What are abnormal nocturnal movements?
It is not uncommon for people to move in their sleep. Most people will change positions four to six times a night (i.e., back, side, and belly). However, frequent, regular, and repeated movements may be the sign of a sleep disorder. Movements which are provoked by discomfort, pain or numbness are also abnormal.
What if my baby makes jerking movements in sleep or hits the crib?
Normal babies will have a jerking motion on sleep onset which is referred to as a hypnic jerk or “sleep start.” It will appear that the baby has suddenly been startled. Typically, it will be a sudden extension of their arms with a slight arching of the head. Some babies may also sigh. The baby will then continue to sleep with no further movements. This is perfectly normal and can also rarely be seen in adults. On the other hand, if the baby also arches their back and has a more prolonged episode, this may be due to infantile spasms. These are associated with hormone deficiencies, epilepsy or Turner syndrome. As these can be treated with steroids and other medications, it is important that children with this suspected problem have a thorough evaluation with a Sleep Specialist, Pediatrician or Pediatric Neurologist or Epilepsy Specialist.
In the first few weeks of a baby’s life, they may also experience benign nocturnal myoclonus. This is a small very brief jerking movement that can recur episodically through the night on one side of the body (sometimes alternating to the other side of the body). These will generally resolve with time and usually do not require further evaluations. On the other hand, if a child displays repeat, rhythmic movements that are prolonged (more than a few seconds), then they should undergo further evaluation for seizures or epilepsy. If the baby or child has a loud cry or other vocalization with events, then further evaluation should also be undertaken.
After the first few months of life, babies can demonstrate other sleep disorders related to movement. One of the more common ones is body rocking or head rolling. This is a rhythmic sideward or rocking motion of the trunk of the body or rolling the head side to side. This will occur immediately prior to sleep and may last for fifteen minutes or less. There are no injuries to the child, and the behavior usually stops when the child achieves sleep. The above-mentioned movement disorders usually resolve by age four. One of the more disruptive rhythmic sleep behaviors seen in children is head banging. Infants and children will repeatedly strike their head against the crib or bed boards prior to the onset of sleep. These episodes usually last less than fifteen minutes. They can usually be disrupted by the parent or caregiver talking to them or touching them. It is important that these children have further evaluation, especially if the episodes are prolonged, to ensure that they are not injuring themselves and be evaluated to see if they need protective padding or a helmet. Few children may require sedating medication to control this behavior. Children with this disorder, or any prolonged or severe rhythmic movement disorder, should also be evaluated for autism.
What can I do if my child grinds their teeth?
Tooth grinding or bruxism (microarousal with rhythmic mastication, or brief awakening and chewing) is a fairly common sleep disorder which can be seen in both children and adults. It may be discovered either by a parent or guardian hearing a gnawing sound when the child is asleep, or by noticing a flattening of the front teeth due to the constant friction of the grinding. This is usually treated with a plastic bite guard which is made by the Dentist and worn at night for sleep. However, severe cases can require medication.
What if my child complains of leg pain and discomfort with sleep?
Children as young as 9-10 years old can complain of leg discomfort and it may be described as “growing pains,” “bugs,” “creepy crawlies” or other sensation of restlessness and discomfort. This can be worse with prolonged sitting or lying in bed. It is also worse with caffeine intake. There is an irresistible urge to move, and the sensation improves with movement, especially walking. This syndrome is referred to as Restless Legs Syndrome, and it occurs during wakefulness when sitting still or at sleep onset. It is like Periodic Limb Movement Disorder or PLMS. PLMS, however, occurs during sleep and is manifested by repeatedly extending the toes and flexing the ankles. Children with either disorder should be thoroughly evaluated, as it can be associated with medication use, iron deficiency anemia, thyroid disease, kidney disease, vitamin D deficiency and other disorders. Warm compresses or ibuprofen may help, although severe cases may require medications which increase dopamine. Dopamine agents are usually used as a last resort, as they carry a risk of daytime sleepiness, tolerance requiring dose-escalation, and malignant melanoma (skin cancer). Treatment is usually considered when children are having moderate to severe disruption of their deep sleep, as seen on a sleep study or polysomnogram, which results in excessive daytime sleepiness with the associated disruption of growth, attention span and behavior or mood as described in the previous section.