SLEEPWALKING(SOMNAMBULISM)

Sleepwalking is a disorder that occurs when a person walks or does another activity while they are still asleep.

Causes

The normal sleep cycle has distinct stages, from light drowsiness to deep sleep. During rapid eye movement (REM) sleep, the eyes move quickly and vivid dreaming is most common.

Each night people go through several cycles of non-REM and REM sleep. There are five stages of sleep. Stages 1, 2, 3 and 4 are characterized as non-rapid eye movement (NREM) sleep. REM (rapid eye movement) sleep is the sleep cycle associated with dreaming as well as surges of important hormones essential for proper growth and metabolism. Each sleep cycle (stages 1,2,3,4 and REM) last about 90-100 minutes and repeats throughout the night. The average person experiences four to five complete sleep cycles per night. Sleepwalking most often occurs during deep, non-REM sleep (stage 3 or stage 4 sleep) early in the night. If it occurs during REM sleep, it is part of REM behavior disorder and tends to happen near morning.

The cause of sleepwalking in children is usually unknown. Fatigue, lack of sleep, and anxiety are all associated with sleepwalking. In adults, sleepwalking may be associated with:

• Mental disorders
• Reactions to drugs and alcohol
• Medical conditions such as partial complex seizures

In the elderly, sleepwalking may be a symptom of an organic brain syndrome or REM behavior disorders.
Sleepwalking can occur at any age, but it happens most often in children aged 4 - 8. It appears to run in families.

Symptoms

When people sleepwalk, they may sit up and look as though they are awake when they are actually asleep. They may get up and walk around, or do complex activities such as moving furniture, going to the bathroom, and dressing or undressing. Some people even drive a car while they are asleep.
The episode can be very brief (a few seconds or minutes) or it can last for 30 minutes or longer. If they are not disturbed, sleepwalkers will go back to sleep. However, they may fall asleep in a different or even unusual place.
Symptoms of sleepwalking include:

• Eyes open during sleep
• May have blank look on face
• May sit up and appear awake during sleep
• Walking during sleep
• Performing other detailed activity of any type during sleep
• Not remembering the sleep walking episode when they wake up
• Acting confused or disoriented when they wake up
• Rarely, aggressive behavior when they are awakened by someone else
• Sleep talking that does not make sense

Exams and Tests

Usually, people do not need further examinations and testing. If the sleepwalking occurs often, the doctor may do an exam or tests to rule out other disorders (such as partial complex seizures).
If you have a history of emotional problems, you also may need to have a psychological evaluation to look for causes such as excessive anxiety or stress.

Treatment

Some people mistakenly believe that a sleepwalker should not be awakened. It is not dangerous to awaken a sleepwalker, although it is common for the person to be confused or disoriented for a short time when they wake up.
Another misconception is that a person cannot be injured while sleepwalking. Sleepwalkers are commonly injured when they trip and lose their balance.

Self-Care at Home

A person who has a sleepwalking disorder can take the following measures:

• get adequate sleep;
  
  
• meditate or do relaxation exercises;
  
  
• avoid any kind of stimuli (auditory or visual) prior to bedtime;
  
  
• keep a safe sleeping environment, free of harmful or sharp objects;
  
  
• sleep in a bedroom on the ground floor if possible to prevent falls and avoid bunk beds;
  
  
• lock the doors and windows;
  
  
• remove obstacles in the room, tripping over toys or objects is a potential hazard;
  
  
• cover glass windows with heavy drapes; and
  
  
• place an alarm or bell on the bedroom door and if necessary on any windows.

Medical treatments

If sleepwalking is caused by underlying medical conditions, for example, gastroesophageal reflux, obstructive sleep apnea, periodic leg movements (restless leg syndrome), or seizures; the underlying medical condition should be treated.
Medications for the treatment of sleepwalking disorder may be necessary in the following situations:

• when the possibility of injury is real;
  
  
• when continued behaviors are causing significant family disruption or excessive daytime sleepiness; and
  
  
• when other measures have proven to be inadequate.

Medications

Benzodiazepines, such as estazolam (ProSom), or tricyclic antidepressants, such as trazodone (Desyrel), have been shown to be useful. Clonazepam (Klonopin) in low doses before bedtime and continued for three to six weeks is usually effective.
Medication can often be discontinued after three to five weeks without recurrence of symptoms. Occasionally, the frequency of episodes increases briefly after discontinuing the medication.

Other remedies

Relaxation techniques, mental imagery, and anticipatory awakenings are preferred for long-term treatment of persons with sleepwalking disorder.

• Relaxation and mental imagery should be undertaken only with the help of an experienced behavioral therapist or hypnotist.
  
  
• Anticipatory awakenings consist of waking the child or person approximately 15-20 minutes before the usual time of an event, and then keeping him or her awake through the time during which the episodes usually occur

Outlook (Prognosis)

Sleepwalking usually decreases as children get older. It usually does not indicate a serious disorder, although it can be a symptom of other disorders.
It is unusual for sleepwalkers to perform activities that are dangerous. However, you may need to take care to prevent injuries such as falling down stairs or climbing out of a window.

Possible Complications

The main complication is getting injured while sleepwalking.

Prevention

• Avoid the use of alcohol or central nervous system depressants if you sleepwalk.
• Avoid getting too tired and try to prevent insomnia, because this can trigger a sleepwalking episode.
• Avoid or minimize stress, anxiety, and conflict, which can worsen the condition.

  
  

  Please Note

  Please discuss the condition with your doctor if:
  
• You also have other symptoms
• Sleepwalking is frequent or persistent
• You perform potentially dangerous activities (such as driving) while sleepwalking.

  
  

  Sleepwalking At A Glance

  
  
  
  
  
  
  
• Sleepwalking is not a serious disorder, although children can be injured by objects during sleepwalking.
  
  
• Although disruptive and frightening for parents in the short-term, sleepwalking is not associated with long-term complications.
  
  
• Prolonged disturbed sleep may be associated with school and behavioral issues.
  
  
• The outlook for resolution of the disorder is excellent