Sleepwalking

Overview

Sleepwalking, also known as somnambulism, is a parasomnia disorder characterized by getting up and walking around while in a state of sleep. It typically occurs early in the night and can last several minutes, but can sometimes last longer. Sleepwalking is more common in children than adults and is usually outgrown by the teen years. Isolated incidents of sleepwalking often don't signal any serious problems or require treatment. However, recurrent sleepwalking may suggest an underlying sleep disorder.

Understanding the disease

Symptoms

The symptoms of sleepwalking include:

1. Getting out of bed and walking around
2. Sitting up in bed and opening eyes
3. Having a glazed, glassy-eyed expression
4. Difficulty waking up during an episode
5. Being disoriented or confused for a short time after being awakened
6. Not remembering the episode in the morning
7. Daytime symptoms of excessive sleepiness or problems functioning Sleepwalking can also involve routine activities, such as getting dressed, talking, or eating, and may sometimes lead to leaving the house, driving a car, engaging in unusual behaviors, or experiencing sleep terrors. Sleepwalking can also result in injury, violence, or confusion upon waking or during the sleepwalking episode.

Risk Factors

The risk factors for developing sleepwalking include genetics, age, and certain underlying conditions or medications. Sleepwalking appears to run in families, and it's more common if one or both parents have a history of the disorder. Sleepwalking occurs more often in children than adults, and onset in adulthood is more likely related to other underlying conditions. Other factors that may contribute to sleepwalking are sleep deprivation, stress, fever, sleep schedule disruptions, travel, or sleep interruptions, as well as underlying conditions affecting sleep such as sleep-disordered breathing or substance use.

Development

Sleepwalking develops as a parasomnia, which is an undesirable behavior or experience during sleep. It is classified as a disorder of arousal, meaning it occurs during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Sleepwalking is more common in children than adults, but recurrent sleepwalking in adults may suggest an underlying sleep disorder or coexist with other sleep disorders or medical conditions. Several factors can contribute to sleepwalking, including sleep deprivation, stress, fever, sleep schedule disruptions, travel, or sleep interruptions. Sleepwalking can also be triggered by underlying conditions that interfere with sleep, such as sleep-disordered breathing or taking certain medications. In a sleepwalking episode, a person may get up and walk around, sit up in bed, have a glazed expression, not respond or communicate with others, and be difficult to wake up. They might be disoriented or confused for a short time after being awakened and may not remember the episode in the morning. Some people may also perform routine activities, such as getting dressed or talking, during sleepwalking episodes. If sleepwalking is causing problems with daytime functioning or safety concerns, such as injury or leaving the house, it is important to consult a healthcare professional.

Assessment and Diagnosis

Triage

You should see a doctor if sleepwalking episodes:

1. Occur often - for example, more than one to two times a week or several times a night
2. Lead to dangerous behavior or injury to the person who sleepwalks or to others
3. Cause significant sleep disruption to household members or the person who sleepwalks
4. Result in daytime symptoms of excessive sleepiness or problems functioning
5. Start for the first time as an adult
6. Continue into your child's teen years Additionally, consult a doctor if sleepwalking is accompanied by sleep terrors or other unusual behaviors, such as urinating in inappropriate places, leaving the house, driving a car, or engaging in sexual activity without awareness.

Diagnosis

To diagnose sleepwalking, your doctor will likely review your medical history and symptoms. A physical exam may be conducted to rule out other conditions such as nighttime seizures, sleep disorders, or panic attacks. Your doctor may also discuss your sleep behaviors and ask about any family history of sleepwalking. In some cases, a nocturnal sleep study (polysomnography) may be recommended to monitor your sleep patterns and behavior.

Management and Treatment

Complications

Complications of sleepwalking can include:

1. Hurt oneself: A person who sleepwalks may hurt themselves by walking near furniture, stairs, or wandering outdoors. They may also eat inappropriate things during an episode or engage in other unusual behaviors.
2. Prolonged sleep disruption: Frequent sleepwalking can lead to excessive daytime sleepiness, which may cause school or behavior issues.
3. Driving or operating heavy machinery: If a sleepwalker attempts to drive a car or operate heavy machinery during an episode, it can be dangerous for both the individual and others around them.
4. Injury or death: In severe cases, sleepwalking can result in injuries or even death if the person falls, jumps from a window, or engages in other dangerous behaviors during an episode. It's important to take precautions to protect a sleepwalker from potential harm and to seek medical advice if sleepwalking becomes a frequent or persistent issue.

Treatment

Treatments for sleepwalking are typically focused on managing underlying causes and minimizing the risk of injury during episodes. Since many factors can contribute to sleepwalking, addressing these factors can help reduce the frequency and severity of sleepwalking episodes. Here are some treatments to consider:

1. Maintain a regular sleep schedule: Establishing a consistent sleep routine can help regulate sleep patterns and reduce the likelihood of sleepwalking.
2. Create a safe sleep environment: Remove any potential hazards from the sleeping area, and consider using bed alarms or door alarms to alert you if your child or someone else sleepwalks.
3. Address underlying medical conditions: If sleepwalking is linked to sleep-disordered breathing, restless legs syndrome, GERD, or other medical conditions, treating these underlying issues may help alleviate sleepwalking episodes.
4. Manage stress and sleep deprivation: Reducing stress and ensuring adequate sleep can help prevent sleepwalking episodes.
5. Avoid alcohol and certain medications: Refrain from consuming alcohol or taking hypnotics, sedatives, or other medications that may trigger sleepwalking episodes.
6. Consider cognitive-behavioral therapy: In some cases, cognitive-behavioral therapy (CBT) may be recommended to address the underlying causes of sleepwalking, such as stress or poor sleep habits.
7. Consult a medical professional: If sleepwalking persists or becomes a significant concern, consult a healthcare provider or sleep specialist for further evaluation and guidance. Remember that the best approach to treating sleepwalking may vary depending on the individual and underlying causes. It's essential to work with a healthcare professional to determine the most appropriate course of action.

Preparing for medical consultation

To prepare for an appointment for sleepwalking, you can:

1. Keep a sleep diary for two weeks before your appointment to help your doctor understand your sleep schedule, factors affecting your sleep, and when sleepwalking occurs.
2. Make a list of any symptoms experienced, including any that may seem unrelated to the reason for the appointment, key personal information, all medications, vitamins, herbs, or other supplements you're taking, and the dosages, and questions to ask your doctor.
3. Gather information about your sleepwalking episodes, including when they occur and any triggers or underlying conditions that may contribute to the sleepwalking.
4. Consider bringing a family member or friend to the appointment who can provide additional information about your sleepwalking.
5. Be prepared to discuss any stressors or mental health concerns that may be contributing to your sleepwalking. Remember to share your concerns about safety and any issues related to sleepwalking with your doctor. They can help you identify appropriate treatment options and make lifestyle changes to reduce the risk of injury or disruption.