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Sleepwalking (Somnambulism)

Is a Sleep Disorder characterized by walking or other activity while seemingly still asleep.  Sleepwalking (Somnambulism) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.  Sleepwalking is a rapid eye movement (REM) behavior disorder occurring in the dream stage of sleep. During this phase, the body releases a chemical that paralyzes the body. However, those who sleepwalk do not have this chemical trigger, hence the behavior.

 

Symptoms and Features:

  • Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in pre-pubertal children.
  • difficulty in arousing the patient during an episode
  • amnesia following an episode
  • episodes typically occur in the first third of the sleep episode
  • polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
  • other medical and psychiatric disorders can be present but do not account for the symptom
  • the ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors.
  • Fatigue (which is not the same as drowsiness), 
  • stress and 
  • anxiety 

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. Rapid eye movement (REM) sleep is a different type of sleep, in which the eyes move rapidly and vivid dreaming is most common. During a night, there will be several cycles of non-REM and REM sleep. Sleep walking (somnambulism) most often occurs during deep non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning.

In children, the cause is usually unknown but may also be related to fatigue, prior sleep loss, or anxiety. In adults, sleep walking is usually associated with a disorder of the mind but may also be seen with reactions to drugs and/or medications and alcohol, and medical conditions such as partial complex seizures. In the elderly, sleep walking may be a symptom of an organic brain syndrome or REM behavior disorders.

The sleep walking activity may include simply sitting up and appearing awake while actually asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer.

One common misconception is that a sleep walker should not be awakened. It is not dangerous to awaken a sleep walker, although it is common for the person to be confused or disoriented for a short time on awakening. Another misconception is that a person cannot be injured when sleep walking. Actually, injuries caused by such things as tripping and loss of balance are common for sleep walkers.

Sleep walking occurs at any age, but it occurs most often in children aged 6 to 12 years old. It may occur in younger children, in adults, or in the elderly, and it appears to run in families.  Sleepwalking (somnambulism) is fairly common, especially among children. An estimated 15 percent of all children between the ages of 5 and 12 have walked in their sleep at least once, and most outgrow the disorder. Typically, the child (or adult) sleepwalker sits up, gets out of bed, and moves about in an uncoordinated manner. Less frequently, the sleepwalker may dress, open doors, eat, or go to the bathroom without incident and usually will avoid obstacles. But sleepwalkers don't always make their rounds in safety. They sometimes hurt themselves, stumbling against furniture and losing their balance, going through windows, or falling down stairs.

In children, sleepwalking is not believed to be influenced by psychological factors. 
In adults, it could indicate a personality disturbance.

Usually, it is enough for parents of sleepwalkers to provide their children with emotional support. They should also lock windows and doors and make sure the child does not sleep near stairways and potentially dangerous objects. For severe cases, a doctor may prescribe drugs.

Medical reports show that about 18% of the population are prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age.  Sleepwalking can have a genetic tendency. If a child begins to sleepwalk at the age of 9, it often lasts into adulthood.

For some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in harm to the patient or others. In its most severe form, the episodes occur almost nightly or are associated with physical injury.  The sleepwalker may feel embarrassment, shame, guilt, anxiety and confusion when they are told about their sleepwalking behavior.

Amnesia is another danger that usually follows a sleepwalking episode. Sleepwalkers usually remember little to nothing. But there are times sleepwalkers have a vague memory of an episode where they think they were being burned, buried alive, caught under a roof or trying to escape a dangerous situation. Sleepwalking primarily occurs in young children and is more prevalent in boys than girls.

Sleepwalking episodes can range from sitting up in bed to walking, and can even lead to frantic attempts to escape as if threatened or fleeing. During an episode, a sleepwalker exhibits behaviors such as sitting up with glassy eyes, picking at the blankets, making body movements and walking around the house. Sleepwalkers may also urinate, defecate or avoid looking at another person who attempts to communicate with them. Exiting through a window is not an uncommon practice, either.

Homicide or suicide during sleepwalking has rarely been reported when a person has tried to awaken a sleepwalker.

Sleepwalking can be treated with drugs, but hypnosis has also proven to be successful on a short-term basis.

An important component in dealing with this disorder is to make the environment as safe as possible, such as having sleepwalker's bedroom on the ground floor, removing hazardous items from the house, locking windows and placing an alarm on the bedroom door.

It is very important that if the sleepwalker exits the house, or is having frequent episodes and injuries are occurring -- DO NOT delay, it is time to seek professional help.

In a few instances, sleepwalking can result in violent behavior. It is very important that a chronic sleepwalker seek professional help.  

Treatment:
There are some things a sleepwalker can do:

  • Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
  • Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; stress can be another trigger for sleepwalking.
  • Remove anything from the bedroom that could be hazardous or harmful.
  • The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.

An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary.

Hypnosis has been found to be helpful for both children and adults.

An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.

Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or considerably reduces them.

 

 

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