Sleepwalking


Introduction

Sleepwalking, medically known as somnambulism, is an incidence whereby one walks and carries out other activities while in the sleep state but partially awake. During the incident, the person will appear confused, disengaged, frigid, and unresponsive. It is caused by a fault in the slow-wave sleep and an over-excitement of the central nervous system (CNS). The brain becomes stimulated when asleep hence causing increased body movement. Like many other flaws originating in the CNS, sleepwalking can be as a result of mental disorders, hereditary factors, and underlying medical conditions. It is more common in children than in adults, and most kids eventually outgrow the condition before adolescence. The condition does not require any treatment in most cases because it resolves on its own, but in some cases, it might be necessary to use medication to prevent harm to the patient or the people around them.

Symptoms

Sleepwalking is mostly experienced during the night, and rarely occurs during short daytime naps. It starts after one to two hours of sleep and can last for several minutes.  An individual who is sleepwalking will show the following symptoms:

  • Walking around the house aimlessly
  • An expressionless stare fixated unnaturally on objects in a room
  • Poor or complete lack of responsiveness to any verbal and physical interactions
  • Carrying out abnormal activities such as opening doors at night and returning to bed
  • Performing routine activities at awkward times such as getting dressed in the middle of the night

It is difficult to awaken the person from the sleepwalking state, and when they are awakened they appear confused and disoriented for a while. They can also have extreme fear reactions when woken up, such as shock and being violent.

Causes of sleepwalking

1. Central Nervous System flaws or underdevelopment

Sleepwalking is common in children since it is mostly caused by a delay in the development of the CNS. In normal situations, the function of the CNS is significantly reduced when a person is asleep. However, due to underdevelopment, the CNS can become stimulated during a sleeping episode causing the individual to become mobile while half asleep.

2. Family history

Genetics play a key role in one’s development. Hence, it is common for the underdevelopment of the CNS during childhood to be passed from parents to children. Therefore, if family members in one’s lineage had a slow-developing CNS, the offspring are likely to have a slow rate of development too. This slow development leads to imperfections in the activity of the CNS and can cause sleepwalking.

3. Circadian rhythm disturbances

The circadian rhythm controls an individual’s sleep and wake patterns. Due to travels across time zones or erratic sleeping patterns, the circadian rhythm can become altered. As a result, it may cause partial wakefulness during a sleeping episode and this state may lead to sleepwalking.

4. Drugs and substance use

Sleepwalking can be caused by the use of intoxicating drugs and substances before sleep. One will react to the dreams in a more active way than usual because of the intoxication, and sometimes experience sleepwalking. Withdrawal from controlled substances, such as cocaine and amphetamines, also increases the risk of sleep walking.  Alcohol consumption has shown potential in causing sleepwalking by altering the sleep structure. It disrupts slow wave sleep, which occurs in the second half of the sleep period. This disruption causes the person to wake up partially in the middle of the night and can lead to sleepwalking.

5. Underlying medical conditions

Sleepwalking is often linked to underlying health conditions, such as:

a. Restless legs syndrome

This is a health condition that makes an individual get an uncomfortable sensation in the legs. It causes an irresistible urge to move one’s legs to get rid of the sensation. The condition occurs in the night time, thus causing sleep interruptions. Continuous sleep interruptions might affect the sleep-wake cycles that may lead to a partial wakefulness state during sleep that is conducive for episodes of sleepwalking to occur.

b. Gastroesophageal reflux disease (GERD)

GERD, commonly known as acid reflux, is a chronic condition in which the stomach acid irritates the lining of the food pipe. The stomach contents flow into the lower esophageal sphincter where they cause burning pain that radiates upwards toward the neck. GERD affects a person’s sleep by making them uncomfortable. These individuals have trouble falling asleep or maintaining sleep throughout the night. The effects of GERD lead to sleep deprivation, which increases the risk of sleepwalking.

c. Night terrors

Night terrors are episodes of extreme panic characterized by screaming, crying, and kicking among other symptoms that occur when a person is asleep but partially awake. They commonly occur together with sleepwalking episodes during the slow-wave sleep stage and are usually a result of faulty activation of the CNS. Hence, individuals who have night terrors may also experience sleepwalking.

d. Sleep-disordered breathing

Sleep disorders that alter a person’s breathing can lead to sleepwalking. Conditions such as obstructive sleep apnea affect a person’s breathing when asleep due to obstruction of the airways. Frequent obstructions may occur throughout the night, thus interrupting a person’s sleep. Eventually, they reduce one’s sleep quality and cause partial awakening during the night. The risk of sleepwalking also increases due to the interruptions and the sleep deprivation caused by the sleep disorder.

e. Febrile illnesses

Acute febrile illness refers to a large group of health conditions that are mainly characterized by an abrupt elevation of body temperatures. The illnesses cause a sudden on-set of fever and a persistent headache. They are generally referred to as fever and are commonly associated with other medical conditions, such as malaria, diarrhea, and pneumonia. The persistent fever caused by febrile illnesses disrupts one’s sleep hence reducing the total sleep time. Further, the illnesses may lead to the erroneous functioning of the CNS during slow-wave sleep. Thus, the CNS can become over-excited when the ill person is asleep leading to sleepwalking. Many adults will only experience sleepwalking episodes when they have a febrile illness or when recovering from the condition.

6. Mental disorders

Sleepwalking episodes can also occur in adulthood if one has a mental disorder. The mental condition might cause flawed activation of the CNS during sleep leading to sleepwalking episodes. Some of the mental conditions that can lead to sleepwalking include schizophrenia and dementia.

7. Medications

Some medicines can induce sleepwalking due to the effects they have on the brain. Some of these medications that can cause sleepwalking episodes include sedatives, antihistamines, steroids, tranquilizers, and antipsychotics.

Diagnosis

Sleepwalking is not usually a cause of concern in most cases because it is prevalent in children who eventually outgrow the condition. In severe situations, however, a doctor may have to diagnose and treat or control it. The doctor analyzes the condition to determine whether there are any underlying health issues. The individuals who experience sleepwalking episodes do not have any memory of the occurrence and, therefore, their family and friends can help by providing the information needed for diagnosis. There are several tools and methods that the doctor can use in diagnosis:

1. Sleep diary

Doctors may require persons that experience sleepwalking to keep a sleep diary for one to two weeks. Since the person with the disorder does not remember most of the occurrences during a sleepwalking episode, other people close to the patient might have to keep records in the sleep diary. The diary contains recorded information about one’s sleep habits, including:

  • Food or drinks taken before sleeping
  • One’s sleeping environment
  • Sleep patterns
  • Sleep onset time
  • Wake times during the middle of the night

2. Polysomnography

This is a test carried out when the doctor suspects that the patient may have an underlying sleep disorder causing sleepwalking. During the test, sleep specialists will monitor the patient while asleep and record several parameters such as:

  • Brain waves
  • Blood oxygen levels
  • Heart rhythms
  • Eye movements
  • Breathing rate
  • Muscle activity
  • Body position

3. Electroencephalography (EEG)

An EEG test can be conducted on a patient to measure brain waves when asleep. A device is attached to the patient’s head to record the activity of the brain when asleep. When an individual has sleepwalking episodes the CNS is over-excited causing a spike in the brain wave activity.

4. Family history

Genetics play a significant role in the occurrence of sleepwalking episodes. This condition can be passed on in the family and, therefore, the doctor at times asks about the patient’s family history. A family lineage with a case of sleepwalking often predisposes its descendants to the condition.

5. Studying one’s medical history

Sleepwalking is commonly associated with other medical and mental conditions that can cause the disorder. The common conditions associated with sleepwalking are febrile illnesses, other sleep disorders, restless legs syndrome, and acid reflux. Mental conditions, such as dementia and schizophrenia also increase the risk of sleepwalking.

Treatment

Sleepwalking in children is normally outgrown in the teen years since it will not manifest once the CNS is fully developed. However, in adulthood or cases where the disorder is severe, treatment is required to manage the condition.  This is especially when one’s quality of life is significantly affected leading to other sleep disorders, such as narcolepsy and excessive daytime sleepiness. The available treatment methods prevent the excitation of the CNS during sleep or treating underlying conditions to impede sleepwalking. They include:

1. Treating the causal condition

Sleepwalking can occur due to other health conditions. Therefore, treating these underlying health conditions reduces the occurrence of sleepwalking and helps the individual get uninterrupted sleep. The treatment prescribed by the doctor is based on the specific condition that is leading to sleepwalking. Nocturnal GERD is commonly treated using antacids, which neutralize stomach acid and prevent the irritation of the esophagus. Febrile illnesses have different causes and, therefore, are treated using a variety of medications, such as anti-bacterials and anti-malarials. Obstructive sleep apnea, which affects one’s breathing, is treated by clearing the airway using continous positive airway pressure (CPAP), nasal decongestants, and even in some cases surgery.

2. Prescription medication

Some of the medications that can be used in the treatment of sleepwalking include:

a. Benzodiazepines

These drugs reduce the activity of the central nervous system when a person is asleep. Consequently, they hinder the excitation of the CNS and prevent the occurrence of sleepwalking episodes. Some common benzodiazepines that are used to manage sleepwalking include Xanax, Klonopin, and Valium.

b.      Tricyclic antidepressants

These drugs are normally used to manage depression, though they have a sedative effect that prevents the excitation of the CNS during sleep. Doctors may prescribe them to ensure that a patient gets enough sleep and also to prevent the occurrence of sleepwalking.

c. Serotonin re-uptake inhibitors (SSRIs)

Serotonin is also referred to as the happiness chemical produced in the brain and intestines. It is a precursor responsible for excitement. SSRIs are prescribed to ensure that the chemical remains in large amounts in the body since it causes calmness and improves sleep quality. It can, therefore, prevent the partial wakefulness state in which sleepwalking occurs.

Alternative treatments

1. Supplements

OTC supplements can be used to improve one’s health and reduce the occurrence of sleepwalking episodes. The advantage with OTC supplements is that they don’t come with harsh side effects like pharmaceutical drugs, OTC supplements’ ingredients are usually sourced from nature or found naturally occurring in the body.  Some of the supplements that help with sleepwalking include:

a. Magnesium supplements

Magnesium is an important mineral that supports physical relaxation and restorative sleep. It also reduces the stress hormone cortisol that affects the production of melatonin. A deficiency in magnesium reduces one’s sleep quality and can lead to sleep deprivation. Magnesium supplements can also mitigate the restless leg syndrome, thus reduce the risk of sleepwalking.

b. Calcium supplements

Calcium enables the brain to use tryptophan to produce melatonin. Melatonin is an important hormone that regulates a person’s sleep and wake patterns. The lack of calcium reduces the production of melatonin, thus causing an individual to wake up at night. Sleep interruptions due to a lack of melatonin increase the risk of sleepwalking.

2. Fixed sleep schedule

The occurrence of sleepwalking episodes can be influenced by one’s sleep schedules. Erratic sleep schedules increase the risk of awakening in the middle of the night. At times, partial awakening might occur leading to sleepwalking.

3. Avoiding drugs and substances

Intoxication with drugs and substances significantly increases the risk of sleepwalking. Many drugs and substances cause an individual to have vivid dreams. The person can act out these dreams when there is a fault in the function of the CNS. This fault occurs in the slow-wave sleep stage causing over-excitation of the CNS. The individual wakes up partially and proceeds to act out the vivid dreams caused by drugs and substances. Abstinence from drugs and substances, therefore, reduces the possibility of sleepwalking.

4. Care from family and friends

Sleepwalking occurs in a partial state of unconsciousness. The individual can, therefore, harm themselves or others if not taken care of. Family and friends should observe a person who experiences sleepwalking to ensure that they are safe when the episodes occur. Doors and staircases can be barricaded to prevent actions that might put a patient at risk of harm such as leaving main entrances open or falling down staircases.

Conclusion

Sleepwalking is a state of partial awakening during which an individual performs aimless activities, such as walking, eating and talking, when asleep. It mostly occurs in children but decreases with the onset of adolescence.

The most common causes of sleepwalking are sleep deprivation and an immature CNS. Additionally, genetics, drugs, and underlying medical and mental conditions can influence the condition. The diagnosis of sleepwalking mainly involves identifying the triggers of the condition. Treatment is only required in severe situations with most medications aimed at depressing the CNS and improving sleep quality.

 

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