Sleepwalking disorder is a condition that is characterized by walking asleep. The activity that a sleep walker usually does during the episode is not limited to just merely walking in a sleep-like state, but it also involved cruising along the stairs, rising from bed and walking around, go out of doors, eat snacks, cleaning, dressing or undressing. The sleepwalking disorder is also called somnambulism characterized by repeated episodes of motor activity during sleep. The sleepwalker may appear to be awake with their eyes opened, but they are considered to be asleep. They often show a blank stare on their face and when they are awakened the person will seldom remember the details of their sleepwalking.
Sleepwalking disorder is a form of parasomnia or sleep disorder associated with wakefulness while the sleepwalker is asleep or in a sleep-like state. Nocturnal sleepwalking occurs where in each episode the person is unconscious about their actions to the level where the memory of sleepwalking can be recalled hence the disorder can occur unnoticed unless someone awakens the sleepwalker. It is common to find sleepwalking children and it can be a normal occurrence at some point and most children usually outgrows their sleepwalking episodes. Somnambulism in adults, however can be chronic and may last for many years. The sleepwalking episode may be brief in seconds or few minutes, but some may last as long as 30 minutes or more. The average duration of the episode is between 5 to 15 minutes.
The activities of a sleepwalker
A person who is sleepwalking can performing some activities unconsciously such as the following:
- Driving cars
- Committing murder
- Engagement to sexual intercourse
- Walking up and down the stairs
- Cleaning the house
Injuries may occur while sleepwalking. Most common are falling from stairs, tripping or loss of balance, stumbling on furniture and go through windows. Sleepwalking in children may occur from age 6 to 12 and it is a condition that is fairly common in this age group. A sleepwalking disorder in children is usually not influenced by psychological factors, but it indicates a personality disturbance in adults.
Why a person sleep walks
The main cause why a person sleep walk may be a mystery to the many of us, but there are different factors that are viewed to influence the behavior. This includes factors such as caused by the environment, drug intake, diseases, sleep deprivation and genetics. Sedative or hypnotics are believed to stimulate sleep and relaxation, causing a person to be in a state of deep sleep. Neuroleptics used for treating psychosis can also produce the same side effects with long term use. Other drugs believed to stimulate sleepwalking are stimulants and antihistamines.
The presence of disease or medical condition can also trigger the cause for sleepwalking. This includes fever, nighttime asthma, arrhythmia, gastroesophageal reflux, obstructive sleep apnea, nighttime seizures, psychiatric disorders such as panic attack, post traumatic stress disorder and multiple personality disorder. Genetic factors are also suspected to increase the risk to sleepwalking. The disorder is highly prevalent in twins and those with first degree relatives having sleepwalking problems. These families are also known to be deep sleepers.
The sleepwalking disorder in children is often unknown, but the condition may be related to fatigue, stress, anxiety and sleep loss. Sleep walking in adults is usually associated with mind disorders and is caused by a reaction to alcohol or drugs as well as other medical conditions. Sleepwalking in the elderly may be a symptom of an organic brain syndrome or disorder in the REM behavior.
Identifying the sleepwalking symptoms
Sleepwalkers usually manifest the following symptoms:
- Eyes are open during sleep
- Walking during sleep
- May have blank facial expression
- May sit up and appear awake during sleep
- No recall of the event upon awaking
- Confusion, disorientation on awakening
- Sleep talking is incomprehensible and non-purposeful
- Blank stares with eyes open as the person roams the house
- Episodes may range from quiet walking to agitated running
- The response is slow and absent on questioning.
- When the person returns to bed without awakening the person has no recollection of the event.
- Older children usually are embarrassed by their behavior. They usually awaken easily at the end of the episode.
- The condition is not associated with previous sleep problems
- There may be brief periods of confusion upon first awakening, but within minutes the patient's mental activity and behavior become normal and unimpaired.
- The symptoms can cause clinically important distress or can impair work, personal or social functioning.
How to diagnose sleepwalking
The diagnosis is based according to certain criteria that requires the person to show the following activities and symptoms:
- There are repeated episodes of rising from bed during sleep. The episode may occur during the first third of the night and may include sitting up in bed, looking around and walking.
- The person is unresponsive to attempts at communication. The person has dilated pupils, eyes open, blank stare and does not respond to communication. Affected persons are usually awakened with great difficulty.
- The sleepwalker has no recollection of the incident. There is no memory of the sleepwalking event and when the person wakes up they have a vague memory of the incident. The person may oftentimes return to bed or fall asleep to a different place without knowing how they get there.
- The condition causes distressing consequences such as disruption to the social and occupational situations and affects their ability to function.
- There is no impairment of mental activity upon waking.
- Sleepwalking is not caused by substance use or abuse. The condition is not diagnosed when the cause is substance-related or due to medication or any medical condition.
Sleepwalking disorder usually no longer needs polysomnogram or sleep study when diagnosing this type of sleep disorder. However, it can also be a helpful diagnostic tool to rule out other sleep disorders. The initial diagnosis for sleepwalking disorder usually involves a medical history and physical examination. These diagnostic procedures are often carried out in order to rule out other underlying medical problems and to make a differential diagnosis. The sleepwalker cannot recall their sleepwalking activity and interview is of little benefit unless the interviewee is someone else who have witnessed the sleepwalking behavior.
Can sleepwalking be treated?
There is actually no specific treatment for sleepwalking disorder. Oftentimes, treatment is no longer necessary unless the condition has distressing consequences. Treatment may consist of the following:
When the cause of sleepwalking disorder is due to stress the following management consist of:
– Stress management
– Relaxation technique
Psychotherapy is most suitable for individuals with underlying psychological issues that contribute to the sleep disorder. Medication treatment is only provided in severe cases in adults that involves the episodes of violence and disruptive activities. Common medications are prescribed for sleepwalking such as Benzodiazepine as an anti – anxiety drug (Diazepam, Alprazolam), Tricyclic antidepressant, Prosom, Klonopin and Trazodone. Medication is often discontinued after several weeks without any sleepwalking recurrence. It should also be noted that sleepwalking increases after the medication is discontinued.
Other forms of treatments include mental imagery and anticipatory awakenings which is the preferred treatment option for long term treatment of sleepwalking disorder. This consists of waking up the person about 15-20 minutes before the usual time of sleepwalking occurrence.
If you think that sleepwalking becomes bothersome make sure to see a doctor to help you overcome the problem and to avoid causing any disruptive changes on your sleep pattern.