What is Somnambulism (Sleepwalking)?
Somnambulism, or sleepwalking, is a condition where a person performs unwanted actions like walking while they are in a deep sleep, but not fully awakened. This happens during a non-rapid eye movement (NREM) sleep and slow-wave sleep–a period of sleep where your brain waves are extremely slow. This often occurs in the earlier part of the night.
Sleepwalkers might not remember any dream content. They can show either simple or complex movements that align with a dream they’re having. During sleepwalking episodes, an individual may not be fully aware of their surroundings and their ability to make decisions, plan or solve problems can be impaired.
Sleepwalking has been found to be related to several other sleep disorders such as confusional arousals (where a child might awaken in a confused state), rhythmic movement disorders (unknown repeated movements during sleep), night terror in children (terrifying episodes occurring during sleep), sleep talking (talking while asleep), and teeth grinding (grinding, gnashing or clenching the teeth during sleep). Additionally, it can also lead to daily tiredness, and cause emotional and behavioral issues in children.
What Causes Somnambulism (Sleepwalking)?
Some people might be more likely to sleepwalk because of their genes. For example, identical twins are more likely to sleepwalk than non-identical twins. Also, more white people who sleepwalk have a certain gene (DQB1*0501) compared to white people who don’t sleepwalk. This suggests that genes named DQB1 might play a part in sleep disorders which involve moving around a lot.
Some research also suggests that sleepwalking might be passed down in families in a way that’s ‘autosomal dominant’. This means if one parent has the trait, there’s a chance their child will get it too, although this isn’t always the case. It’s also thought that a number of different medications such as antibiotics, antidepressants, antiepileptics, sleeping tablets (like benzodiazepines), mood stabilizers (such as lithium), heart medications (beta-blockers) and other specific types of antidepressants can cause sleepwalking in people who’ve never done it before.
In particular, a type of sleeping tablet called zolpidem has been strongly linked with sleepwalking, even in people with no prior history of doing so. Going without sleep for more than 24 hours can also make sleepwalking more likely, especially in people already at greater risk. When people are sleep deprived, their sleepwalking behavior might also be more noticeable and complex. A few cases have also shown that an overactive thyroid (hyperthyroidism), can prompt sleepwalking.
Risk Factors and Frequency for Somnambulism (Sleepwalking)
Somnambulism, also known as sleepwalking, is a common issue that affects how people sleep. However, we’re still not entirely sure how many people it impacts. What we do know is that kids tend to sleepwalk more than adults. A detailed study estimated that around 6.9% of people will experience sleepwalking at some point. There’s no significant difference in sleepwalking reports between children and adults over a lifetime.
- The number of sleepwalking cases in the past 12 months is notably higher among children at 5.0% compared to 1.5% in adults.
- This might be because adults have less slow-wave sleep than kids, which reduces the chance of sleepwalking.
- While sleepwalking usually starts in childhood, it can somewhat continue or even start for the first time in adulthood.
- Very few people start sleepwalking as adults. When they do, it’s usually linked to medications and diseases that affect the nervous system.
Signs and Symptoms of Somnambulism (Sleepwalking)
Most people who sleepwalk don’t remember doing so. Sometimes, their partners will see them moving things around their room while sleepwalking. There are also cases where sleepwalkers talk in their sleep or exhibit unusual sexual behavior. Other sleepwalkers have been known to leave food out during the night to find it in the morning. This behavior can be on and off, and such individuals do not often seek immediate medical help. Doctors usually don’t find any specific physical signs related to sleepwalking.
Testing for Somnambulism (Sleepwalking)
We’re still learning much about sleepwalking. Currently, the best way to diagnose sleepwalking is through a test called polysomnography. This test records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements while you sleep.
However, this test isn’t usually recommended as the first step toward diagnosing sleepwalking due to its high cost and inconvenience. This test also has a tough time capturing sporadic behaviors like sleepwalking which don’t occur regularly.
Usually, what you remember about your sleep and any incidents reported by people close to you is enough to diagnose sleepwalking. Polysomnography is mostly used in legal cases or when doctors are unsure about what’s causing the sleep disturbances.
Also, doctors should thoroughly review all your current medications, check how your thyroid is functioning, and screen you for neurological conditions such as Parkinson’s disease, which affects movements and can cause tremors.
Treatment Options for Somnambulism (Sleepwalking)
Sleepwalking is a common condition where a person walks or performs some activities while they’re still asleep. In most cases, sleepwalking is harmless and doesn’t require any treatment. Unfortunately, there isn’t much research on how to best treat sleepwalking. However, when sleepwalking becomes problematic either for the person experiencing it or for their family, there are some tactics that are usually helpful and safe.
One proven method is “scheduled waking”, which means that someone wakes the sleepwalker up 15-30 minutes before the time they typically start sleepwalking. Another approach is through hypnosis, which is done by suggesting that the sleepwalker should wake up the moment they touch the ground with their feet. This method helps to interrupt and avoid sleepwalking. Both methods need to be done daily for about 2 to 3 weeks.
Ensuring safety of the sleepwalker is also very important. It’s recommended to lock windows and doors and remove objects that can break easily to prevent injuries during sleepwalking episodes.
While no medication has been officially approved to treat sleepwalking, some medicines may help based on doctors’ experiences. For example, medicines like clonazepam and gabapentin that enhance a chemical in the brain called gamma-aminobutyric acid (GABA), might be helpful if taken about an hour before bedtime. Please consult with your doctor before starting any new medication.
What else can Somnambulism (Sleepwalking) be?
When figuring out if someone is sleepwalking, doctors need to consider a variety of other conditions that can cause similar symptoms. These include the following:
- Parkinson’s disease: This is a degenerative disorder that affects the brain and can result in various sleep-related behavioral problems, including sleepwalking.
- Medications: Some medications, such as antibiotics, anticonvulsants, antidepressants, benzodiazepines, lithium, antipsychotics, SSRIs, quinine, beta-blockers, and tricyclic antidepressants, can cause sleepwalking.
- REM sleep behavior disorder: This is a sleep disorder that causes people to physically act out vivid, often violent dreams.
- Smith-Magenis syndrome: This syndrome causes frequent awakenings at night and excessive sleepiness during the day, which can lead to a significant amount of distress.
Understanding and considering these alternatives can help doctors make the correct diagnosis and plan the most effective treatment.
What to expect with Somnambulism (Sleepwalking)
Sleepwalking, also known as somnambulism, usually has a positive outcome for most people. However, in some cases, it can lead to injuries such as falling from a height or walking through a glass window. It can also result in awkward situations, for instance, being found wandering around in public unclothed.
In general, children who sleepwalk tend to outgrow this behavior by their teenage years and typically do not require any treatments or medicine.
Possible Complications When Diagnosed with Somnambulism (Sleepwalking)
Sleepwalking, for the most part, is typically harmless. But there are instances where injuries related to sleepwalking have happened such as falling from heights or even walking through glass windows. Generally, most people who’ve experienced such incidents didn’t need to stay in the hospital, yet there is the potential for serious injury.
Common Risks or Consequences of Sleepwalking:
- Falling from heights
- Walking through glass windows
- Potential for major injuries
- Occasional need for hospitalization
Preventing Somnambulism (Sleepwalking)
People who sleepwalk, or walk while still asleep, could potentially hurt themselves. For children who sleepwalk, their parents must take actions to stop any dangerous situations, like falling down stairs or off balconies. It’s recommended for sleepwalkers to have bedrooms on the first floor of the house, with all windows and doors securely locked. If parents have a child who sleepwalks, it’s important not to try to stop it themselves and they should never slap, shake, or shout at the kid. Usually, children who sleepwalk get better on their own by the time they become teenagers, and they don’t necessarily need any special treatment or medications.
People who live with sleepwalkers, such as caregivers or partners, should know about scheduled awakenings. This means parents with a child who sleepwalks may be asked to record the times their child sleepwalks for several nights. They then aim to gently wake the child about 15 minutes before the usual sleepwalking time, ensuring the child stays fully awake for a little while.
This kind of education can also be handy for adults who start sleepwalking. Waking up a sleepwalker about 15 to 30 minutes before their usual sleepwalking time can be useful.
