Child will sit up and look around, appearing strange and confused for a few seconds to minutes (as if they don't know where they are) before falling back to sleep. Spells may occasionally last longer, and your child may become agitated or get out of bed to move around during the spells.

Child will get out of bed and walk. Complex behavior like walking out of the room or house, and even driving can be seen. Occasionally, children may urinate in odd places and the sleepwalker may become violent.

Diagnosis/ treatment: see below

A piercing scream or cry is heard as your child sits up in bed, associated with sweating, pounding of the heart and intense fear. These spells last only seconds to a few minutes. Occasionally it may last longer up to 40 minutes. Sometimes scary images can be seen during these spells and the child may get up and walk around.

These spells are seen in up to 40% of children and can be very disturbing for the parents. The children however, usually fall back to sleep and will have partial or no memory of what happened when they wake up in the morning.

Diagnosis/ treatment: see below

Unlike other NREM parasomnias, SRED is more common in adults (average age of onset 22 - 29 years) and is more common in women (65 – 80%). It is an ongoing and long-lasting problem. Spells consist of preparing and eating food during sleep. This includes out of control eating and drinking behavior, involving consumption of high-carbohydrate and high-fat foods. Many people with SRED have episodes of eating almost every night. Rarely, even inedible and toxic items are eaten.

Weight gain, obesity and other health issues may be seen depending on their eating pattern. Sedative medications such as Zolpidem occasionally precipitate these spells. Other underlying sleep conditions such as sleep apnea, restless legs, and irregular sleep wake cycles may be present.

If these spells are frequent, medication treatment will be required.

Evaluation by a Sleep Specialist is required for appropriate diagnosis and treatment. If possible, record events with a camera or cell phone to show your doctor. They will be very helpful in understanding your events. Occasionally, further testing like a sleep study, epilepsy monitoring or an MRI of brain may be required to make a correct diagnosis.

Although these spells can be disturbing, most children will eventually outgrow them.

Strategies to manage NREM parasomnias (confusional arousals, sleepwalking, sleep terrors and SRED)

1. Avoid triggers which precipitate these conditions like:
    a. Irregular sleep wake schedule or sleep loss. This can happen during travel, and may also occur
    when your child starts school due to change in their sleep-wake pattern and restriction of nap time.
    b. Stress
    c. Illness like fever, cough, cold, loose stools.
    d. Substances like alcohol, cigarettes and certain medications.

2. If children are having an event, don't try to wake them up, or force them to go back to bed, especially if they are agitated. If you do this, they may become violent. Instead, try to lead them back to bed by placing a reassuring hand on their shoulder.  

3. Safety issues: if these spells are occurring frequently:
     a. keep all sharp or dangerous objects away from their reach.
     b. Don't keep their bed next to the window or allow them to sleep at a height (top bunk bed).
     c. Keep alarms on the doors so if they try to go out of the room or house, you will know.  

4. Most cases will improve with a regular sleep wake schedule and by correcting potential underlying cause of arousals. Sometimes a benzodiazepine medication may be required.