Facts About Sleep Walking or Somnambulism
Did you know that some people walk in their sleep? I was enlightened with this knowledge with a bitter experience. Last December, my cousin showed up at my home. He had come to appear for his entrance test. I gave him some company till late at night while he was in his last round of revision. While in the room, he asked me to recheck whether the door is locked or not. He told me he has the habit of walking while asleep and he would be laying somewhere else in the home. I mocked him by telling “Maybe the angles would have tried to kidnap you, you being heavy they leave you and flee instead”. In my lazy mood, I gave him the false assurance that I will recheck. But I went to sleep instead. By midnight I jumped from my bed hearing the shattering of glass, shrill, and him crying. I rushed to the guest room and saw him lay on the floor, crying in pain, and held his hands. I stood clueless, my parents helped him and made him sit in a chair. They asked him about what happened, he pointed at me and told about the sleepwalk and complained that I hadn’t closed his door.
So what is a sleepwalking? Is it a disorder? Does it have a medical term? Sleepwalking is called somnambulism. It affects roughly four percentage of adults and seventeen percent of children. Somnambulism is a type of sleep disorder that comes under parasomnia. During Somnambulism there are serious changes in behavior and causes abnormal moments in the bed followed by sleepwalking. Parasomnia is a hereditary disorder that runs within the family. Parasomnia includes behavioral changes, abnormal moments that include sleep bruxism (grinding of teeth during sleep), sleepwalking, and sleep terrors such as screaming during sleep, sweating, fast breathing, and increased heartbeat. Somnambulism is a self-limiting disorder, mainly seen in younger children and less frequent in adults. Sleepwalking often decreases once you attain puberty. But recurrent sleepwalking is noted in 25% of the children in their adulthood. Studies have noted that there are adults who have a history of sleepwalking episodes more than once a week for 12 years.
In sleepwalkers, the eyes are open while they sleepwalk. They don’t see things the same way they do when they’re awake. This is why they can harm someone who interrupts in between. Sleepwalkers often think they were in different rooms of the house or different places. Sleepwalkers most likely go back to bed by themselves and they won’t remember anything that happened by morning.
Sleepwalking can cause serious health problems. It can range from daytime fatigue to serious fatal injury. Studies have shown it would cause daytime sleepiness and insomnia. Frequent episodes of sleepwalking harm a person’s day to day life. It significantly decreases the performance in one’s work, behavioral changes such as getting irritated, anger with no reason. Sleepwalk can affect your psychological wellbeing causing distress, interference with the relationship. Sleepwalking has an extreme variant that is homicidal sleepwalking. Homicidal sleepwalking is a condition where one who is suffering from it may commit murders during its episodes.
Sleepwalking and brain activity.
Polysomnography is the only accurate method of assessing sleepwalking episodes. Sleep can broadly be divided into two that is rapid eye movement (REM) sleep and non-REM sleep (which has three different stages). Polysomnography reveals each stage of sleep that shows a specific pattern of a waveform that depicts the neuronal activity. In your sleep, you will go through all the stages of sleep. Alternatively, you will have both non-REM and REM sleep several times at night. You will have longer deeper REM periods of sleep occurring towards morning.
In Stage 1 non-REM sleep you change from wakefulness to sleep state. This consists of a short period (lasting several minutes) of light sleep. You will have a slow heartbeat, breathing, and eye movements, and your muscles get relaxed. Your brain waves begin to slow from their daytime wakefulness patterns.
In Stage 2, non-REM sleep consists of light sleep before you enter deeper sleep. Your heartbeat and breathing are slow, and muscles relax even further. Your eye movements stop and your body temperature drops. Brain wave activity slows. You will have repeated sleep cycles in stage 2 sleep than in other sleep stages.
In Stage 3 non-REM sleep is a period of deep sleep that makes you feel refreshed in the morning. It occurs during the first half of the night. You will have a slow heartbeat and breathing. Your muscles are relaxed and it may be difficult to awaken you. Your body activity is at its lowest pace. Brain waves are slower than in other stages.
REM sleep occurs about 90 minutes after falling asleep. Your eyes move rapidly from side to side. Your breathing becomes faster, and your heart rate and blood pressure increase. Mixed brain activity as you were awake. Most of your dreaming occurs during REM sleep. Your arm and leg muscles become temporarily paralyzed.
Sleepwalking occurs during non-REM sleep. Adults go through sleep cycles from the lightest stages of non-REM to the deepest non-REM, and then back to the lightest non-REM and then REM sleep. Sleepwalking occurs during the deepest stages of non-REM. It usually happens during the first third of the night. It may last 30 seconds to 30 minutes. Some scientists suggest that during sleepwalking the brain tries to wake up from deep non-REM sleep, rather than going through the proper stages of the sleep cycle.
The key factor that seems to increase sleepwalking is the amount of time people spend in the deepest stage of sleep. Sleep deprivation, fever, and excessive tiredness contribute to sleepwalking. Sleeping pills commonly prescribed to treat depression/anxiety, are known to increase the duration of deep sleep.
Neurology studies suggest that sleepwalking is correlated with a mental illness, such as clinical depression, obsessive-compulsive disorder, and alcoholism. People who take sleeping pills are more likely to sleepwalk at least twice a month than those who don’t.
What are the causes of sleepwalking?
There are various reasons for sleepwalking. Sleepwalking has been found to have a strong relationship with the family inheritance. Studies have reported that 47% of children who got affected by sleepwalking have one of the parents giving a history of the same. In 61% of children both the parents were affected with sleepwalking. This clearly shows the genetically susceptible nature of the disorder.
Severe sleep deprivation can increase the risk and can be a triggering factor for sleepwalking. This is because one will sleep more than normal due to sleep deprivation.
Injuries to the brain that causes swelling of the brain as in encephalitis condition can cause sleepwalking. Fever can be a reason for sleepwalking. Sickness makes one wake intermittently during sleep causing sleep deprivation. Drinking beverages containing caffeine and alcohol regularly can affect one’s sleep stages. Alcohol usage initially helps one to get quicker and deep sleep. As it becomes routine, alcohol impairs sleep causing insomnia and affecting your balanced sleep.
Forms of stress such as physical and/or emotional will have a direct relation with sleep. If you are stressed you will get improper sleep and if you get improper sleep it will again increase your stress. Studies have noted that stress reduces one’s REM sleep, and indeed their sleep efficiency.
Obstructive sleep apnea is a sleep disorder where one will experience episodes of breathlessness while sleeping. This is due to the loss of muscle tone causing the tongue to fall back and block the airway. This temporary cessation of breathing causes violent snoring followed by wakening from sleep. This episode repeats several times in the range of 10 to 100 times at night. Marked sleep interruption can cause sleepwalking.
Restless leg syndrome is also known as Wills-Ekbom disease. It is a condition where one has an extreme urge to move their limbs and legs while lying down. This condition is mostly noted at night time disrupting sleep that may result in a sleepwalk.
Taking certain medications, such as hypnotics, sedatives or certain medications used for psychiatric disorders, medications such as zolpidem, triazolam, eszopiclone and some antihistamines that have a sedative effect can cause sleepwalking.
There are various factors to be taken into account while treating sleepwalking such as the patient’s age, frequency of getting sleepwalk, behavioral changes, and effects of sleep walk in daily activity. Do not interpret the condition to be a less harmful condition. It is always better for both children and adult groups to take advice from doctors who can assure you a proper treatment plan.
In most of the cases of sleepwalking, there is no requirement for active treatment. This is because as age goes on there is a significant decrease in the frequency of getting sleepwalk. Episodes get almost nil when one reaches adulthood. Sleepwalking has a good prognosis with any specific treatment.
Your doctor takes a detailed history regarding your sleepwalk, behavioral changes, psychological discomfort due to sleepwalking, and daily activities. Your doctor may advise you with general instructions and may prescribe you medications.
Your doctor would advise your partner to remove all sharp objects or weapons and to lock it to make it out of your reach. All doors, windows should be tightly shut. If one has a frequent episode of sleepwalking it will be useful to install motion censored light, door alarms, and bed alarm that rings immediately one gets out from the bed.
Your doctor would focus on treating your underlying causes such as obstructive sleep apnea or resting leg syndrome. Treating such a cause will resolve the sleepwalk. Some sedative drugs can be the reason for sleepwalking. Your doctor may change the drug dosage or recommend you to change your drug.
Anticipated sleep awakening is a technique where your partner or parent would wake you up before the anticipated time of episodes of sleepwalking can happen. Since Sleepwalk is associated with the sleep cycle, one will be getting the sleepwalk around the same time every night. By doing this one can prevent their partner from falling into a partial awakened state and thus preventing from sleepwalking. This technique has shown promising results in children to stop sleepwalking.
Your doctor may advise you to reframe your sleep routine. This is to improve your sleep hygiene (sleep-related habits). Poor sleep hygiene such as no specific time for going to sleep at night and having habits such as drinking alcohol, caffeine before bedtime in a course of time causes sleep deprival leading to sleepwalking. Improving your sleep hygiene helps you recover from sleep deprival and you will get more relaxed deep sleep.
Cognitive-behavioral therapy (CBT) is talk therapy that helps to reduce negative thoughts that have disturbing and destructive effects on the mind causing stress and anxiety. CBT reprograms your thought patterns to a more optimistic, and tension-free state. It is more like therapy for the mind that helps to get relaxed. This allows one to go to bed without a heavy mind. Cognitive-behavioral therapy helps one to get deep sleep and prevent stress-related sleepwalk.
Medication is considered when other treatments are not effective. Medications may be considered to try to stop sleepwalking. Benzodiazepines and antidepressants are mainly used. Estazolam is a benzodiazepine used to treat sleepwalking. Estazolam makes the brain relaxed and gives a calming effect. Estazolam helps to get proper deep sleep. Clonazepam belongs to the class of benzodiazepines. It is a long-acting drug used for the management of non-REM parasomnia. Clonazepam works by relaxing muscles and reduces sleepwalk in the non- REM sleep stage. Trazodone is an antidepressant. Trazadone helps you to improve your mood, decrease your depression, and gives your proper sleep. Early research has indicated that melatonin may help cure sleepwalking. Any medication, whether prescription or over-the-counter, has potential benefits and risks. A doctor is in the best position to determine whether it is appropriate in any person’s specific situation. If you get a prescribed medication, follow your doctor’s instructions properly. You are not supposed to change the drug dosage or stop the medication without taking advice from your doctor.