confusional arousals

"Confusional arousal" is the term applied to a variant of night terrors in older infants and toddlers. These "arousal disorders" typically occur at the end of the first or second sleep cycle of the night, and reflect the fact that children often sleep so deeply that the normal awakening at the end of a sleep cycle is partially stifled or suppressed. The result is the child may groan and thrash around without actually awakening to full awareness.

As is the case with night terrors, confusional arousals happen in the first half of the night (although if there are several during the night, they may spill over into the second half of the night, too). They can last from 5 to 45 minutes, but usually subside after about 5 or 10 minutes. The episode may seem to subside, then start again.

If a child is having confusional arousals, he or she will begin with moaning, which typically progresses to crying, thrashing around, sitting or standing (as opposed to night terrors, which begin suddenly). A few recognizable words may be blurted out, but most of the child's utterances are unintelligible. When picked up, these kids arch and thrash around. With toddlers, the behavior can look a lot like a temper tantrum. Attempts to fully awaken the child are futile until the episode has run its course.

There is not much to do for confusional arousals. The child is asleep and not in any distress; attempting to awaken the child often makes the time needed to resettle to quiet sleep longer. If the child is overtired (and sleeps deeper as a result), the events are more likely to be triggered. Anything that upsets normal sleep rythmns (illness, travel, disrupted naps) tends to make arousal disorders more likely.

Ensuring adequate rest and regular sleep habits helps to reduce the chances of an attack. Behavioral waking episodes later in the night can aggravate confusional arousals earlier in the night, so elimination of these problem wakings can help reduce or eliminate confusional arousals. Medication can be tried if the arousals are very frequent and disruptive of family sleep. The tranquilizer clonazepam is most often used at bedtime for this problem (0.125-0.5 mg). It is given for a few weeks and then usually withdrawn without resumption of the attacks.

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