About Sleep
Sleep Related Conditions
Sleep Disorders
Sleepwalking is a sleep disorder characterized by waking up and walking while still being asleep. Sleepwalking tends to run in families due to genetic reasons. Sleepwalkers can usually stop sleepwalking by themselves and get back to sleep.
Definition of Sleepwalking
Sleepwalking — also called Somnambulism — involves getting up and walking around while in a state of sleep. Usually, the isolated sleepwalking incidents do not signal any severe issues or require treatment. However, recurrent sleepwalking may indicate some type of underlying sleep disorder. In adults, Sleepwalking has a higher possibility of being confused with or coexisting with other sleep disorders as well as medical conditions. Nonetheless, it is imperative to protect a sleepwalker from potential injuries.
Sleepwalking (Somnambulism) mainly occurs during deep and non-REM sleep (called N3 sleep) early at night.
Sleepwalking and Parasomnia
Experts classify sleepwalking as parasomnia — an undesirable behavior or experience during sleep. During N3 sleep, the deepest stage of Non-Rapid Eye Movement (NREM) sleep, it is an arousal disorder. Another NREM disorder is sleep terrors, which can occur in conjunction with sleepwalking.
Prevalence of Sleepwalking
It is much more frequent in children and younger adults than in older adults. It is because aging people get less N3 sleep. Therefore, if a senior adult is a victim of sleepwalking, the underlying reason might be a symptom of medical conditions causing reduced mental functionality and neurocognitive disorder.
In children, sleepwalking starts between ages 6 and 12. They outgrow sleepwalking in most cases. Their sleepwalking is usually benign, with a reasonable possibility of prognosis. Moreover, it typically disappears in children before and after puberty.
Many research studies suggest that Somnambulism has an inheritance pattern, as it occurs in children if their parents have sleepwalking issues. In addition, individuals with irregular life patterns and long-term sleep deprivation are also prone to Somnambulism.
What Causes Sleepwalking?
Factors Contributing To Sleepwalking
- Vigorous sports, fever, fatigue.
- Sleep deprivation or disorders—e.g., staying up late for an extended period, repeated jet-lag, and inadequate sleep habits—may cause Somnambulism.
- Changes in the sleep environment such as sleep schedule disruptions, frequent traveling or sleep interruptions, and stimulation of noise or light.
- Mental disorders, including life stress, Post-Traumatic Stress Disorder (PTSD), panic disorder, long-term depression, or anxiety increase the somnambulism risk.
- Medication can also cause sleepwalking, including sedative-hypnotics, neuroleptics, anxiolytics, and central stimulants. Similarly, antihistamines like zolpidem with other benzodiazepine agonists, lithium preparations, phenothiazine, etc., can create Somnambulism.
Underlying Conditions That May Trigger Sleepwalking
- Sleep-disordered breathing— a group of disorders featuring abnormal breathing patterns during sleep can trigger Somnambulism. For instance, obstructive sleep apnea without treatment or newly started continuous positive airway pressure.
- Alcohol consumption can stimulate a situation to interfere with sleep.
- The restless legs syndrome can also cause Somnambulism.
- Gastroesophageal Reflux Disease (GERD) may disrupt sleep schedule to develop Somnambulism.
- Nervous diseases like migraine, craniocerebral trauma, encephalitis, and epilepsy may lead to sleepwalking.
Risk Factors of Sleep Walking
- Genetics: Sleepwalking appears to run in families. For instance, it is more common for individuals to have one parent with a history of sleepwalking. It is even more frequent if both parents have a history of the sleepwalking disorder. Some research studies have determined various gene loci and genetic patterns.
- Age: Sleepwalking occurs more frequently in children than adults, and its onset in adulthood is more likely related to many other underlying conditions.
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What Are the Symptoms of Sleepwalking?
The sleepwalking or, somnambulism, episode can be brief (a few seconds or minutes) or lasting 30 minutes or longer. However, most episodes last for less than 10 minutes. Here are the most frequent symptoms of sleepwalking.
- Sitting up and looking awake while actually asleep.
- Getting up and walking around.
- Performing complex activities, such as: moving furniture, going to the bathroom, dressing or undressing, driving a car (in complicated cases).
- Returning to sleep automatically if not disturbed.
- Falling asleep in different or unusual places.
- Confusion if awakened, with partial or no memory of the events.
- Impaired orientation and slow language speed.
- Modified consciousness and sluggish response.
- Anterograde and degenerative amnesia.
- Reduced perception function to the outside world.
- Decreased vigilance and impaired cognitive response.
- Inappropriate behaviors, such as: urinating in garbage baskets, climbing out of windows.
- Walking in familiar regions, bypassing obstacles, and avoiding falls.
- Sometimes, violent behaviors in male sleepwalkers.
Diagnosis of Sleepwalking
For a proper diagnosis, the doctors can ask about the sleepwalker’s medical history comprehensively, including the initial symptoms, frequency and duration, generic health status, medication, family history, etc.
It’s important to note that occasional sleepwalking episodes do not usually create concern and typically resolve without treatment. However, a proper diagnosis requires the following criteria:
- Sleepwalking episodes can occur more than once, twice a week, or several times a night.
- They lead to dangerous behavior or injury in the sleepwalk.
- Sleepwalking may cause significant sleep disruption to household members or sleepwalkers.
- It can result in daytime symptoms of excessive sleepiness or problems functioning.
- It may start for the first time as an adult.
How is sleepwalking diagnosed?
Here are the three primary diagnostic methods for identifying sleepwalking:
- If an individual has a history of emotional issues, they also require a mental health evaluation to investigate causes like excessive anxiety or stress.
- Polysomnography (PSG) helps exclude various other diseases causing similar symptoms, such as REM Sleep Behavior Disorder (RBD) or nocturnal seizures. Moreover, PSG can also determine potential triggering factors, such as sleep-disordered breathing and periodic limb movements in sleep. However, the researchers have not evaluated the specificity and sensitivity of these techniques in clinical applications.
- Differential diagnoses like sleep shock, nightmares, REM behavior disorder, etc.
How is Sleepwalking Treated?
Most people do not require specific treatment for sleepwalking. However, they should take safety precautions to prevent injuries, including moving objects like electrical cords or furniture, to reduce the chance of tripping and falling. Moreover, they should block stairways at the gate to avoid any falling.
In the case of drug therapy, the doctors usually prescribe benzodiazepines (BZRA), tricyclic antidepressants (TCA), and selective serotonin reuptake inhibitors (SSRIs). Moreover, they emphasize that sleepwalkers should take these drugs before sleep. For individuals with Somnambulism complicated with sleep apnea, their sleepwalking events decrease significantly after effective apnea treatment.
If there are potentially violent or harmful actions, sleepwalkers should go to the sleep disorders center for regular evaluation to exclude mental diseases.
Management of Sleepwalking
Social Support
- Family members must pay attention to controlling the sleep environment, lock the doors and windows before bed, and avoid getting lost when an individual sleepwalks. They should avoid keeping any dangerous things or evade fire in the room. These things can cause injury to the sleepwalker and others. In addition, family members should pay attention to the attack to prevent accidents.
- Family members should pay attention to the sleepwalker’s psychological state, appease their anxiety, tension, and fear, and help them comprehend diseases correctly.
- Supervising sleepwalkers to stick to a bedtime routine may help them minimize the occurrence of sleepwalks.
Behavior Management
- Avoid talking about the severity of the condition and sleepwalking in front of individuals not to increase their tension, anxiety, and fear. Avoid aggravating night travel symptoms.
- Parents should pay attention not to wake sleepwalkers forcibly, as it may make individuals appear more severe in confusion and agitation. They should take the sleepwalker gently to bed.
- Develop good sleep habits and lifestyle rules. Avoid excessive fatigue. Similarly, sleepwalkers should avoid high tension, pay attention to early bed and early rise. Preventing sleep deprivation or watching exciting movies and reading books before bed is imperative. Listening to soothing music, moderate stretching, abdominal breathing, and meditation would help.
- Sleepwalkers should take enough protein, carbohydrates, cellulose, vitamins, etc. They should not overeat before bed and avoid drinking strong tea and coffee.
- Proper physical exercise is essential. However, it is not suitable to do strenuous exercise within four hours before bed.
- Maintain a positive state of mind. Eliminate tension, and avoid excessive stress, excitement, anxiety, and depression.
Monitoring Diary
In case of frequent attacks, sleepwalkers should record frequency, duration, and onset situations to explore whether there are new symptoms. During the treatment, the doctors conduct an efficacy assessment once a month to check whether the symptoms of sleepwalking have improved or disappeared and whether daily life has returned to normal in the sleep disorders center.
If the attack frequency of sleepwalking is low, the doctors suggest doing only close monitoring. Moreover, they conduct a comprehensive assessment, including a sleep diary and review scales, after every six months. Another evaluation six months after treatment discontinuation is necessary to monitor the recurrence of sleepwalking.
The ShutEye app® offers a convenient solution for recording daily sleepwalking episodes. You can test it for free for 7 days.
Tips to Prevent Sleepwalking
- Maintain a positive and healthy psychological state: An adequate awareness of the disease reasonably relieves stress and avoids anxiety, tension, depression, and other emotions.
- Create a good sleeping environment: Keeping the bedroom clean and quiet is vital.
- Remove harmful triggering factors: Avoid overeating, smoking, drinking alcohol, tea, coffee, or antidepressant medicines, among others, before going to bed.
- Develop good work and rest habits: Sleep and get up on time, avoid sleep deprivation, and try to prevent insomnia because these factors can trigger sleepwalking.
Complications
Sleepwalkers can endure physical injuries due to falling or hitting some hindrances. In other cases, they might drive a car without awareness and cause an accident to endanger their own or others’ lives.
