Sleepwalking


Sleepwalking

Description, Causes and Risk Factors:

Sleepwalking is a sleep disorder that causes people to get up and walk while sleeping.

Episodes of sleepwalking typically occur when a person is in the deep stages of sleep. The sleepwalker is unable to respond during the event and does not remember sleepwalking. In some cases, sleepwalking is associated with incoherent talking.

Several different factors may be involved in the development of sleepwalking. These may include genetics (traits that run in families), environmental, and medical conditions. Sleepwalking is not associated with other sleep problems, sleeping alone in a room or with others, fear of the dark, or anger outbursts.

Causes and Risk Factors:

Genetics: Sleepwalking occurs more frequently in identical twins, and is 10 times more likely to occur if a first-degree relative has a history of sleepwalking. Therefore, it is thought the condition can be inherited.

Environmental Factors: Certain factors may cause a person to sleepwalk, such as:

    Sleep deprivation.

  • Chaotic sleep schedules.

  • Stress.

  • Alcohol intoxication.

  • Drugs such as sedative/hypnotics (drugs that promote relaxation or sleep), neuroleptics (drugs used to treat psychosis), stimulants (drugs that increase activity), and antihistamines (drugs used to treat symptoms of allergy)

Medical Conditions: Medical conditions that have been linked to sleepwalking include:

    Arrhythmias (abnormal heart rhythms).

  • Fever.

  • Gastroesophageal reflux (food or liquid regurgitating from the stomach up into the food pipe).

  • Nighttime asthma.

  • Nighttime seizures (convulsions).

  • Obstructive sleep apnea (condition in which breathing stops temporarily while sleeping).

  • Psychiatric disorders, for example, posttraumatic stress disorder, panic attacks, or dissociative states, such as multiple personality disorder.

Sleepwalking itself is very common, particularly amongst children but it is not uncommon for adults to also have episodes of sleepwalking. Sleepwalking most commonly first occurs between the 4 to 8 years of age when about 20% will experience episodes. In school-aged children, sleepwalking is more common in boys than in girls. Childhood sleepwalking also often occurs with bed wetting. In adults, sleepwalking incidences are less common than with children but about 2.5% of adults will sleepwalk.

Despite the commonness of sleepwalking in children, only about 1-5% of children meet the diagnostic criteria of sleepwalking disorder. Childhood sleepwalking can continue into adulthood as many adults with sleepwalking disorder had episodes during childhood. Only about 0.5% of adults meet the diagnostic criteria for a sleepwalking disorder.

Symptoms:

    Episodes range from quiet walking about the room to agitated running or attempts to "escape." Patients may appear clumsy and dazed in their behaviors.

  • Typically, the eyes are open with a glassy, staring appearance as the person quietly roams the house. They do not, however, walk with their arms extended in front of them as is inaccurately depicted in movies.

  • On questioning, responses are slow with simple thoughts, contain non-sense phraseology, or are absent. If the person is returned to bed without awakening, the person usually does not remember the event.

  • Older children, who may awaken more easily at the end of an episode, often are embarrassed by the behavior (especially if it was inappropriate). In lieu of walking, some children perform repeated behaviors (for example, straightening their pajamas). Bedwetting may also occur.

  • Sleepwalking is not associated with previous sleep problems, sleeping alone in a room or with others, achluophobia (fear of the dark), or anger outbursts.

  • Some studies suggest that children who sleepwalk may have been more restless sleepers when aged 4-5 years, and more restless with more frequent awakenings during the first year of life.

Diagnosis:

Sleepwalking disorder is a type of parasomnia sleep disorder defined by the Diagnostic and Statistical Manual of Mental Health Disorders fourth Edition (DSM IV). Patients must meet these criteria to be diagnosed with a sleepwalking disorder:

    Sleepwalking episodes occur repeatedly. Sleepwalking involves getting out of bed while still asleep and most frequently occurs in the first third of the sleep cycle.

  • During the sleepwalking episodes, the person must be unresponsive, has a blank facial expression, and cannot be awaken easily.

  • Once woken, the person does not recall the sleepwalking episode.

  • Once woken, the person returns to normal cognitive functioning within a few minutes.

  • The sleepwalking episodes are not caused by external factors such as drugs or a medical problem.

  • The sleepwalking episodes cause significant impairments or distresses to functioning, such as socially or at work.

Treatment:

Treatment for sleepwalking disorder is not always necessary, particularly in children where it is likely that they will outgrow the disorder. Often, the foremost concern for treating sleepwalking disorder is preventing any possible harm which could be caused by the sleep activities, such as by clearing clutter from the floor of the sleepwalker's room, keeping doors locked, and securing windows shut. In adults, preventing possible harms from sleepwalking activities can be more complex - particularly if the adult is engaging in activities like sleep driving or preparing meals. In these cases, creative measures may be employed to reduce risk of harm - such as hiding car keys.

One of the most effective methods of preventing sleepwalking is waking the person before the sleepwalking episode begins. To do this, the activity of the sleepwalker must be analyzed until the regular time of the episode can be determined. Then the sleeper is awoken about 15 minutes before the episode is likely to begin and required to remain awake for a minimum of 5 minutes before going back to sleep. This method has proven very effective in children. It is also recommend that children be encouraged to empty their bladders before going to bed as a full bladder may trigger sleepwalking.

For severe cases of sleepwalking disorder, a doctor may prescribe medications such as sedatives, hypnotics or antidepressants. Behavioral therapy focusing on sleep hygiene can also help reduce sleepwalking episodes. If an underlying mental health condition is suspected of causing the sleepwalking disorder, then treatment may involve psychotherapy or other methods of treating this disorder.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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