Sleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness family.[2] Sleepwalkers arise from the slow wave Slow-wave sleep , often referred to as deep sleep, consists of stages three and four of non-rapid eye movement sleep, according to the Rechtschaffen & Kales (R&K) standard of 1968. As of 2008, the American Academy of Sleep Medicine (AASM) has discontinued the use of stage 4, such that the previous stages 3 and 4 now are combined as stage 3 sleep stage in a state of low consciousness and perform activities that are usually performed during the day. These activities can be as benign as sitting up in bed, walking to the bathroom, and cleaning, or as hazardous as cooking, driving, extremely violent gestures, grabbing at hallucinated objects,[3] or even homicide.[4][5][6]
Although generally sleepwalking cases consist of simple, repeated behaviours, there are occasionally reports of people performing complex behaviours while asleep, although their legitimacy is often disputed.[7] In 2004, sleep medicine experts in Australia For at least 40,000 years before European settlement in the late 18th century, Australia was inhabited by indigenous Australians, who belonged to one or more of the roughly 250 language groups. After sporadic visits by fishermen from the immediate north and discovery by Dutch explorers in 1606, Australia's eastern half was claimed by Britain in 177 claimed to have successfully treated a woman who claimed to have sex with strangers in her sleep.[7] In December 2008, reports were published of a woman who sent semi-coherent emails while sleepwalking, including one inviting a friend around for dinner and drinks.[8] Sleepwalkers often have little or no memory of the incident, as they are not truly conscious. Although their eyes are open, their expression is dim and glazed over.[9] Sleepwalking may last as little as 30 seconds or as long as 30 minutes.[3]
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Nomenclature, classification & codification
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Explanation
Sleep stages
Sleep is categorized into stages of a cycle between REM sleep and NREM sleep. NREM sleep is further divided into four stages Sleep is a naturally recurring altered state of consciousness with relatively suspended sensory and motor activity, characterized by the inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, but it is more easily reversible than hibernation or coma. Sleep is a heightened: stage 1 (a light sleep period), stage 2 (a consolidated sleep period), and stage 3 and 4 (slow wave Slow-wave sleep , often referred to as deep sleep, consists of stages three and four of non-rapid eye movement sleep, according to the Rechtschaffen & Kales (R&K) standard of 1968. As of 2008, the American Academy of Sleep Medicine (AASM) has discontinued the use of stage 4, such that the previous stages 3 and 4 now are combined as stage 3 sleep periods). This is followed by stage 3, stage 2, stage 1, and a REM period. In normal adults, a cycle will last about 1.5 hours.[10] According to Lavie, Malhotra, and Pillar, "The length and content of sleep cycles change throughout the night as well as with age." Sleepwalking generally occurs during the first third of the night (between 11 p.m. and 1 a.m.)[9] during the slow wave NREM sleep stage. High delta activity A delta wave is a high amplitude brain wave with a frequency of 1–4 hertz which can be recorded with an electroencephalogram and is usually associated with slow-wave sleep (SWS) within the brain usually accompanies slow wave NREM sleep, and when 20–50% of all activity is delta activity, stage 3 is scored. When delta activity reaches 50% or higher, stage 4 is scored.[10] Usually, if sleepwalking occurs at all, it will only occur once in a night.[3]
Automatism
Researchers sometimes disagree about the classification of sleepwalking as an automatism Automatic behavior, from the Greek automatos or self-acting, is the spontaneous production of often purposeless verbal or motor behavior without conscious self-control or self-censorship. This condition can be observed in a variety of contexts, including schizophrenia, psychogenic fugue, epilepsy , narcolepsy or in response to a traumatic event. According to the popular source of MedicineNet, an automatism is "an unconscious movement that may resemble simple repetitive tics or may be a complex sequence of natural-looking movements." The individual often won't remember what he was doing or how he was doing it.[11] These repetitive actions may include chewing, lip-smacking, pulling at clothing, or wandering around looking confused. Epileptic automatisms Absence seizures are one of several kinds of seizures. These seizures are sometimes referred to as petit mal seizures are also associated "with the absence attacks of petit mal epilepsy."[12] In the case of the law, an individual can be accused of non-insane automatism In criminal law, automatism is a complex and sometimes controversial excuse to liability where physical or environmental factors negate the existence of the actus reus or insane automatism In criminal law, automatism is a complex and sometimes controversial excuse to liability where physical or environmental factors negate the existence of the actus reus. The first is used as a defense for temporary insanity or involuntary conduct, resulting in acquittal. The latter results in a "special verdict of not guilty by reason of insanity."[13] This verdict of insanity can result in a court order to attend a mental institution.[14] Some actions that take place during sleepwalking could be classified as automatisms.
Causes
Several experts theorize that the development of sleepwalking in childhood is due to a delay in maturation. There are also high-voltage delta waves A delta wave is a high amplitude brain wave with a frequency of 1–4 hertz which can be recorded with an electroencephalogram and is usually associated with slow-wave sleep (SWS) in somnambulists up to 17 years of age. This presence might suggest an immaturity in the central nervous system, also a possible cause of sleepwalking.[3] Sleepwalking is clustered in families, and the percentage of childhood sleepwalking increases to 45% if one parent was affected, and 60% if both parents were affected. However, there is no recorded preference to male or female individuals.[9] Thus, heritable factors appear to predispose an individual to develop sleepwalking, but expression of the trait may be also influenced by environmental factors.[15] Other precipitating factors to sleepwalking are those factors which increase the slow wave sleep stage.[16] These most commonly include sleep deprivation, fever, and excessive tiredness. The use of some neuroleptics An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis (including delusions or hallucinations, as well as disordered thought), particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s. Most of the drugs in the second or hypnotics Hypnotic drugs are a class of psychoactives whose primary function is to induce sleep and to be used in the treatment of insomnia and in surgical anesthesia. When used in anesthesia to produce and maintain unconsciousness "sleep" is metaphorical and there are no regular sleep stages or cyclical natural states; patients rarely recover can also cause sleepwalking to occur.[17]
Treatment
There are some drugs that can be prescribed for sleepwalkers such as a low dose benzodiazepine A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and made available in 1960 by Hoffmann–La Roche, which has also marketed diazepam (Valium) since 1963, tricyclic antidepressants Tricyclic antidepressants are heterocyclic chemical compounds used primarily as antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced later in the decade. They are named after their chemical structure, which contains three rings of atoms. The tetracyclic antidepressants (TeCAs), which contain four, and clonazepam Clonazepam is a benzodiazepine derivative with anticonvulsant, muscle relaxant, and anxiolytic properties. It is marketed by Roche under the trade-names Klonopin in the United States, and Ravotril in Chile. Other names like Rivotril or Rivatril are known throughout the large majority of the rest of the world. Clonazepam is generally considered to.[3] However, for most sleepwalkers, many experts advise putting away dangerous items and locking doors and windows before sleep to reduce risks of harmful activity. Good sleep hygiene and avoiding sleep deprivation is also recommended.[9]
There are conflicting viewpoints on whether it is harmful to wake a sleepwalker. Some experts say that sleepwalkers should be gently guided back to bed without waking them. Others counter that idea and state that waking a sleepwalker may result in their disorientation, but it is not harmful.[18]
Epidemiology
According to the National Sleep Foundation, sleepwalking is prevalent in 1–15% of the general populace.[19] Sleepwalking is most prevalent in children, and usually disappears by adolescence. Sleepwalking in adults is less common, but when it does occur, the events occur three times more often per year and last for more years than in children. Sleepwalking in old age is rare and usually indicates another disorder. Old age disorders may include delirium, drug toxicity or a seizure disorder.[3]
Children
Sleepwalking events are common in childhood and decrease with age. According to Lavie, Malhotra and Pillar, the peak age is 4–8 years, when prevalence is 20% frequency of events.[9] It is also known that "between 25–33% of somnambulists have nocturnal enuresis Bedwetting is involuntary urination while asleep after the age at which bladder control would normally be anticipated. The medical term for this condition is "nocturnal enuresis." Primary nocturnal enuresis is when a child has not yet stayed dry on a regular basis. Secondary nocturnal enuresis (SNE) is when a child or adult begins" (bed-wetting). Like sleepwalking, enuresis is more common in children and fades away as the child ages. Some children who sleepwalk are also affected by night terrors. However, night terrors are much more common in adult sleepwalkers, up to 50% more common.[3] Some parents worry about the psychological implications of sleepwalking on their child, but Larissa Hirsch, MD, editor of the website KidsHealth, says, "Sleepwalking is not usually a sign that something is emotionally or psychologically wrong with a child. And it doesn't cause any emotional harm."[18]
In the study "sleepwalking and sleep terrors in prepubera children" they found that if a child had another sleepdisorder such as restless leg syndrome Restless legs syndrome , also known as Wittmaack-Ekbom's syndrome, is a condition that is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso. Moving the affected body part modulates the sensations, providing temporary relief. RLS (RLS) or sleep-disorder breathing (SDB) that they had a greater chance of sleepwalking. The study found children with chronic parasomnias may often also present SDB or, to a lesser extent, RLS. Furthermore, the disappearance of the parasomnias after the treatment of the SDB or RLS periodic limb movement syndrome suggests that the latter may trigger the former. The high frequency of SDB in family members of children with parasomnia provided additional evidence that SDB may manifest as parasomnias in children. Children with parasomnias are not systematically monitored during sleep, although past studies have suggested that patients with sleep terrors or sleepwalking have an elevated level of brief EEG arousals. When children receive polysomnographies, discrete patterns (e.g., nasal flow limitation, abnormal respiratory effort, bursts of high or slow EEG frequencies) should be sought; apneas are rarely found in children. Children's respiration during sleep should be monitored with nasal cannula/pressure transducer system and/or esophageal manometry, which are more sensitive than the thermistors or thermocouples currently used in many laboratories. The clear, prompt improvement of severe parasomnia in children who are treated for SDB, as defined here, provides important evidence that subtle SDB can have substantial health-related significance. Also noteworthy is the report of familial presence of parasomnia. Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias. RLS and SDB have been shown to have familial recurrence. RLS has been shown to have genetic involvement.[20]
Adults
The persistence or onset of sleepwalking in adulthood is far less common than in children. It is a misconception that adult sleepwalking always indicates a psychological disorder. Sleepwalking can, however, be a symptom of people with psychological disorders. In one study, adult test subjects were given the Minnesota Multiphasic Personality Inventory The Minnesota Multiphasic Personality Inventory is one of the most frequently used personality tests in mental health. The test is used by trained professionals to assist in identifying personality structure and psychopathology, a psychiatric test. According to the study, patients showed "outwardly directed behavior patterns...suggest[ing] that these adults had difficulty handling aggression. They did not support an interpretation of sleepwalking as 'hysterical dissociation Dissociative identity disorder is a psychiatric diagnosis that describes a condition in which a person displays multiple distinct identities or personalities , each with its own pattern of perceiving and interacting with the environment. In the International Statistical Classification of Diseases and Related Health Problems the name for this'."[3]
Psychological disorders and drug use
In some cases, sleepwalking in adults may be a symptom of a psychological disorder or of drug use. One study done by A.H. Crisp et al. of St. George's Hospital Medical School in London supports the possibility of dissociation in adult sleepwalkers because the test subjects scored unusually high on the hysteria portion of the Crown-Crisp experiential index.[21] According to J.E. Orme, an expert in psychology, "A higher incidence [of sleepwalking events] has been reported in patients with schizophrenia Schizophrenia is a serious mental illness characterized by a disintegration of the process of thinking and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in, hysteria and anxiety neuroses Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic. Once a common psychiatric diagnosis, the term is no longer part."[citation needed] Also, patients with migraine Migraine is a neurological syndrome characterized by altered bodily perceptions, severe headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne . The French term derived from a vulgar pronunciation of the Late Latin word headaches or Tourette Syndrome Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane. Tourette's is defined as part of a spectrum of tic disorders, which includes transient and chronic tics are 4–6 times more likely to sleepwalk. Some medications that may precipitate sleepwalking include: Chlorpromazine (Thorazine), perphenazine (Trilafon), lithium, benzodiazepine (Triazolam), amitriptylin (Elavel, Endep), Zolpidem (Ambien) and beta blockers.[3]
The State Journal-Register
That poor guy discovered the risk of sleepwalking in that apartment complex. It can be even more dangerous to do it at work. It's totally unnecessary, too, ...
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Sleep walking Valley of the Kings Egypt According to writtings the Pharaoh Setnakhte was buried in the tomb of Queen Twosret because the tomb he had begun to construct was abandoned
Q. I have a 5 yr old daughter who has been sleep walking and talking since she was about 1 yr old, and as she gets older it's getting worse. We've had to put locks on the tops of the doors so she can't leave the house. She screams and cries like you would'nt beleive. What can I do to help her with this?
Asked by artkrista - Fri Apr 7 00:32:02 2006 - - 5 Answers - 0 Comments
A. Don't believe those who tell you there's nothing you can do and it's a normal stage of development. Bah. She has a pediatrician, doesn't she? Sleep walking can be a signal of something else going on. Take her to her pediatrician and tell him/her what's going on. Don't take this "it's normal" routine. Be sure to keep asking questions until you get some answers that satisfy you.
Answered by dstluke - Fri Apr 7 00:42:08 2006
