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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Sleep-walking

Have you ever dreamed that you got out of bed whilst asleep at night, got changed, did all the naughty things that you normally dared not do, and enjoyed yourself with whatever fantasy you had? When someone knocked on your door and complained of what you had done, you told him you were innocent for you were sleep-walking. What in fact is sleep-walking?

Sleep-walking, technically known as somnambulism, is more common in children, and is estimated to occur in 15 per cent of normal children. They may sit up in their beds or get out of bed and walk around in the bedroom, then go back to sleep. Some sleep-walkers may carry out some simple activity they do daily. Some may get dressed, open doors, open and close drawers, or use the bathroom without knowing it. Their eyes саn see where they
are going but they are not in focus, and their activities are poorly coordinated and primitive. If they are spoken to, they may reply in single words or just utter some murmur. They carry out simple tasks that do not require any decision or intellectual thinking. One оf my patients told me his girlfriend was making a cup of coffee one night whilst sleep-walking. Sleep-walkers аррear to be in a trance. However, it is definitely impossible to carry out naughty activities that you normally do not dare do. Any complicated behaviour is not performed by the sleep-walker. After they wake up the next

morning, they will not remember that they have been sleep-walking. This is because sleep-walking occurs during NREM sleep, and we have no memory or thoughts during NREM sleep.

What about the mechanics of sleep-walking? Millions of years ago, mankind had a primitive brain that could do simple tasks without much thinking, including activities such as eating, walking, etc. After years of evolution, the brain attained a thinking and much more intellectual part. During NREM sleep, the thinking part is truly at rest, as shown by the EEG However, the primitive part can still be partially awake. For some reasons unknown to us, the primitive part of the brain carries out these primitive activities automatically during sleep-walking. The sleep-walker appears to have the ability to dissociate the two parts of the brain during sleep. This ability of dissociation is important when a person is going into hypnosis. It is known that a sleep-walker can go into hypnosis much more easily than someone who does not sleep-walk.

Most children who sleep-walk gradually grow out of it. As they grow older, their sleep becomes less deep. Most sleep-walkers are not suffering from any form of serious illness in the brain. If there is a sleep-walker in your house, he should be protected from any possible injury; try to put away sharp objects and block off the stairs at night to prevent the sleep-walker from accidentally injuring himself. If he is found sleep-walking, do not try to wake him up, as he will be quite confused. Just take him back to his bed and he will continue to sleep again. Sleep-walking, in general, does not require treatment, as it generally disappears as a person gets older.

Sleep-talking

‘Joan, darling, I am going to see you soon’: the husband was repeating this whilst asleep. Next morning his wife Pat was very angry as she had overheard this other woman’s name; a big scene followed. The husband could not think of anyone he knew called Joan, and explained that it must have been Joan Collins, as she was to be on television that night.

In fact, this is extremely rare. People who sleep-talk do not confess any secrets that they would not say whilst awake. The accuracy of these messages in sleep-talking are always in doubt. Sleep-talking can happen during both REM and NREM sleep. Some experts report that talk during REM sleep is often charged with emotion, relating to the contents of the dreams taking place. In contrast, talk during NREM sleep is deficient of any emotional content.

Normally sleep-talking consists of simple phrases or single words,

such as ‘Yes, that is it’, ‘No, oh, no’, or ‘Well done’. Sleep-talking is more common in children and is normally quite harmless. There is no need for any treatment.

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