Jose has no problems falling asleep by himself at home. He sleeps in a crib in his own room, falling asleep without the presence of one of his parents. He typically bangs his head into the pillow while lying on his back. The family can observe his behavior with a video baby monitor and notes he does this at sleep onset and once or twice during the night after awakenings, though he is able to return to sleep. If they go into the room and speak to him, he will stop the head banging and try to get them to pick him up. They resist going into to his room and he will usually fall asleep within 15 minutes.
- Head banging or other rhythmic movements occur at sleep onset and after awakenings during the night. Children can cease the activity if requested. Medical conditions that disrupt sleep such as OSA or gastroesophageal reflux may increase awakenings and subsequent head banging. Body rocking is the most common rhythmic movement behavior, followed by head rolling and head banging. Most of these behaviors will resolve by age 5 years.
- Sleep related seizures can cause stereotypic movements and may occur only during sleep. Children cannot cease seizure activity upon command.
- Sleep starts are a singular movement at sleep onset so are not repeated like rhythmic movement behaviors. Periodic leg movements are repeated behaviors but do not involve large muscle groups as rhythmic movement behaviors do.
Jose is well rested in the morning and has appropriate napping behavior for his age.
- Rhythmic movement behaviors do not typically result in daytime sleepiness. Nocturnal seizures may also occur during wakefulness leading to what may appear as daytime sleepiness. PLMs/RLS may result in daytime sleepiness if sleep is sufficiently disrupted (see first case).
Jose will awaken once or twice a night and return to sleep within minutes with a repeat of his head banging behavior. Jose’s head banging does not awaken him but follows an awakening.
- Rhythmic movement behaviors will often be repeated throughout the night after awakenings.
- Nocturnal seizures can occur throughout the night with stereotypic behaviors noted.
- PLMs can also occur throughout the night but involve small muscle movements rather than movements of large muscle groups.
Jose has a consistent bedtime and wake time. He has a regular bedtime routine and enough time in bed to obtain adequate sleep.
- This history helps determine what might be causing symptoms of non-restorative sleep and daytime sleepiness if they are felt to be an issue. It is important to determine if a child has adequate for age sleep before attributing daytime sleepiness to an underlying sleep disorder.
Jose has mild snoring and restlessness noted during sleep.
- Screening for OSA is important as movements during sleep can be noted at the termination of respiratory events mimicking PLMs. Additionally, untreated OSA may result in awakenings and increased occurrence of rhythmic behaviors during sleep. Untreated OSA has also been linked to poorer control of seizures.