ICSD CLASSIFICATION FOR CONFUSIONAL AROUSALS:
- Subject or observer noted recurrent mental confusion upon arousal or awakening in the subject
- Spontaneous confusional episodes can be induced by forced arousal
- An absence of fear, walking behavior or intense hallucinations with events
- DPSG showing arousals from SWS
- The symptoms are not associated with any other medical condition
- The symptoms do not meet the diagnostic criteria for other sleep disorders
Precipitating factors: Sleep disordered breathing, sleep apnea, allergic rhinitis, restless sleep and periodic limb movement in sleep.
Complete history and physical examination. Usually does not require an overnight sleep study unless the cases are considered complicated. Videotaping may be helpful.
The key to treatment is accurate diagnosis. If events are rare and do not affect family dynamics treatment is not required. Reassurance is usually sufficient. Treatment should include avoidance of precipitating factors such as sleep deprivation and stress. Parents should be advised not to interfere with the event. Clear room of obstacles or safety hazards. If appropriate add additional locks to doors.
If the events have become disruptive and dangerous to the patient and family and no obvious precipitant is recognized then pharmacological management is an option.
First goal of management should be to get sufficient sleep as insufficient sleep can be a trigger for parasomnias.Address all precipitating factors as any triggers for arousal can predispose to parasomnia events.
Stress reduction and relaxation therapy, hypnosis. When significant psychopathology is identified then psychotherapy for the patient and possibly family should be considered
Benzodiazepines are effective for controlling parasomnias but the effectiveness may decrease over time and the events may return once medications are stopped. Tricyclic antidepressants can also be used
Most parasomnias will resolve without intervention but may take longer to clear up. Confusional arousals and night terrors tend to resolve though night terrors may occur even in adults. Sleep walking is more common in adults.