Sleep-Wake Transition Disorders

Sleep-wake transition disorders occur in the transition from wakefulness to sleep or vice versa. Because these disorders most often occur in otherwise healthy persons, they are considered variants of normal physiology rather than indicators of pathophysiology. The term rhythmic movement disorders is preferred to the term head banging. Sleep starts, body rocking, sleep talking, and nocturnal leg cramps also are included in this category. Klackenberg (1982) reported that at age 9 months, 58% of infants exhibited at least one of these repetitive behaviors (head turning, head banging, or rocking). The prevalence of these activities decreased to 33% by age 18 months and to 22% by age 2 years. When intense rocking or head banging persists and is disruptive, parents may view the behavior as a problem. Most often, providing guidance and support for the parent suffices. The only concern should be in securing the child's safety from self-injury.

Conclusions

In this chapter I have attempted to describe the assessment, phenomenology, and treatment of the more common childhood sleep disorders. The disorders have been viewed in a developmental framework from infancy to adolescence and placed in the structure of sleep-wake state organization. The large majority of dyssomnias that affect infants, children, and adolescents can be diagnosed from a careful history and physical examination. Sleep logs are useful to place a disorder in a temporal and chronological context as well as to gauge severity and the efficacy of treatment. Sleep laboratory investigations should be considered for all dyssomnias that are characterized by excessive somnolence. The dyssomnias associated with some neurological diseases and with developmental delay often respond better to behavioral management strategies than to hypnotic medications. Those sleep disorders that are associated with primary psychiatric or medical conditions have not been reviewed specifically. Treatment of the primary condition often leads to improvement of the sleep problem. The principles reviewed for the management of primary dyssomnias also can be useful for such secondary dyssomnias.

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