Sleepwalking

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Sleepwalking
Synonyms	Somnambulism, noctambulism
Pronounce	N/A
Specialty	N/A
Symptoms	Walking or performing other complex behaviors while asleep
Complications	Injury, sleep deprivation
Onset	Childhood
Duration	Episodes typically last a few minutes
Types
Causes	Sleep deprivation, stress, fever, certain medications
Risks	Family history, sleep deprivation, stress
Diagnosis	Clinical diagnosis, polysomnography
Differential diagnosis	REM sleep behavior disorder, night terrors, epilepsy
Prevention	Good sleep hygiene, reducing stress
Treatment	Ensuring safety, medication in severe cases
Medication	Benzodiazepines, antidepressants
Prognosis	Generally good, often resolves with age
Frequency	Affects 1-15% of the general population
Deaths	N/A

Sleepwalking, also known as somnambulism or noctambulism, is a phenomenon that combines sleep and wakefulness. It is a sleep disorder classified within the parasomnia family. Sleepwalking occurs during the slow-wave sleep stage, with individuals performing activities that are typically done while fully conscious. These activities can range from harmless actions like talking or walking to more dangerous ones, such as cooking, driving, or even violent gestures and homicide.

Characteristics

Sleepwalking typically occurs during slow-wave sleep (N3) of non-rapid eye movement sleep (NREM sleep) cycles, generally within the first third of the night. Sleepwalking is characterized by:

• Partial arousal during NREM sleep
• Dream content that may or may not be recalled when awake
• Dream-congruent motor behavior that may be simple or complex
• Impaired perception of the environment
• Impaired judgment, planning, and problem-solving

The sleepwalker's eyes are open but may appear as a glassy-eyed stare or blank expression, and their pupils are dilated. They are often disoriented upon awakening, with confusion fading within minutes. Sleepwalkers may talk during episodes, but their speech typically does not make sense to observers. The extent of amnesia associated with sleepwalking varies, from no memory to vague memories or a complete narrative.

Associated Disorders

In the study "Sleepwalking and Sleep Terrors in Prepubertal Children," it was discovered that children with another sleep disorder, such as restless leg syndrome (RLS) or sleep-disordered breathing (SDB), had a higher likelihood of sleepwalking. The study found that children with chronic parasomnias often also had SDB or, to a lesser extent, RLS. Moreover, the disappearance of parasomnias after treating SDB or RLS suggests that these conditions may trigger parasomnias. Sleepwalking may also accompany night terrors, particularly in children. During night terrors, the affected person may wander in a distressed state while still asleep, and there have been reports of sufferers attempting to run or aggressively defend themselves during these incidents. In some cases, sleepwalking in adults may be a symptom of a psychological disorder. Patients with migraine headaches or Tourette Syndrome are 4–6 times more likely to sleepwalk.

Consequences

Most sleepwalkers have injuries at some point during sleepwalking, often minor injuries such as cuts or bruises. In rare occasions, however, sleepwalkers have fractured bones and died as the result of a fall. Sleepwalkers may also face embarrassment if found naked in public.

Causes

The cause of sleepwalking is unknown. A number of unproven hypotheses are suggested for why it might occur, including:

• Delay in the maturity of the central nervous system
• Increased slow-wave sleep
• Sleep deprivation
• Fever
• Excessive tiredness

There may be a genetic component to sleepwalking. One study found that sleepwalking occurred in 45% of children who have one parent who sleepwalked, and in 60% of children if both parents sleepwalked. Thus, heritable factors may predispose an individual to sleepwalking, but expression of the behavior may also be influenced by environmental factors. Genetic studies using common fruit flies as experimental models reveal a link between night sleep and brain development mediated by evolutionary conserved transcription factors such as AP-2. Sleepwalking may be inherited as an autosomal dominant disorder with reduced penetrance. Genome-wide multipoint parametric linkage analysis for sleepwalking revealed a maximum logarithm of the odds score of 3.14 at chromosome 20q12-13. This suggests that a gene for sleepwalking may be located in this region of chromosome 20. Other factors that may contribute to sleepwalking include alcohol consumption, sedative agents (including sedative hypnotics), certain medications, medical conditions, and mental disorders. Sleepwalking can also be triggered by stress, anxiety, and sleep deprivation.

Diagnosis

There is no specific diagnostic test for sleepwalking. The diagnosis is usually based on a detailed history provided by the patient or the patient's family. A sleep study, or polysomnography, may be helpful in identifying other sleep disorders that could contribute to sleepwalking, such as sleep apnea. The American Academy of Sleep Medicine (AASM) includes sleepwalking in the International Classification of Sleep Disorders (ICSD) as a NREM-related parasomnia.

Treatment

In many cases, no treatment is necessary for sleepwalking, as the episodes are usually harmless and decrease in frequency over time. However, if sleepwalking is causing distress or risk of injury, some treatments may be recommended, including:

• Sleep hygiene: Maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and ensuring a comfortable sleep environment can help reduce sleepwalking episodes.
• Medication: In some cases, medications such as benzodiazepines or antidepressants may be prescribed to help manage sleepwalking. However, these medications should be used with caution, as they can have side effects and may not be suitable for everyone.
• Psychotherapy: Cognitive-behavioral therapy (CBT) or other forms of therapy may help address underlying psychological issues contributing to sleepwalking.
• Hypnosis: Some studies have found that hypnotherapy can be an effective treatment for sleepwalking, particularly in adults.

Prevention

To minimize the risk of injury during sleepwalking episodes, it is important to make the sleep environment safe. This may include:

• Removing sharp or dangerous objects from the bedroom
• Placing soft materials on the floor near the bed
• Locking doors and windows
• Installing gates at the top of staircases
• Using an alarm or bell on the bedroom door to alert others when the sleepwalker leaves the room.
• In addition to these safety measures, addressing any underlying sleep disorders or medical conditions that may contribute to sleepwalking is essential for prevention.

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