Sleepwalking

Definition
Sleepwalking is a disorder characterized by walking or other activity while seemingly still asleep.

Causes, incidence & risk factors
The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. During rapid eye movement (REM) sleep, the eyes move rapidly and vivid dreaming is most common.

Each night there are several cycles of non-REM and REM sleep. Sleepwalking (somnambulism) most often occurs during deep, non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning.

The cause of sleepwalking in children is usually unknown but may be related to fatigue, prior sleep loss, or anxiety. Sleepwalking in adults can be associated with mental disorders, reactions to drugs and alcohol, or medical conditions such as partial complex seizures. In the elderly, sleepwalking may be a symptom of an organic brain problem or REM behavior disorders.

The sleepwalking activity may include simply sitting up and appearing to be awake while actually being asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer.

One common misconception is that a sleepwalker should not be awakened. It is not dangerous to awaken a sleepwalker, although it is common for the person to be confused or disoriented for a short time on awakening. Another misconception is that a person cannot be injured when sleepwalking. Actually, injuries caused by such things as tripping and loss of balance are common for sleepwalkers.

Sleepwalking can occur at any age, but it happens most often in children aged 6 to 12. It appears to run in families.

Symptoms

• eyes open during sleep
• may have blank facial expression
• may sit up and appear awake during sleep
• walking during sleep
• other detailed activity during sleep, any sort
• no recall of the event upon awaking
• confusion, disorientation on awakening
• sleep talking is incomprehensible and non-purposeful

Tests
Usually, no further examination and testing is necessary. If sleepwalking is frequent or persistent, examination to rule out other disorders (such as partial complex seizures) may be appropriate. It may also be appropriate to undergo a psychologic evaluation to determine causes such as excessive anxiety or stress, or medical evaluation to rule out other causes.

Treatment
Usually no specific treatment for sleepwalking is needed.

Safety measures may be necessary to prevent injury. This may include modifying the environment by moving objects such as electrical cords or furniture to reduce tripping and falling. Stairways may need to be blocked off with a gate.

In some cases, short-acting tranquilizers have been helpful in reducing sleepwalking episodes.