Sleepwalking disorder



Sleepwalking Disorder 898
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Definition

Sleepwalking disorder, also called somnambulism, is characterized by repeating episodes of motor activity during sleep such as sitting up in bed, rising, and walking around, among others. The person appears to be awake because their eyes are usually open and they can maneuver around objects, but is considered asleep.

Sleepwalking disorder is one of several sleep disorders listed in the Diagnostic and Statistical Manual of Mental Disorders , often called DSM-IV-TR , produced by the American Psychiatric Association and used by most mental health professionals in North America and Europe to diagnose mental disorders.

Description

Sleepwalking episodes usually occur during the first third of the night during the deepest phase of sleep. The episodes can last anywhere from a few minutes up to one hour, with five to 15 minutes being average. Sleepwalkers appear to be awake but are typically unresponsive to individuals who attempt to communicate with them. Persons who sleepwalk typically have no memory or awareness of their actions or movement upon waking.

Causes and symptoms

Causes

There appears to be a genetic component for individuals who sleepwalk. The condition is 10 times more likely to occur in close relatives of known sleepwalkers than in the general public. These families also tend to be deep sleepers.

Sleepwalking may also be triggered by fever, which directly affects the nervous system, general illness, alcohol use, sleep deprivation, and emotional stress . Hormonal changes that occur during adolescence, menstruation, and pregnancy can be also be triggers for sleepwalking. Sleepwalking episodes are more likely during times of physiological or psychological stress.

Certain classes of medication have also been shown to precipitate sleepwalking episodes in some individuals. These include: Anti-anxiety or sleep-inducing drugs, antiseizure medications, stimulants, antihistamines, and anti-arrhythmic heart drugs.

Symptoms

The DSM-IV-TR specifies six diagnostic criteria for sleepwalking disorder:

  • Repeated episodes of rising from bed during sleep: These episodes may include sitting up in bed, looking around, and walking, and usually occur during the first third of the night.
  • Is unresponsive to attempts at communication: During sleepwalking, the person typically has eyes open, dilated pupils, a blank stare, and does not respond to another's attempts at communication. Affected persons typically are only awakened with great difficulty.
  • No recollection of the sleepwalking incident: Upon waking, the person typically has no memory of the sleepwalking events. If the individual does awaken from the sleepwalking episode, they may have a vague memory of the incident. Often, sleepwalkers will return to bed, or fall asleep in another place with no recall as to how they got there.
  • No impairment of mental activity upon waking: If an individual awakens during a sleepwalking episode, there may be a short period of confusion or disorientation, but there is no impairment of mental activity or behavior.
  • Causes significant distress to life situations: Sleepwalking causes significant disruption of social and occupational situations, or affects other abilities to function.
  • Not due to substance use or abuse: Sleepwalking disorder is not diagnosed if the cause is related to drug abuse, medication, or a general medical condition.

Demographics

Sleepwalking can occur at any age but is most common in children, with the first episodes usually between the ages of four and eight years. The peak of sleepwalking behavior occurs at about 12 years of age. Between 10 and 30% of children have had at least one episode of sleepwalking. Sleepwalking disorder is seen in only 1–5% of children and occurs more frequently in boys. Adults who sleepwalk typically have a history of sleepwalking that stems back to childhood. Sleepwalking events occur in approximately 1–7% of adults while sleepwalking disorder occurs in about 0.5%.

Diagnosis

The line that separates periodic sleepwalking from sleepwalking disorder is not clearly defined. Individuals or families most often seek professional help when the episodes of sleepwalking are violent, pose a risk for injury, or impair the person's ability to function. For a diagnosis of sleepwalking disorder to be made, the person must experience a significant amount of social, occupational, or other impairment related to the sleepwalking problem. Episodes that have a long history extending from childhood through adolescence and especially into adulthood are more likely to be diagnosed with sleepwalking disorder.

Since the individual cannot recall the sleepwalking activity, diagnosis by means of interview is of little benefit, unless it involves someone who has witnessed the sleepwalking behavior. The preferred method for accurate diagnosis is through polysomnography . This technique involves hooking electrodes to different locations on the affected person's body to monitor brain wave activity, heart rate, breathing, and other vital signs while the individual sleeps. Monitoring brain-wave patterns and physiologic responses during sleep can usually give sleep specialists an accurate diagnosis of the condition and determine the effective means of treatment, if any.

Sleepwalking disorder can be difficult to distinguish from sleep terror disorder . In both cases, the individual has motor movement, is difficult to awaken, and does not remember the incident. The primary difference is that sleep terror disorder typically has an initial scream and signs of intense fear and panic associated with the other behaviors.

Treatments

Treatment for sleepwalking is often unnecessary, especially if episodes are infrequent and pose no hazard to the sleepwalker or others. If sleepwalking is recurrent, or daytime fatigue is suspected to result from disturbed sleep patterns, polysomnography may be recommended to determine whether some form of treatment may be helpful. If stress appears to trigger sleepwalking events in adults, stress management, biofeedback training, or relaxation techniques can be beneficial. Hypnosis has been used help sleepwalkers awaken once their feet touch the floor. Psychotherapy may help individuals who have underlying psychological issues that could be contributing to sleep problems.

Medications are sometimes used in the more severe cases with adults. Benzodiazepines—anti-anxiety drugs— such as diazepam (Valium) or alprazolam (Xanax) can be used to help relax muscles, although these may not result in fewer episodes of sleepwalking. When medications are used, they are typically prescribed in the lowest dose necessary and only for a limited period.

Prognosis

Most cases of sleepwalking subside over time. Sleepwalking in childhood usually disappears without treatment by age 15. If sleepwalking episodes persist into early adulthood, treatment is recommended. With an accurate diagnosis and appropriate treatment, episodes of sleepwalking can be greatly reduced and, in some cases, eliminated.

Prevention

In children, sleepwalking is relatively common and is not cause for concern. The major risk associated with sleepwalking is accidental injury. Parents should take precautions to block stairways, lock windows, keep floors cleared of harmful objects, etc.

If taking certain medications, a medical condition, or exposure to significant stressors are suspected triggers of sleepwalking episodes, a doctor should be consulted for a complete assessment.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

Beers, Mark H., M.D., and Robert Berkow, M.D., eds. The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories,1999.

Hales, Diane., Robert E. Hales, M.D. Caring for the Mind: The Comprehensive Guide to Mental Health. New York: Bantam Books, 1995.

ORGANIZATIONS

American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901, (507) 287-6006 <http://www.assmnet.org/> .

American Psychiatric Association. 1400 K Street NW, Washington D.C. 20005. <http://www.psych.org> .

Better Sleep Council. 501 Wythe Street, Alexandria, VA 22314. (703) 683-8371. <http://www.bettersleep.org/> .

Health Communications.com. Sleep Channel. <http://www.sleepdisorderchannel.net/sleepwalking/index.shtml> .

Gary Gilles, M.A.



User Contributions:

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Jun 24, 2011 @ 2:02 am
Hello their my name is Chris Mikey Delong i sleepwalk quite often. What really scares me is that i remember every thing that i do its like my vision is very blurry, and also in the episode it seems like im talking but my mother says all i do is mumble what should i do?
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Jul 20, 2011 @ 8:08 am
my son just had an episode last night, with screaming, he's 22. never happened before as far as i know. things were pulled off the bookcase. so loud the dogs next door were barking. sleep terror?
Julie
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Sep 1, 2011 @ 6:06 am
About a month and a half ago I was concious sleep walking and fell down my flight of stairs(18 wood ones, ouch) got major brusies and a sprained ankle and part of my leg that has still no feeling in it. Sleep downstairs on my couch for about a month then tried upstairs again, a few days went by great,no problems. Then 2 days/nights ago I was about to do it again until my husband mananged to stop my just in the nick of time, I was at he top of the stairs when he got me... What could be wrong as I don't want to be afraid to sleep in my bedroom anymore?

Thank you
Ida
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Nov 15, 2012 @ 9:21 pm
I just had a sleepwalking episode earlier on.it was half vague to me.only thing i remembered was that i keep looking at my watch a lot and doing my daily routine.like getting ready for work and all that.but i woke up and i was already in the train to work.and i was actually an hour late reaching the office.i did have sleepwalking problems when i was a child.it stopped during my late teens age.is there a possibility that sleepwalking could come back when i'm already at the age of reaching thirty's now
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Aug 7, 2013 @ 5:17 pm
I sleepwalk , play out my dreams ( I have many different dreams during the night) and mostly all are terror dreams, talk and hit my husband/boyfriend (but i donot know it is my husband/boyfriend in my dreams it is someone else that is trying to hurt me),but I am doing all this as I dream. I kick out at the person in my dreams and hit them with my fist I have many different nightmares during the night when I am a sleep. It is getting so scary for me to go to sleep as I remember most of my dreams when I wakeup. but I do not remember hitting the person. My Husband/boyfriend yells my name and then I usually wake up, but the moment I fall back to sleep I start dreaming a new dream which I again react to with sleep walking, talking and hitting. During some of my dreams, at times I can not seem to get out of bed as I feel like I have MS and have a great deal of terror while sleeping. Last night I gotup to find the phone to call 911 in my sleep walking and I stopped and woke up again when my husband/boyfriend yelled at me to ask me what was I doing? I need help desperately to stop my sleep walking, talking, kicking, hitting each night I go through this.

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