Somnambulism is a sleep disorder colloquially known as sleepwalking. The cause of this disorder is largely unknown. In the main, it affects children.
What is somnambulism?
Somnambulism characterizes a condition in which the affected person walks around during sleep, possibly performing complex actions. As a sleep disorder, this disorder belongs to the group of parasomnias. As a rule, the affected person does not remember it at all later on, or there are only fragments of memory. Colloquially, somnambulism is referred to as sleepwalking or moonstruck. In the past, the full moon was considered to trigger the nocturnal activities because of its brightness. The event of sleepwalking usually lasts only a few minutes. Mainly children (10 to 30 percent) are affected. After puberty, the tendency to sleepwalk disappears in most cases. In adults, there are only one to two percent chronic sleepwalkers. Somnambulism is not a serious condition, but usually a harmless disorder of waking. In persistent cases, however, there is a risk of injury from falls.
Causes
Not much is known about the causes of somnambulism. The finding that it mainly affects children suggests a maturational problem of the central nervous system. During childhood and adolescence, the maturation process within the nervous system is not yet complete. With the end of puberty, the somnambulism that is still typical for many children and adolescents usually also ends. In only one to two percent of cases, it continues to occur in adulthood. Sometimes the condition becomes chronic. In some cases, it rarely occurs anymore. There are even cases in which somnambulism occurs for the first time in adulthood. It has been established with certainty that the cause of somnambulism has a genetic component. Thus, somnambulism occurs in clusters in some families. Stress and other stressful situations are also suspected as triggering factors. Sedative medications, fever, all-nighters or alcohol consumption can also trigger the sleep disorder. Somnambulism never occurs during dream sleep (REM sleep) but always during deep sleep or normal sleep. There is a presumption that after an internal or external arousal stimulus, the waking process is not complete. Thus, an intermediate state develops in which one part of the brain is awake while the other brain areas are still asleep. In this situation, complex actions can be performed. Why the waking process is not complete has not yet been elucidated.
Symptoms, complaints, and signs
Somnambulism is manifested by wandering during deep sleep, nonresponsiveness to external stimuli, rigid facial expression, and severe wakefulness. In rare cases, aggressive behavior may occur. After a few minutes, the sleepwalker usually returns to bed and continues to sleep. Sleepwalking usually occurs in the first third of the night. The activity is intensified by stimuli such as light or noise. A distinction must be made between four forms of somnambulism:
- In the subclinical form, activity does not always occur. However, corresponding brain activity can be detected in the electroencephalogram (EEG), electrocardiogram (ECG) and electromyogram (EMG).
- In the so-called abortive form of somnambulism, activities are limited to the bed. The affected person either just sits down or talks indistinctly during sleep.
- In classic somnambulism, the affected person wanders during sleep, may perform complex actions, and puts himself at risk of injury by not responding to external stimuli.
- In rare cases, an aggressive to violent course form also occurs. Just here, however, there is also the risk of confusion with other forms of sleep disorders, which often have much more serious psychological disorders as a basis.
Diagnosis and course of the disease
Somnambulism is usually a harmless disorder of sleep. However, it must be differentially diagnosed from other, much more serious sleep disorders. For example, there are certain forms of epilepsy that occur at night and can be confused with somnambulism.Furthermore, certain REM sleep disorders (Schenck syndrome) can simulate the aggressive form of somnambulism. In this case, however, the activities occur during dream sleep, and the patient reacts aggressively to dream content and is able to recall some of it later. Other diagnoses of exclusion represent states of confusion in dementia as well as psychic states of exception. An electroencephalogram, electrocardiogram, or electromyogram can be used to make a definite diagnosis of somnambulism.
Complications
Somnambulism itself is not problematic in most cases. However, sleepwalking carries an increased risk of accidents and falls. For example, during nighttime activities, the sufferer may fall from the stairs, trip, or turn on the stove. If the sleepwalker is awakened, this can trigger a shock and a heart attack may occur. Occasionally, sufferers become handsy because they cannot distinguish between dreams and reality. In adults, somnambulism may indicate diseases of the brain. It cannot be ruled out that sleepwalking is due to a neurological disorder or even a brain tumor – both of which must be treated before further complications develop. Most often, sedatives or sleeping pills are prescribed for sleepwalking, which are always associated with side effects and interactions. Benzodiazepines and antidepressants also carry risks. If a possible mental illness is not recognized, the medication can lead to an intensification of the symptoms. In most cases, well-being then also decreases and the quality of life declines. Behavioral therapy usually proceeds without complications, but should still be carried out under the guidance of an expert.
When should you see a doctor?
In most cases, sleepwalking does not require a doctor. It is often a temporary or one-time occurrence that does not require action. If no other irregularities or behavioral abnormalities are apparent, it is not always necessary to see a doctor. In a large number of cases, the affected person finds his way back to his bed without further complications and does not require assistance. Consultation with a physician is indicated as soon as regular or repeated nighttime problems occur. Daytime fatigue, lassitude or a decrease in mental as well as physical performance are indications that should be followed up. If sleep disturbances, anxiety or inner restlessness occur, the complaints should be clarified. If abnormal behavior, aggressive behavior or changes in personality occur, an evaluation by a physician or therapist is recommended. If various stress factors are present, the well-being is reduced or there is a withdrawal behavior of the affected person, the developments should be discussed with a doctor. In the case of dangerous situations or self-destructive actions, consultation with a specialist is advisable. The affected person and the relatives need advice on how to deal with the sleepwalker properly and should optimize sleep hygiene so that there is relaxation for everyone involved.
Treatment and therapy
During the activity phase of somnambulism, the affected person should not be awakened because disorientation increases the risk of injury. Panic reactions may even occur. Only in cases where the somnambulist enters a danger zone should he be spoken to quietly and gently led to the bed. Care should be taken to ensure that the bedroom is always darkened, as sleepwalkers react to light. If sleepwalking is a frequent occurrence, risks of injury should be minimized by locking windows and doors and removing sharp objects. There is no known therapy to treat somnambulism.
Follow-up
Dealing with somnambulists presents a special challenge for family members in everyday life. To protect the affected person from possible accidents, it is important to prevent dangerous situations. On the one hand, the sleepwalker must be prevented from running away while asleep, but at the same time escape routes must be kept open so that rapid action can be taken in the event of danger. Stress has a negative influence on sleepwalkers. Therefore, it is important for the affected person to reduce stress factors in everyday life and, ideally, to minimize them in advance.Excessive demands and emotional stress often contribute to the aggravation of somnambulism and must be overcome. Therapeutic support can be very helpful for the sufferer. It is also important to familiarize the person’s environment with the disease in order to avoid unnecessary complications. Optimal sleep hygiene also helps to improve the situation. Daytime and nighttime rhythms should be routine and adapted to the needs of the sleepwalker. In the sleepwalking phase, the affected person should not be awakened insistently under any circumstances. Often it is enough to gently talk to the sleepwalker to get him to return to bed and to prevent him from further activities. Since memory lapses often occur in the affected person, they should be informed about the event in the aftermath.
Prevention
There are some measures to prevent the activity episodes associated with somnambulism. The risk can be minimized by good sleep hygiene. For example, the affected person should maintain his or her sleep rhythm, avoid sleep deficits, and refrain from taking a midday nap. In the case of stress or existing conflicts, cognitive behavioral therapy has proven effective. Certain relaxation techniques, such as autogenic training or progressive muscle relaxation, have also shown good results in the treatment of somnambulism.
What you can do yourself
In everyday life, dealing with somnambulists is a particular challenge. On the one hand, adequate protection against possible accidents or running away in sleep should be ensured. On the other hand, however, escape routes must be kept open and accessible for emergencies so that no dangerous situation occurs. It is therefore often not easy to find a happy medium for all concerned. The affected person himself can reduce stressors in everyday events. These have a negative influence on the process of sleepwalking and should therefore be minimized. States of emotional stress or excessive demands must be overcome or should be treated therapeutically. In addition, the close environment must be informed about the processes and the possibilities of sleepwalking. Proper management of the affected person is important to avoid complications. It has been shown that an optimization of sleep hygiene contributes to an improvement of the overall situation. Therefore, daytime and nighttime rhythms should be adapted to the body’s needs and routine procedures should take place. In the situation, calmness should be maintained by all involved. Under no circumstances should the sleepwalker be awakened forcefully. Often, light communication and a request to return to bed are enough to dissuade the sleepwalker from further plans. Since the memory subsequently clouded it, there is a need for education of the affected person.
