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Sleepwalking

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Sleepwalking, also known as somnambulism, is a type of sleep disorder that involves walking around or doing other activities while asleep. 
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The condition is characterized by complex behaviors performed during non-rapid eye movement sleep, typically during the first third of the night.<a href="#accordion">[2]</a> These behaviors can range from simple activities like sitting up in bed to complex ones like driving a car.

According to a study, the prevalence of sleepwalking among children aged 2-13 years is 29%, whereas only 4% of adults experience it.<a href="#accordion">[3]</a> Children usually outgrow it by their adolescent years.

Another study showed that 22.8% of adult sleepwalkers had episodes every night, while 43.5% of them had an episode once a week.<a href="#accordion">[4]</a> 
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Sign and Symptoms

Sleepwalking often starts 1-2 hours after falling asleep. So, it&rsquo;s rare that an episode is triggered during a nap. An episode may last 10 minutes or less, or it may be longer. At the end of every episode, the individual either goes back to bed and sleeps or wakes up.

During the episode, individuals get out of bed and engage in activities such as walking, cooking, or even driving while asleep. Upon waking, they may have little to no recollection of their sleepwalking episode.

On the contrary, the majority of them experience <a href="merisehat.pk/disease/confusion">confusion </a>and disorientation. It&rsquo;s also possible that other comorbidities, such as sleep terrors, are present along with sleepwalking.

The person may move around easily in a familiar setting but fail to recognize other people around them or speak gibberish. Often, they will have a glassy-eyed or glazed expression. 
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Causes

These include:<a href="#accordion">[1][2]</a>

<ul>
	<li>Lack of adequate sleep or poor sleep quality </li>
	<li>Emotional stress </li>
	<li>Certain medications, such as sedatives or hypnotics</li>
	<li>Underlying <a href="merisehat.pk/disease/sleep-disorders-in-adults">sleep disorders</a>, such as obstructive sleep apnea and restless legs syndrome </li>
	<li>Other health issues, like an infection with a high temperature 
	&nbsp;</li>
</ul>

Diagnosis

Diagnosis is primarily based on clinical evaluation, medical history, and, in some cases, polysomnography to assess sleep architecture and rule out other sleep disorders. 
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Treatment

An isolated incident usually does not indicate a serious issue. However, recurring episodes should be treated to protect the individual from causing harm to themselves or others.

In some cases, medications such as antidepressants or benzodiazepines have been used to manage sleepwalking episodes. If the doctors suspect that certain medications are triggering it, they may adjust the dosage.

Psychological treatments, such as hypnotherapy or cognitive behavioral therapy, have also shown promise in addressing underlying stress and anxiety that may contribute to sleepwalking.<a href="#accordion">[5]</a>

Further, it is important to eliminate safety risks. Depending on the patient&rsquo;s age, how frequently it occurs, and how dangerous their episodes are, close doors and windows, install lights with motion sensors, keep sharp objects locked, and use bed alarms to help them or protect them during a potential episode. 
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First and foremost, sleepwalkers are at risk of injury. For instance, they may fall down stairs or walk into dangerous situations. They may become violent during the period of sleepwalking or immediately after waking up. They may even engage in sexual activity.

The condition also affects the quality of life due to daytime sleepiness and impairment in daily functioning. It may lead to anxiety or depression because of strained relationships, shame, and embarrassment.

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The following triggers are often present in individuals who sleepwalk:

<ul>
	<li>Genetics &ndash; Individuals are 10 times more likely to have an episode if a close relative is diagnosed.<a href="#accordion">[6]</a></li>
	<li>Age &ndash; It mostly affects children, especially those aged 10-13 years old; onset in adulthood is usually related to underlying conditions.</li>
	<li>Lifestyle And Environment &ndash; Drug intoxication and stress increase the frequency of episodes.</li>
	<li>Other Conditions &ndash; Pregnancy, fever, migraine, GERD, and Tourette syndrome are associated with sleepwalking. 
	&nbsp;</li>
</ul>

Generally, it helps to:

<ul>
	<li>Establish a regular sleep routine</li>
	<li>Practice sleep hygiene</li>
	<li>Manage stress and anxiety through relaxation techniques and therapy 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li style="list-style-type:none">Sleepwalking, also known as somnambulism, is a type of sleep disorder that involves walking around or doing other activities while asleep.</li>
	<li>Signs and symptoms of sleepwalking include performing activities while asleep, limited memory of the event, inappropriate behavior, and confusion upon waking.</li>
	<li>Causes of sleepwalking include sleep deprivation, stress, medication side effects, and underlying sleep disorders.</li>
	<li>Diagnosis is primarily based on clinical evaluation and, in some cases, polysomnography to rule out other sleep disorders.</li>
	<li>Treatment options include medication and psychotherapy.</li>
	<li>Complications of sleepwalking include injury risk and disruption of daily functioning.</li>
	<li>Risk factors for sleepwalking include age, family history, lifestyle, and environment.</li>
	<li>Preventive measures include maintaining a regular sleep schedule and stress management.</li>
</ul>

[1] Conway, S., Coelho, L., Lopes-Conceição, M., Hachul, H., & Tufik, S. (2011). Psychological treatment for sleepwalking: two case reports. Clinics, 66(3), 517-520.

[2] Horváth, A., Papp, A., & Szűcs, A. (2016). Progress in elucidating the pathophysiological basis of nonrapid eye movement parasomnias: not yet informing therapeutic strategies. Nature and Science of Sleep, 73.

[3] Sleepwalking: What is somnambulism? Sleep Foundation. October 26, 2023. Accessed November 30, 2023.

[4] Kingshott R. Sleepwalking causes &amp; the dangers of sleepwalking in adults. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers.