SLEEP DISORDERS: NIGHT TERROR AND BED-WETTING
Night terror
This condition is rare and is related to sleep-walking. Sleeping young children may suddenly scream hysterically at the top of their voices as if they have seen something horrible. Their parents rush to their bedside and try to comfort them. These children have their eyes wide open but are not aware of the presence of their parents. They may push them aside and continue to act as if extremely frightened. After ten minutes or so they fall back into deep sleep again as if nothing had happened. In the morning they cannot remember any bad dreams or anything horrible.
Night terror is not to be confused with nightmares. Nightmares are bad dreams. Night terror is not a dream and occurs in stages 3 and 4 of NREM sleep. Just as in sleep-walking, dissociation between the primitive part and the intellectual part of the brain occurs and the child experiences some primitive emotion such as fear and goes into primitive screaming. Since they are in NREM sleep, they are not dreaming and will have no recollection of the experience.
Night terror is very alarming to parents, but in fact children who scream are not experiencing any horrible dreams. Do not try to wake them up during an attack of night terror because they will be quite confused and disorientated, making the experience worse. Just stay with them until they fall back into sleep spontaneously. If there are frequent attacks of night terror, the child must be seen by a doctor to make sure there is no source of pain or illness that may cause these terrible screams.
Bed-wetting
Bed-wetting at night during sleep is technically known as nocturnal enuresis. Bed-wetting is a nuisance to parents, and hence toilet training begins at an early age. After the age of four, when they start going to school, most children are dry at night. However there are some that continue to wet their beds at night even to a much older age.
In the past, a lot of people believed that children wet their beds while dreaming. Now, with the advent of the sleep laboratory, we are certain that they wet their beds during NREM sleep, especially in stages three and four of deep sleep. Children who sleep deeply lose control of their bladders in NREM deep sleep. As the children grow older, it is normal for them to sleep less deeply and this increases their bladder control. Ultimately, as these bed-wetters become older, bed-wetting cures itself.
Most parents seek medical advice if their children still bed-wet at about school age. The doctor will make sure there is no urine infection or sugar diabetes. Diabetes mellitus, having sugar in the urine, is known to cause excessive urination, although few sufferers of diabetes bed-wet. If the doctor is satisfied that there is no physical illness, normally no treatment is required before the age of eight, as bed-wetting is a self-limiting condition. We are quite sure that the majority of bed-wetters are of normal intelligence and parents need not be worried or concerned about their child’s future development. These children should be rewarded when they have a dry night, and when they have a wet night it should be ignored. Do not punish them, as this will only give them a feeling of guilt which may be harmful to their future personality and may make their bed-wetting worse.
If treatment is required, two methods are commonly used. The first is a medicine called imipramine. This can be given to children when they need to be dry for a night or more as when they stay overnight at a friend’s home or go away to a school camp. It is only a temporary measure, as relapse is common once the medicine is stopped.
A second well-known method is the pad and alarm system. This is an electrical device consisting of two electrical pads separated by a small piece of cloth, and it is placed under the bed sheet. When the child wets the cloth between the pads, a short circuit is created which switches on a battery-run alarm which then wakes the child up. This trains the child to wake up once bed-wetting begins. This training may take anything up to 12 weeks before bed-wetting stops.
Bed-wetting sometimes runs in families and seems to be an inherited characteristic. It has been shown that an identical twin has double the chance of bed-wetting if the other twin bed-wets. Bed-wetting can also be caused by emotional factors; for example the addition of a new baby to the family may be perceived as a threat to the older child. In these cases of stress induced bed-wetting, most of the children have been dry for a period of months or years after toilet training, but bed-wetting begins again when they experience emotional stress. This is called secondary bed-wetting and is commonly stress related. This is less common than primary bed-wetting, in which the child has not gained bladder control at night since birth.
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