Sleep Wake Transition Disorders

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Head Banging and Body Rocking

Rhythmic movement disorders such as nocturnal head banging (jactatio capitis nocturna), body rocking, and head rolling typically occur in infants and toddlers as they are trying to fall asleep. They can be present in deep sleep and in wakefulness. They are more common in children with ID. They will typically remit by five years of age but may persist into adult life. Management relies on good sleep hygiene and padding the headboard so the rest of the house is not awakened. Rhythmic movement disorders that are not clearly associated with the sleep-wake transition state but persist through the night respond less well to behavioral management techniques; rarely, medications such as benzodiazepines may be helpful. There are occasional reports of head banging in adults.52

Sleep Starts/Hypnic Jerks

Vigevano's group used videorecordings to report repetitive sleep starts in children who also had epilepsy and tetraplegic cerebral palsy.53 These jerks occurred repetitively at the onset of sleep in clusters lasting several minutes, with arousal appearance on EEG but no jerk-related spike discharges. The authors emphasized the need to differentiate these sleep starts from epileptic seizures, particularly as the children also had epilepsy, so as to avoid excessive inappropriate antiepileptic medication. I have had personal experience of a child with Down syndrome who had recovered from West syndrome but presented for reevaluation of seizures in sleep. These proved to be sleep starts.

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