An episode may begin with movements and moaning and then progress to agitated and confused behaviour with crying, calling out or thrashing about. This type of arousal disorder occurs mainly in infants and toddlers, perhaps most of whom have such episodes to some degree. In predisposed individuals, the arousal may be precipitated by such factors as a febrile illness, central nervous system depressant medication sometimes combined with alcohol, sleep loss or disruption in which SWS is increased (as in some other sleep disorders such as obstructive sleep apnoea) or psychological stress. Often there is a strong family history of an arousal disorder. However, repeated episodes sometimes occur throughout the night. Usually, only one episode occurs on the night in question, within two hours or so of going to sleep when SWS is most prevalent. The patient remains asleep during the episode itself, although waking sometimes at the end of it. Various behaviours can occur, from simply sitting up in bed and mumbling to rushing about in a highly agitated state.
Arousal in this context does not mean that the patient wakes up fully in fact, the arousal is partial, usually from deep non-rapid-eye-movement (NREM) sleep (otherwise known as slow wave sleep or SWS) to a lighter stage of NREM sleep or REM sleep. The so-called arousal disorders are common in children but are by no means rare in adults.
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