Confusional arousals are associated with what appear to be sudden awakenings -- the child acts confused and disoriented. The child will frequently sit up, look around the room, and possibly moan or have inappropriate speech or behavior.
Despite appearing awake, they are still asleep. Attempts to communicate with the child will be unsuccessful (unless the child should fully awaken). The events tend to last for several minutes. Afterward, the child will lie back down and resume normal sleep. These events are very common in children under five years old.
Sleep terrors can be very frightening events for the parents. They have many aspects in common with confusional arousals, but they are associated with the child screaming and looking terrified.
An increased heart rate, rapid respirations, sweating, and dilated pupils are frequently described. Despite appearances, the child is still asleep.
Children will frequently push away family members who are trying to comfort them; they might even become more agitated by this interaction.
As with confusional arousals, the episodes will end as spontaneously as they began. If the child should awaken from one of these events, he or she will have no recollection of the episode and will not be able to identify any “precipitating dream”.
This is in contrast to nightmares (which originate from REM sleep and occur later in the evening), for which the child can usually describe their dreams in detail.
Sleep terrors can last for up to several minutes and may be associated with sleep walking. The overall incidence is 3 percent in children. They usually occur between four and 12 years old with a peak incidence around age eight.
Sleep walking (somnambulism) is walking while asleep. Sleep walking is frequently staggered and clumsy, with the child having a blank expression on his or her face. The episode can be more than just walking; patients have been noted to do complicated or bizarre maneuvers such as opening doors and going outside, climbing out windows, or turning on the gas in the kitchen.
As with sleep terrors, trying to awaken the child can frequently be associated with combative behavior. Episodes can last as long as 30 minutes but are usually shorter. Sleep walking is very common, with an overall incidence of between 1 to 15 percent (15 to 40 percent of children will do it at least once in their lifetime, and 3 to 4 percent of children will have frequent episodes).
Peak incidence occurs between four and eight years old. There is also an increased incidence of sleep talking reported in patients who sleep walk (a 30 percent incidence in sleep walkers versus 5 percent in the general population). Many children with sleep walking report having had confusional arousals when younger.