![]() The most common confusional behavior syndromes are sleep terrors and sleep walking. In older teenagers, alcohol intake and sleep deprivation must also be taken into consideration. It has also been hypothesized that stress or anxiety could be an added trigger. The health problem brings the child very abruptly from the deep sleep to a near awakening. One hypothesis is that the other health problem (fever, sleep-disordered-breathing as an example) already disturbs sleep, particularly when the child is trying to go to deep sleep. It was also shown that another sleep disorder such as sleep-disordered-breathing and to a lesser extent restless legs syndrome or nocturnal asthma may be seen in association with the confusional behaviors. It was shown that fever, abrupt sleep loss, migraine, irregular sleep-wake schedules can be more associated with these events. It seems that a small disruption of sleep due to another cause, such as a health problem or travel, may elicit behaviors associated with confusional arousals. There may be periods where a child has several episodes during a single night and then go several weeks without a single episode. Usually only one episode occurs during the night and often it is within the first 2 hours of falling asleep However, there are always exceptions to this rule. For example, a child may go into a closet looking for the bedroom door, or may go into a closet and urinate before returning to bed. The complex behaviors may seems goal oriented or they may be poorly directed. The child may quietly walk around the bedroom or rush around in highly agitated state hitting the furniture. Finally, very complex behaviors such as sleep walking are possible. However, more elaborate behaviors are also possible, for example crying loudly in distress, inconsolable and ignoring the reassurance of the parents, seemingly “very far away.” The child may even exhibit aggressive behavior against parents that want to reassure the child and trying to escape an embrace. Simple behaviors would include mumbling during sleep or sitting up in bed then falling right back asleep. Various behaviors can occur during sleep ranging from simple to complex activities. There is usually little or no recall of the arousal or any event that may had occurred during the episode the next morning or even 10 to 30 minutes later if the child is to awaken completely. They can be relatively unresponsive to solicitations from parents as well as from other environmental challenges. However, the child simultaneously appears to be disoriented, and confused. On one hand, the child may appear to be alert by crying very loudly, moving, or even running. During such an episode, the child presents features suggestive of being simultaneously awake and asleep. ![]() This stage shift will commonly lead to a confusional state or a “confusional arousal”. Most commonly the child transitions from deep sleep to a mixture of very light sleep and/or partial wakefulness. The “arousal” is a partial arousal usually from “deep” sleep also called “slow wave sleep”. Arousal does not mean that the child wakes-up. Arousal disorders are common in children.
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