A 6-year-old boy is brought to the office due to frequent nighttime awakenings. Several times a week over the past month, he has come to his parents' bed around 3 AM, frequently crying, appearing frightened, and saying that he became lost in a crowd and couldn't find his parents. Although he is comforted by their reassurance, he refuses to return to his room and eventually falls back asleep in their bed. The boy is about to start first grade at a new school. He is healthy and developmental milestones are normal. Examination shows no abnormalities. The sleep stage associated with this child's frightening experience is characterized by which of the following?

Question

A 6-year-old boy is brought to the office due to frequent nighttime awakenings.  Several times a week over the past month, he has come to his parents' bed around 3 AM, frequently crying, appearing frightened, and saying that he became lost in a crowd and couldn't find his parents.  Although he is comforted by their reassurance, he refuses to return to his room and eventually falls back asleep in their bed.  The boy is about to start first grade at a new school.  He is healthy and developmental milestones are normal.  Examination shows no abnormalities.  The sleep stage associated with this child's frightening experience is characterized by which of the following?

Quizplus · Accepted Answer

This boy's recurrent awakenings with associated dream content and ability to be comforted are characteristic of nightmares, a common and developmentally normal experience for most children. Nightmares occur during rapid eye movement (REM) sleep and are more frequent in the final third of the night when REM periods become longer (Choice A). Children can often describe the nightmare, become fully alert after awakening, and are typically able to be consoled. In contrast, sleep terrors are a common non-REM parasomnia of childhood that occur during slow-wave sleep in the first third of the night. Unlike nightmares, the child with sleep terrors does not fully awaken, is unresponsive to comfort, and has no associated dream content. REM sleep is characterized by the defining feature of rapid eye movements, vivid dreaming, and voluntary muscle atonia due to inhibition of motor neurons. EEG activity during REM sleep is similar to the waking state, consisting of a combination of alpha, beta, and desynchronous EEG waves (sawtooth waves). (Choices B, D, and E) These EEG findings are characteristic of different sub stages of non-REM sleep (typically divided into 3 stages). Theta waves are seen in stage 1 (transition from wakefulness to sleep) and stage 2 (light, stable sleep). Sleep spindles and K complexes are characteristic of stage 2. Delta waves are characteristic of slow-wave sleep or deep sleep (stage 3). Non-REM arousal disorders (eg, sleep terrors) often occur in stage 3. Educational objective: REM sleep is characterized by dreaming and voluntary muscle paralysis, and occurs more often during the final third of the night. Nightmares occur during REM sleep and can be differentiated from sleep terrors, a non-REM parasomnia characterized by incomplete arousals and lack of recall of dream content. __________ References: REM sleep at its core - circuits, neurotransmitters, and pathophysiology. (http://www.ncbi.nlm.nih.gov/pubmed/26074874) Just a scary dream? A brief review of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder. (http://www.ncbi.nlm.nih.gov/pubmed/24126984)

A 6-Year-Old Boy Is Brought to the Office Due to Frequent