SLEEPWALKING DISORDER
INTRODUCTION
Sleepwalking, formally known as somnambulism, is a
behavior disorder that originates during deep sleep and results in walking or
performing other complex behaviors while asleep. It is much more common in
children than adults and is more likely to occur if a person is sleep deprived.
Because a sleepwalker typically remains in deep sleep throughout the episode,
he or she may be difficult to awaken and will probably not remember the
sleepwalking incident.[1]
So in this work we are going to consider both this sleepwalking disorder and
sleep terror disorder.
SLEEPWALKING
DISORDER
Sleepwalking usually involves more than just walking
during sleep; it is a series of complex behaviors that are carried out while
sleeping, the most obvious of which is walking. Symptoms of sleepwalking
disorder range from simply sitting up in bed and looking around, to walking
around the room or house, to leaving the house and even driving long distances.
It is a common misconception that a sleepwalker should not be awakened. In
fact, it can be quite dangerous not to wake a sleepwalker.[2]
The prevalence of sleepwalking in the general
population is estimated to be between 1% and 15%. The onset or persistence of
sleepwalking in adulthood is common, and is usually not associated with any
significant underlying psychiatric or psychological problems. Common triggers
for sleepwalking include sleep deprivation, sedative agents (including
alcohol), febrile illnesses, and certain medications.[3]
The prevalence of sleepwalking is much higher for
children, especially those between the ages of three and seven, and occurs more
often in children with sleep apnea. There is also a higher instance of sleepwalking
among children who experience bedwetting. Sleep terrors are a related disorder
and both tend to run in families.
SYMPTOMS:
Sleepwalking is most often initiated during deep sleep
but may occur in the lighter sleep stages or NREM, usually within a few hours
of falling asleep, and the sleepwalker may be partially aroused during the
episode.
In addition to walking during deep sleep, other
symptoms of sleepwalking include:[4]
- Sleep
talking
- Little
or no memory of the event
- Difficulty
arousing the sleepwalker during an episode
- Inappropriate
behavior such as urinating in closets (more common in children)
- Screaming
(when sleepwalking occurs in conjunction with sleep terrors)
Treatment of Sleepwalking
disorder
Treatment for sleepwalking in adults may include hypnosis. In fact,
there are many cases in which sleepwalking patients have successfully treated
their symptoms with hypnosis alone. Also, pharmacological therapies such as
sedative-hypnotics or antidepressants have been helpful in reducing the
incidence of sleepwalking in some people. Sleepwalking is common in children
and is usually outgrown over time, especially as the amount of deep sleep
decreases.
SLEEP TERROR DISORDER
Sleep terrors
(also referred to as night terrors or pavor nocturnus) are a specific sleep
disruption most remarkable for their intensity and anxiety-inducing nature.
Several precipitating factors have been suggested, but no consistent structural
or biochemical abnormality has been identified to account for all cases of
sleep terrors.
Signs and symptoms of
Sleep Terror disorder
Symptoms of
sleep terrors include the following:[5]
- Sudden
arousal from non–rapid eye movement (NREM) sleep, usually occurring in the
first third of the night
- Associated
autonomic and behavioral manifestations of fear
- Agitation
(more commonly seen in adults)
- Significant
autonomic hyperactivity
- No
or minimal response to external stimuli during the event
- Upon
wakening: Confusion, disorientation, and amnesia regarding the event
There are no
specific physical findings or signs found on routine physical examination when
the individual is awake.[6]
Diagnosis of Sleep Terror
The diagnosis
is made primarily based on a history that identifies the classic symptoms of
sleep terror and by excluding other possible etiologies for the sleep
disturbance based on the clinical presentation. There have been no identified
irregularities in laboratory evaluation, and no additional workup is required
in a classic sleep terror presentation. Further evaluation may be useful as
follows:
- Sleep
diary to help identify sleep patterns and triggers for sleep terrors
- Investigation
of comorbidities
- Assessment
for significant daytime somnolence, violent behavior during episodes, or
severe distress on the part of family members
- Polysomnography
for a suspected respiratory disturbance
- Routine
electroencephalography (EEG) or sleep-deprived EEG if nocturnal seizures
are suspected
- Recurrent
episodes of abrupt terror arousals from sleep, usually beginning with a
panicked scream; intense fear and signs of autonomic arousal
- Relative
unresponsiveness to efforts to comfort the individual during the episode
- Little
or no recall of dream imagery
- Amnesia
for the episode
- Significant
distress or impairment in social, occupational or other areas of
functioning
- The
symptoms cannot be explained by another mental disorder, medical
condition, or the effects of a drug of abuse or medication.
Management
Because sleep
terrors are typically benign and self-limited, most affected individuals
require no specific medical intervention other than reassurance and education.
Measures that
may be helpful include the following:
- Appropriate
treatment of associated comorbid conditions
- Promoting
a stable environment with adequate regular sleep habits
- Routine
follow-up and developmental assessment for affected children
- Continued
support and reassurance for affected families
- Surveillance
for deviation from classic sleep terror characteristics or increasing
severity of behavior during episodes
- Efforts
to keep affected individuals from harming themselves or others during
episodes
- Scheduled
awakenings
Etiology of the Disorder
No specific
cause has been identified for sleep terrors. Suggested triggers have included
the following:[8]
- Inadequate
or irregular sleep schedule
- Unfamiliar
or disruptive sleep environment
- Concurrent
fever or illness
- Certain
medications, including central nervous system (CNS) depressants (eg,
sedative-hypnotics and alcohol) and some stimulants
- A full
bladder during sleep
- Generalized
stress
- Obstructive
sleep disorders
No trigger
is uniformly or consistently seen in most individuals who experience sleep
terrors. These triggers do not appear to cause sleep terrors but may lower the
threshold for sleep terror events.
CONCLUSION
We have in
this work considered sleep walking and sleep terror disorders. By first
explaining what they mean individually and then their various etiology, signs
and symtoms, management, diagnosis and treatment.
[1]
American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders. Fourth Edition, (Washington, DC:
American Psychiatric Association; 2000).p.335.
[2] Cf. American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
Disorders. Fourth Edition.
[3] Cf. American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
Disorders. Fourth Edition.
[4] Cf. American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
Disorders. Fourth Edition.
[5] Cf. Guilleminault C,
Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in
prepubertal children: what triggers them?. Pediatrics.
[6] Cf. Mindell JA & Owens
JA. A Clinical Guide to Pediatric Sleep: Diagnosis
and Management ofSleep Problems. (Philadelphia: Lippincott Williams
& Wilkins; 2003),p. 64.
[7] Cf. American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
Disorders. Fourth Edition.
[8] Cf. Mindell JA & Owens
JA. A Clinical Guide to Pediatric Sleep: Diagnosis
and Management ofSleep Problems. p. 70.
Comments
Post a Comment