الفهرس 
NORMAL HUMAN SLEEPOnly 14 pages are availabe for public view
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Abstract
Until the 80ies, parents, clinicians, and researchers have paid relatively little attention to sleep disorders in children. Parents rarely ask for help until the problem has become chronic and the whole family is suffering. Clinicians have tended to fall back on the use of medication as the only way of relieving problems, although research on efficacy has been equivocal (Mindell et al., 1999).
The child may be getting sufficient sleep and be functioning quiet well. The parents may not be. Two brief waking at night cannot be considered abnormal, but if a parent must quickly cover the child each time and if the parent cannot return to sleep quickly, the parent has a complaint. In childhood, many sleep patterns are possible (early bedtime and early waking. Late waking, long naps and short night sleep, short naps and long night sleep, one long nap, several short naps) and these may all be variations of normal. The problem may come when the particular patterns occurring are ones that conflict with the desires of the parents (Ferber, 1995).
In preschool-aged children, sleep problems have been correlated with childhood behavior problems (Achenbach, 2005). In a study of healthy preadolescents, sleep problems were associated with an increased risk of learning and behavioral problems (Lavigne et al., 2000). Parenteral reports of sleep problems have also been associated with several child psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), mental retardation, and childhood depression (Stien et al., 2001).
The parasomnias consist of clinical disorders that are not abnormalities of the processes responsible for sleep and awake states per se but, rather, are undesirable physical phenomena that occur predominantly during sleep. Parasomnias in children include most commonly: sleepwaking, night terrors, somniloquy, enuresis, sleep bruxism, and body rocking. Besides insomnia and frequent nocturnal awakenings, they are considered to be the most frequent sleep disorders of childhood reaching 70% in early childhood (Laberge et al., 2000).
Bedtime problems and night wakings in children are extremely common, and the treatment literature demonstrates strong empirical support for behavioral interventions. Most children respond to behavioral interventions, resulting not only in better sleep for the child, but also better sleep and improved daytime functioning for the entire family (Moore et al., 2008).
Disorders of arousal are the most impressive and most frequent of the NREM sleep phenomena. They share common features—patients have a positive family history, suggesting a genetic component; they tend to arise from slow-wave sleep (stage 3 and 4 of NREM sleep), therefore usually occurring in the first third of the sleep cycle (and rarely during naps); and they are common in childhood, usually decreasing in frequency with increasing age(Mahowald & Schench, 1998).
Confusional arousals (also termed sleep drunkenness) are often seen in children, and are characterized by movements in bed, occasionally, thrashing about, or inconsolable crying (Lamm, 2002).
Sleepwalking is prevalent in childhood (1%-17%), peaking at 11 to 12 years of age. Sleepwalking may be either calm or agitated, with varying degrees of complexity and duration (Lamm, 2002).
The sleep terror is the most dramatic disorder of arousal. It is frequently initiated by a loud, blood-curdling scream associated with extreme panic, followed by prominent motor activity such as hitting the wall, running around or out of the bedroom, sometimes resulting in bodily injury or property damage. A universal feature is inconsolability. Complete amnesia for the activity is typical, but may be incomplete. Although usually benign, the behaviors may be violent, resulting in considerable injury to the victim or others or damage to the environment, occasionally with forensic implications (Laberge et al., 2000).
Treatment of sleep disorders in pediatrics often is not necessary. Reassurance of the event’s generally benign nature, lack of psychological significance, and their usual tendency to diminish over time, often is sufficient. Benzodiazepines (clonazepam) or tricyclic antidepressants (imipramine) may be effective, and should be administered if the behaviors are dangerous to person or property or extremely disruptive to family members. Nonpharmacologic treatment such as psychotherapy, progressive relaxation, hypnosis, or anticipatory awakening is recommended for long-term management. Avoidance of potential triggering factors such as drugs, alcohol, and sleep deprivation also is important (Mahowald, 2002b).
Rhythmic movement disorder (RMD) refers to a group of behaviors characterized by stereotyped movements (Rhythmic oscillation of the head or limbs, head banging, or body rocking during sleep) seen most frequently in childhood and, rarely, in adults. It has been seen to arise from all stages of sleep. The cause is unknown, and no predictably effective pharmacologic or behavioral treatment has been reported. Benzodiazepines and tricyclic antidepressants may be tried. Rarely, RMD may be the sole manifestation of a seizure (Mahowald & Schenck, 1998).
Bruxism (teeth grinding),intermittent grinding, or clenching of the teeth during sleep may occur during any stage of sleep. Recent studies indicate that bruxism may actually represent a symptom of a number of different disorders, including simple bruxism, orofacial dyskinesia, mandibular dystonia, and tremor. There is little support for previously proposed causes that are local (malocclusion), systemic, psychological, occupational, and developmental. Proposed treatments are legion and invalidated. Formal sleep studies to rule nocturnal seizures are indicated in individuals who experience significant oral damage (Ohayon et al., 2001).
Primary nocturnal enuresissometimes presents significant psychological problems for children and their parents. Causative factors may include maturational delay, genetic influence, difficulties in waking and decreased nighttime secretion of antidiuretic hormone. Anatomic abnormalities are usually not found, and psychologic causes are unlikely. Evaluation of enuresis usually requires no more than a complete history, a focused physical examination, and urine specific gravity and dipstick testes. Nonpharmacologic treatments include motivational therapy, behavioral conditioning and bladder-training exercise. Pharmacologic therapy includes imipramine, anticholinergic medication and desmopressin. These drugs have been used with varying degrees of success (Jalkut et al., 2001).
Serious attention should be paid to sleep disorders complaints under these circumstances. Formal PSG studies, appropriately performed, provide direct or indirect diagnostic information in the majority of cases. That is more than academic interest because most of the conditions are readily treatable. Care must be taken to obtain the required studies; routine PSGs performed for conventional sleep disorders are inadequate. Multiple night studies may be required to capture an event (Mahowald & Schenck, 2000a).
In conclusion, many children suffering from sleep problems but these problems have a little attention from the parents and clinician till become chronic and the whole family is suffering. Sleep disorders in pediatrics have different types and need our good attention, diagnosis and treatment from the begining of the problem.