Sleepwalking/Somnambulism: Causes, Diagnosis & Treatment

There is no generalized treatment for somnambulism and it doesn’t necessarily require medical treatment unless it is caused by an underlying medical problem.
The act of getting up and moving around while still asleep is referred to as sleepwalking or somnambulism.
The act of getting up and moving around while still asleep is referred to as sleepwalking or somnambulism. Pixabay

The act of getting up and moving around while still asleep is referred to as sleepwalking or somnambulism. Sleepwalking is more prevalent in children than adults, and is typically outgrown by adolescence. In most cases, the child/adult has no memory of getting up or participating in the activities as all the actions occur in N3 sleep.

Sleepwalking episodes that occur occasionally don't always indicate more significant issues or call for medical attention. However, recurrent sleepwalking might be a sign of a sleep disorder. It's important to safeguard any members of your family who sleepwalk from any possible harm.

Sleepwalking is a type of parasomnia, which is an unwanted non-deliberate motor or subjective phenomenon that occurs when a person awakens from sleep or transitions from wakefulness to sleep. Since sleepwalking is an arousal disorder, it takes place during the deepest stage of NREM sleep, known as N3 sleep (typically within an hour or two of falling asleep). Sleep terrors are another NREM disorder that can coexist with sleepwalking.

Sleepwalking episodes might be occasional or frequent, and last a few minutes on average but can last longer.

SYMPTOMS

  • Waking up in the middle of sleep and walking around with a dazed look

  • Not able to respond when spoken to or giving unclear answers

  • Difficult to wake up in the middle of an episode

  • Being briefly dazed or perplexed after awakening

  • Not able to recall the incident in the morning

  • Sleep talking or screaming

  • Inappropriate social behavior, such as urinating in closets

CAUSES

  • Hereditary: An individual may be more likely to experience somnambulism if either of the parents has a history of it.

  • Age: Sleepwalking is more common in children than in adults, and it is more likely to start in adults when there are other underlying disorders.

  • Disturbed sleep schedule or pattern

  • Lack of sleep

  • Migraine 

  • Head Injuries 

  • Medications like sleep-inducing pills

  • Having a full bladder before going to bed

  • Noise or change in sleeping environment/place

  • Prescription drugs that cause arousal (such as phenothiazines, chloral hydrate, and lithium) as well as other conditions (obstructive sleep apnea, distended bladder, loud noise)

The majority of cases are Idiopathic.

The act of getting up and moving around while still asleep is referred to as sleepwalking or somnambulism.
SLEEP PARALYSIS: Paranormal or disorder, Prevention & Treatment

Adult sleepwalking is a potentially dangerous condition that can lead to violent conduct, self-injury or harm to bed companions, disturbance of sleep, excessive daytime sleepiness, weariness, and psychological discomfort, all of which have an impact on the quality of life in terms of one's health.

A study led by Dr. Yves Dauvilliers (MD Neurology, Ph.D. neurosciences, Director of the sleep lab at Gui-de-Chauliac Hospital in Montpellier, France) was published in the journal SLEEP's March, 2013 issue, featured a prospective case-control investigation including 100 adult patients in whom primary sleepwalking was identified between June 2007 and January 2011. The sleepwalkers' ages ranged from 18 to 58, with 30 as the median age. A comparison of the results was made with 100 healthy control subjects.

According to the findings, 22.8 percent of sleepwalkers experienced nightly episodes, while 43.5% experienced weekly occurrences. Additionally, 58 percent had a history of aggressive sleep-related behaviors, with 17 percent of them having at least one event in which the sleepwalker or bed partner suffered injuries that needed medical attention. One person who jumped out of a third-floor window suffered several fractures and major head trauma in addition to reported bruises, nose bleeds, and fractures.

In the subjects with the sleepwalking disorder, a higher frequency of daytime drowsiness, fatigue, insomnia, depressive and anxiety symptoms, and reduced quality of life in patients was found as compared to the control group.

According to the study, factors that increase slow wave sleep (SWS) and NREM sleep instability are:-

  • stressful events, 

  • strong positive emotions, 

  • sleep deprivation, 

  • drug or alcohol intake, or

  • intense evening physical activity

“Sleepwalking is an underdiagnosed condition that may be clearly associated with daytime consequences and mood disturbances leading to a major impact on quality of life,” said Dauvilliers. “The burden of sleepwalking in adults needs to be highlighted and emphasized.

MedBound Times reached out to Dr Abhinav Singh for his insights on Sleepwalking.

Sleepwalking or somnambulism are events that are usually part of the cluster disorder of the arousal period. They indicate incomplete arousal from slow wave sleep or stage 3 typically in the first one-third of the night period. They occur frequently in kids than in adults and are often extinguished by adolescence. It's almost like being stuck between sleep and wake. You are neither asleep nor awake. And the characteristic feature includes a lack of screening and autonomic features. This is what differentiates sleepwalking from sleep terrors for example. Both children and adults with a history of sleepwalking should be questioned for signs of other sleep disorders. Something I.e. provoking them to get up in the middle of sleep with or without their knowledge. Behaviors can be simple or elaborate. Common ones include dressing up, walking, unlocking doors, and simple little tasks. Sometimes it can get dangerous and include walking far away from the home especially if you are in a high-rise building, even driving at times is being reported. Patients usually will have no memory of the event. They do not exhibit autonomic activations which you can see in night terrors and nightmares such as tachycardia, sweating, fear, etc. Again, anybody who frequently sleepwalks and finds himself in dangerous situations should be evaluated by a sleep professional.

Dr Abhinav Singh – MD, MPH, FAASM, D.ABIM-SM (Sleep Medicine) Facility Director, USA

DIAGNOSIS

  • Physical examination - Your doctor may do a physical examination to rule out any illnesses that could be mistaken for sleepwalking, such as panic attacks, nightly seizures, or other sleep disorders.

  • Discussion of your symptoms

  • Polysomnography - In some circumstances, your doctor might advise participating in an overnight sleep study. While you sleep, sensors attached to your body will record and keep track of your brain waves, blood oxygen levels, breathing, heart rate, and eye and leg movements. In order to record your actions during sleep cycles, you can be videotaped.

In some circumstances, your doctor might advise participating in an overnight sleep study. While you sleep, sensors attached to your body will record and keep track of your brain waves, blood oxygen levels, breathing, heart rate, and eye and leg movements. In order to record your actions during sleep cycles, you can be videotaped.
In some circumstances, your doctor might advise participating in an overnight sleep study. While you sleep, sensors attached to your body will record and keep track of your brain waves, blood oxygen levels, breathing, heart rate, and eye and leg movements. In order to record your actions during sleep cycles, you can be videotaped.Wikimedia Commons

TREATMENT

There is no generalized treatment for this and it doesn’t necessarily require medical treatment unless it is caused by an underlying medical problem. In children, it gradually goes away with time.

Treatment may include:-

  • Fixing your sleep schedule i.e going to bed at a fixed time daily and getting adequate sleep.

  • Try meditation and you can do calming activities before going to bed like reading books or maybe a piece of light music before sleep.

  • Avoiding alcohol.

  • If sleepwalking is an underlying cause of sleep deprivation, a sleep disorder, or another medical issue, treating the underlying illness may help.

  • If a certain drug is the cause of sleepwalking, the medication should be changed.

  • Drugs such as antidepressants, or BZDs like Estazolam, Trazodone, and Clonazepam may be prescribed by a doctor. After several weeks, medications can be discontinued without recurrence of sleepwalking 

  • One can consider therapy or counseling with a mental health practitioner who can offer recommendations for improving sleep, stress-reduction methods, self-hypnosis, and relaxation.

Consult your doctor if you have worries about your safety or underlying medical disorders and you sleepwalk. Your doctor may recommend a sleep specialist to you. If at all feasible, consider bringing a relative or close friend to help explain your sleepwalking.

References

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