National Sleep Foundation

Chapter 6: Parasomnias

A Case Study in Parasomnias

Patient History and Examination: Marc, a healthy 10-year-old, is referred to the sleep clinic due to frequent sleep terrors.

History of Present Illness: None relevant

Past Medical History: None relevant

Social History: The patient’s parents are concerned that the sleep terrors will interfere with their son’s upcoming adjustment to summer camp.

Family History: None relevant

Review of Sleep Pattern: Marc awakens 2-4 times per week screaming, sweating, and wildly flailing his arms. This usually occurs when his parents are going to bed. They report that he experiences a few minutes of “raw terror,” starting with a piercing scream, after which he calms down and falls asleep again within 5 minutes. Marc does not recall the sleep terrors when he wakes up.

Evaluation and Diagnosis: A lab evaluation ruled out nocturnal epileptic phenomena and obstructive sleep apnea. During the evaluation, however, Marc showed 2 minor arousals during which he abruptly awakened from delta sleep, sat up with a blank stare, and then returned to sleep. Because disorders of arousal are often vastly attenuated when recorded in the sleep lab, these two arousals, supporting Marc’s history, led to the diagnosis of an arousal disorder (sleep terror).

Treatment and Follow-up:  The patient’s parents were advised that such sleep terrors usually are benign and will disappear with increasing age, but are aggravated when Marc does not get plenty of sleep. A 2-mg dose of diazepam was prescribed as a prophylactic measure to be taken at bedtime while at camp. Marc experienced only one mild sleep terror at camp. Discontinuation of diazepam after camp led to a reappearance of sleep terrors. During the fall, they gradually diminished to less than two per month, reappeared dramatically when he was transferred to a new school, and then disappeared completely within the next two years.