Table 1

Specific sleep conditions

Specific sleep conditionConsiderations
Partial arousal parasomnias
(confusional arousals, sleep terrors, sleepwalking):
Occurs between sleep states; accompanied by movement. Usually occurs at predictable times earlier in the night (generally before midnight).
Ensure safety measures (eg, window and door locks) for sleepwalkers. Warn that changes in the environment may confuse/be hazardous to children who may be able to navigate their way around the ‘known’ environment.
Frightening for families, but does not generally cause harm. Reassurance and explanation needed.
Obstructive sleep apnoea:
Snoring, gasping, pauses in breathing, daytime somnolence. Can be a contributing factor to enuresis.
Further assessment required which may include pulse oximetry, polysomnography and/or referral to appropriate specialist (eg, ENT, respiratory paediatrician or sleep service).
Restless legs syndrome:
Compelling feeling to move legs; associated with sensory symptoms for example, skin crawling, itching (difficult for child to describe).
Can be associated with iron deficiency; consider trial of iron treatment if ferritin <50 µg/L.
Often interpreted as ‘growing pains’.
Nocturnal pain and night-time sweating:
Waking complaining of pain/ache.
Report of significant sweating in sleep.
Common presentations, but potentially worrying therefore warrants evaluation.
Pain that is persistent, or not responsive to simple measures, may indicate pathological pain such as dental pain or malignancy.
Sleep hyperhidrosis may occur as commonly as in 11% of children;22 can be associated with obstructive sleep apnoea, atopy and parasomnias.
Usually a method of self-soothing (cf thumb-sucking); can be associated with moaning.
Needs reassurance, generally does not result in injury.
Delayed sleep phase in adolescents:
Significantly delayed sleep onset.
Some degree of circadian shift is physiological and normal in adolescence. Very disordered sleep patterns (eg, staying awake all night and sleeping in the morning) that are disruptive to everyday functioning warrant referral for specialist assessment.