Sleepwalking (Somnambulism)
Miller-Keane
Medical Dictionary, 2000
Rising from bed and
walking during an apparent state of sleep
Much mystery has
been attached to this, although it is no more mysterious than dreaming. The
chief difference between the two is that the sleepwalker, besides dreaming, is
also using the part of the brain that stimulates walking. This usually occurs
during the first third of the night and lasts for a few minutes to a half hour.
It is most likely to happen during periods of emotional stress and usually
ceases when the source of anxiety is removed. Often it occurs only once or
twice and does not happen again. If sleepwalking recurs frequently, it may stem
from serious emotional distress.
Parasomnias
http://www.stanford.edu/~dement/para.html
Disorders that intrude into the sleep
process and create disruptive sleep-related events.
These behaviors and experiences occur
usually while sleeping, and are most often infrequent and mild. They may happen
often enough or become so bothersome that medical attention is required.
The parasomnias are divided into four
groups:
- arousal disorders
- sleep-wake transition disorders
- parasomnias usually associated with REM sleep
- other parasomnias
What are Arousal Disorders?
Arousal disorders are parasomnia disorders
presumed to be due to an abnormal arousal mechanism. Forced arousal from sleep
can induce episodes. The "classical" arousal disorders are
sleepwalking(somnambulism), sleep terrors and confusional arousals. Experts
believe the various types of arousal disorders are related and share some
characteristics. These arousals occur when a person is in a mixed state of
being both asleep and awake, generally coming from the deepest stage of
nondreaming sleep. This means a person is awake enough to act out complex
behaviors but still asleep and not aware or able to remember these actions.
What are the causes arousal disorders?
These disorders tend to run in families and
are more common in children. Being over tired, having a fever or taking certain
medications may make it worse. Because disorders of arousal are less common in
adults, having an evaluation is important. In some cases, these disorders are
triggered by other conditions, such as sleep apnea, heartburn,
or periodic limb movement
during sleep. A sleep specialist should evaluate the person's behaviors and
medical history.
How are arousal disorders treated?
If it is a severe case that leads to injury
or involves violence, excessive eating, or disturbs the bedpartner or family,
treatment by a sleep specialist may be necessary. Treatment might involve
medical intervention with perscription drugs or behavior modification through
hypnosis or relaxation/mental imagery.
Diagnostic Classification
Steering Committee, Thorpy MJ, Chairman. International Classification of Sleep
Disorders: Diagnostic and Coding Manual. Rochester, Minnesota: American Sleep
Disorders Association, 1990.
Kryger, Meir H., Roth,
Thomas, Dement, William C. Principles and Practice of Sleep Medicine, 2nd
Edition. Philadelphia, Pennsylvania: W.B. Saunders Company, 1994.
Parasomnias: Things That
Go Bump in the Night, A patient-education brochure. American Sleep Disorders Association,
1992
Confusional
Arousals - Sleep Inertia
Confusional arousals consist of confusion
during and following arousals from sleep, most typically from deep sleep in the
first part of the night.
Sleep Research Zurich Papers
- Abstracts 1995
Sleepwalking
(Somnambulism)
What is Sleepwalking?
A series of complex behaviors that are
initiated during slow wave sleep and result in walking during sleep.
What are the symptoms of Sleepwalking?
Ambulation (walking or moving about) that
occurs during sleep. The onset typically occurs in prepubertal children.
Associated features include:
- 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
How Common is Sleepwalking?
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.
How serious is Sleepwalking?
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.
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 from a sleep disorder center
in your area. There have been some tragedies with sleepwalkers, don't let it
happen to your loved one!
In a few instances, sleepwalking can result
in violent behavior. It is very important that a chronic sleepwalker seek
professional help and follow the suggestions listed below to prevent having any
violent episodes.
There was amurder trial in Arizona where
Scott Falater was accused of stabbing his wife 44 times and drowning her while sleepwalking.
If you would like to read about it, the Arizona Republic carried articles about
the trial. Several sleep specialists were expert witnesses for Scott. For
background information on the case, the Phoenix New Times did a very good story
on it. (6/15/99)
What can be done about sleepwalking?
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.