warmth and support to children who experience night terrors. The condition does not indicate any personality disorder.

Nightmares, unlike night terrors, can be recalled afterward and are accompanied by much less anxiety and movement. These frightening dream experiences, which tend to occur at times of insecurity, emotional turmoil, depression, or guilt, can occur in all age groups. They are rarely accompanied by the anguished, terrified scream of the night-terror arousal. A person experiencing a nightmare will usually recount in detail a threat which ultimately led to the awakening. Some people rarely have nightmares, while others seem pre-disposed to them.

Bedwetting (enuresis) is a common childhood sleep disorder which, contrary to popular belief, is almost never emotionally or psychologically caused; less than 1 percent of bedwetting has an emotional source. About 5 to 17 percent of children aged 3 to 5 wet their beds; usually the condition will stop by the age of 4 or 5. However, a bedwetting child may feel guilty or ashamed. Waking the child up in the middle of the night or handing out punishments and rewards may only serve to increase the problem.
In most cases, the cause is unknown, but a congenitally small bladder, a bladder infection, or some other physical problem may be responsible. Bedwetting that continues into adolescence or adulthood may be attributed to emotional problems, but neurological disease or diabetes also can be the cause. If the disorder persists, a physician should be consulted. For some children, drugs or time away from home may be prescribed for short periods, such as a week at camp or a weekend with friends or relatives.

Help for Sleep Disorders

If your sleep is continually disrupted and you lack initiative and energy during the day, you should seek professional help. In most cases of sleep disorder, it's best to see your own physician first, in order to sort out the general nature and severity of a sleep problem. The physician may conduct a thorough physical examination, ask you questions about your sleep habits and emotional state, and can often determine whether the sleep difficulty is related to treatable causes. However, if necessary, a referral to a mental health specialist or facility, a sleep clinic, or a sleep disorders center may be made.

The same basic service is provided by both sleep clinics and sleep disorders centers. Generally, sleep clinics are set up as a part of hospitals. Sleep disorders centers may be associated with hospitals, medical centers, universities, or psychiatric or neurological institutes. Most clinics or centers primarily treat patients on referral from general practitioners and internists. However, it is possible to obtain information on specific sleep problems directly from a clinic or to make an appointment for a consultation.

Specialized sleep facilities usually have on their staffs experts called somnologists with training in a variety of medical and scientific fields. A sleep disorders team will often include a physician, a psychologist, a psychiatrist, and a surgeon.

Patients are typically seen as outpatients. They are interviewed thoroughly, given a battery of psychological tests and, if indicated, have their sleep patterns recorded in the laboratory for one night (sometimes two or three consecutive nights) to determine the cause of the sleep disturbance. Fees vary, depending on the clinic or center. An entire analysis can range from a few hundred to about a thousand dollars. Insurance companies or Medicare may cover some of the cost. (This can be determined by consulting the center or your insurance company.)

Special sleep facilities are scattered throughout the country. Your physician or nearest hospital should be able to help you locate the nearest sleep clinic or center.