Sleepwalking (Somnambulism)
is a series of complex behaviors that are initiated during slow wave sleep
and result in walking during sleep.
What are the symptoms of
Sleepwalking (Somnambulism)?
Ambulation (walking or moving
about) that occurs during sleep. The onset typically occurs in prepubertal
children.
Associated features include:
- difficulty in arousing the
patient during an episode
- amnesia following an episode
- episodes typically occur in
the first third of the sleep episode
- polysomnographic monitoring
demonstrates the onset of an episode during stage 3 or 4 sleep
- other medical and psychiatric
disorders can be present but do not account for the symptom
- the ambulation is not due
to other sleep disorders such as REM sleep behavior disorder or sleep
terrors
How Common is Sleepwalking?
Medical reports show that about
18% of the population are prone to sleepwalking. It is more common
in children than in adolescents and adults. Boys are more likely to
sleepwalk than girls. The highest prevalence of sleepwalking was 16.7%
at age 11 to 12 years of age. Sleepwalking can have a genetic tendency. If
a child begins to sleepwalk at the age of 9, it often lasts into adulthood.
How serious is Sleepwalking?
For some, the episodes of sleepwalking
occur less than once per month and do not result in harm to the patient
or others. Others experience episodes more than once per month, but not
nightly, and do not result in harm to the patient or others. In its most
severe form, the episodes occur almost nightly or are associated with physical
injury. The sleepwalker may feel embarrassment, shame, guilt, anxiety
and confusion when they are told about their sleepwalking behavior.
If the sleepwalker exits the
house, or is having frequent episodes and injuries are occurring -- DO
NOT delay, it is time to seek professional help from a sleep
disorder center in your area. There have been some tragedies with sleepwalkers,
don't let it happen to your loved one!
What can be done about sleepwalking?
There are some things a sleepwalker
can do:
- Make sure you get plenty of
rest; being overtired can trigger a sleepwalking episode.
- Develop a calming bedtime
ritual. Some people meditate or do relaxation exercises; stress can
be another trigger for sleepwalking.
- Remove anything from the bedroom
that could be hazardous or harmful.
- The sleepwalker's bedroom
should be on the ground floor of the house. The possibility of the
patient opening windows or doors should be eliminated.
- An assessment of the sleepwalker
should include a careful review of the current medication so that modifications
can be made if necessary.
- Hypnosis has been found to
be helpful for both children and adults.
- An accurate psychiatric evaluation
could help to decide the need for psychiatric intervention.
- Benzodiazepines have been
proven to be useful in the treatment of this disorder. A small dose
of diazepam or lorazepam eliminates the episodes or considerably reduces
them.
What
are Sleep Terrors?
Sleep Terrors are characterized
by a sudden arousal from slow wave sleep with a piercing scream or cry,
accompanied by autonomic (Controlled by the part of the nervous system that
regulates motor functions of the heart, lungs, etc.) and behavioral manifestations
of intense fear. Also known as Pavor Nocturnus, incubus, severe autonomic
discharge, night terror.
What are the symptoms of
Sleep Terrors?
- A sudden episode of intense
terror during sleep
- The episodes usually occur
within the first third of the night
- Partial or total amnesia occurs
for the events during the episode.
Associated features include:
- Polysomnographic monitoring
demonstrates the onset of episodes during stage 3 or 4 sleep
- Tachycardia usually occurs
in association with the episodes.
- Other medical disorders are
not the cause of the episode, e.g., epilepsy
- Other sleep disorders can
be present, e.g., nightmares.
How serious are Sleep Terrors?
Some people have episodes of
sleep terror that may occur less than once per month, and do not result
in harm to the patient or others. While some people experience episodes
less than once per week, and do not result in harm to the patient or others.
In its severest form, the episodes occur almost nightly, or are associated
with physical injury to the patient or others. Consult a sleep specialist
if you are concerned.
What
is Sleep Bruxism?
Sleep Bruxism is a stereotyped
movement disorder characterized by grinding or clenching of the teeth during
sleep. The disorder has also been identified as nocturnal bruxism,
nocturnal tooth-grinding and nocturnal tooth-clenching.
What are the Symptoms?
The symptoms of Sleep Bruxism
are tooth-grinding or tooth-clenching during sleep that may cause:
- abnormal wear of the teeth
- sounds associated with bruxism
(It's about as pleasant as fingernails on a chalkboard!)
- jaw muscle discomfort
How serious is the disorder?
Some people have episodes that
occur less than nightly with no evidence of dental injury or impairment
of psychosocial functioning. And others experience nightly episodes
with evidence of mild impairment of psychosocial functioning. Yet others
have nightly episodes with evidence of dental injury, tempomandibular (jaw)
disorders, other physical injury or moderate or severe impairment of psychosocial
functioning.
When someone with suspected
sleep bruxism has a polysomnographic test there is evidence of jaw muscle
activity during the sleep period and the absence of abnormal movement during
sleep. Other sleep disorders may be present at the same time, e.g.,
obstructive sleep apnea, restless legs syndrome.
What
is Fibromyalgia?
Fibromyalgia is a disorder involving
chronic pain in your muscles, ligaments and tendons. Fibromyalgia is also
known as Fibromyositsis, rheumatic pain modulation disorder or Fibrositis
Syndrome.
What are the symptoms of
Fibromyalgia?
- Unrefreshing sleep
- Muscular pain
- Firm, tender zones are found
within the muscles, particularly those of the neck and shoulders
Polysomnography shows alpha activity
during non-REM sleep, particularly stage 3 and 4 sleep. A Multiple Sleep
Latency Test (MSLT) shows a normal amount of time in falling asleep.
What is the treatment for
Fibromyalgia?
A low dose of tri-cyclic antidepressants
seem to help. Exercise and relaxation techniques are suggested. Sometimes
an analgesic is prescribed.
What
is Hypersomnia?
Hypersomnia is excessive sleepiness. It
is an excessively deep or prolonged major sleep period. It may be associated
with difficulty in awakening. It is believed to be caused by the central
nervous system and can be associated with a normal or prolonged major sleep
episode and excessive sleepiness consisting of prolonged (1-2 hours) sleep
episodes of non-REM sleep.
What are the Symptoms?
- Long sleep periods
- Excessive sleepiness or excessively
deep sleep
- The onset is insidious (gradually,
so you are not aware of it at first)
- Typically appears before age
25
- Has been present for at lest
six months
How does a doctor determine
that I have hypersomnia?
The first step is to consult
a sleep specialist. The specialist will probably order a polysomnography
test (sleep study) where you stay overnight while Technologists monitor
your muscle movement, heartbeat, eye movement, leg movements and respiration. The
specialist may also want to do a Multiple Sleep Latency Test (MSLT) that
tests how sleepy you are.
How can it be treated?
Since the cause is still unknown,
treatment consists of behavioral changes, good sleep hygiene and taking
stimulants to help you be more alert. Limit your naps to one (preferably
in the afternoon) lasting no longer than 45 minutes. Get at least 81/2 hours
of sleep. Avoid shiftwork, alcohol and caffeine. Your doctor will
determine the amount and type of stimulant you should take.
Books
to read:
Go to The
SleepMall and click on Sandman's Bookstore. Most books that
focus
on many unusual sleep disorders will be in the General and Misc. Sleep Books
category.
Much of the above information
was provided by dipping into Dr. William C. Dement's SleepWell.
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