[Author Affiliation]Ozlem Ozcan. Department of Child and Adolescent Psychiatry, Inonu University Medical Faculty, Malatya, Turkey.Yunus Emre Donmez. Department of Child and Adolescent Psychiatry, Inonu University Medical Faculty, Malatya, Turkey.Address correspondence to: Yunus Emre Donmez, MD, Department of Child and Adolescent Psychiatry, Inonu University School of Medicine, Malatya, Turkey, E-mail: dryemredonmez@yahoo.comTo The Editor:Sleep terror is a parasomnia seen during nonrapid eye movement (NREM) sleep, and characterized by extreme terror, motor agitation, intense vocalization, and high levels of autonomic discharge (profuse sweating, mydriasis, tachycardia, and tachypnea). The episode usually lasts no more than a few minutes; afterward, the child usually relaxes and returns spontaneously to sleep. Sleep terrors are classified as arousal disorders by The International Classification of Sleep Disorders (ICSD-2) (American Academy of Sleep Medicine 2005; Provini et al. 2011).Sleep terror is reported to affect ∼ 3% of children and The etiology of sleep terror is not fully understood, and there is, to date, no clearly defined treatment for it. Different therapeutic strategies have been proposed for sleep terror such as a behavioral approach, reinforcing age-appropriate sleep patterns, reassuring and guiding parents, and pharmacotherapy (Weissbluth 1984). The most commonly used medications in the pharmacological treatment of sleep terror are benzodiazepines and antidepressants (Howell 2012).The purpose of this case report is to discuss the response of a 36-month-old male patient beginning treatment with melatonin after being diagnosed with sleep terror.Case ReportA 36-month-old male patient was brought to the child psychiatry clinic by his parents with complaints of a sleep disorder exhibited by the child waking up frequently at night. It was understood from the interview with his parents that the patient had had sleep problems since his birth; he slept well for 30 minutes to 1 hour during the daytime, and his parents rocked him to sleep at ∼10 pm. His parents stated that he shouted out agitatedly, screamed, and made gestures such as struggling ∼30 minutes after sleeping, had tachypnea, repeated such screams and actions four to five times at night, and then fell sleep again, and that he had a facial expression as if crying during moments of shouting, screaming, and struggling. According to the information obtained from the parents; the patient was an intended and planned baby, born after a stressful pregnancy, that he started to walk when he was 18 months old, started to talk when he was 24 months old, and had no health problem other than the sleep disorder.The mother described the patient as a warm-hearted child who shouted and insisted when he was angry. The patient had been taken care of by his babysitter during the daytime for the past 1.5 years; the 32-year-old university graduate mother described herself as a hot-tempered and intolerant person, and she stated that she received regular psychiatric support for manic-depressive disorder. The 32-year-old university graduate father had no psychiatric disorder, but had similar sleep problems when he was a child; the 8-year-old brother of the patient had short sleeping periods and had difficulty falling asleep.During the psychiatric evaluation, it was observed that the patient was dressed appropriately for his age and sociocultural level, and that his verbal and nonverbal communication was normal and his cognitive functions were consistent with his age. …
Read more
68