Sleepwalking is a sleep disorder where the sleeper arises from the slow-wave, deep sleep stage and performs tasks that only a conscious person does. A sleepwalker usually performs repeated behaviors, but sometimes they transgress into complex and often violent actions that they do not remember anything about when awake.
Sleepwalkers are difficult to awaken, with a dim and glazed overexpression over their faces during the sleepwalk incidents. In the past, sleepwalking was thought of as a dreamer acting out a dream.
Sleepwalking Definition, Classification and Interpretation:
Sleepwalking is formally known as somnambulism or noctambulism. It belongs to the parasomnia family. Parasomnias are sleep disorders involving abnormal movements, perceptions, behaviors, and emotions that occur while falling asleep, sleeping, between sleep stages, or attempting to wake from sleep.
Parasomnias can occur at any sleep stage and during either rapid eye movement (REM) sleep or non-rapid eye movement sleep (NREM). Among NREM parasomnias are sleepwalking, confusional arousals, night terrors (sleep terrors), teeth grinding (bruxism), restless legs syndrome (RLM) and periodic limb movements (PLM), sleep sex and sleep-related eating disorder (SRED). REM parasomnias include REM sleep behavior disorder (RBD), recurrent isolated sleep paralysis and catatonia.
Slow-wave (deep) sleep is the third stage of NREM sleep. It has about 20%-50% of delta activity (an aid in characterizing the depth of sleep). If a person is woken up from this stage of sleep, they will feel groggy, and Who will slightly impair their mental performance.
Sleepwalking behaviours might be recognized as automatic behaviors that spontaneously produce (often purposeless) verbal or motor behaviours without conscious self-control or self-censorship. Arguing that sleepwalking behaviors are insane automatisms or non-insane automatisms are important in courts where crime is involved.
Nocturnal Sleep-Related Eating Disorder (NSRED) is a state of sleepwalking that includes behaviors connected to a person’s conscious wishes or wants. It is also called somnambulistic eating, and it combines the traits of parasomnia with an eating disorder.
NSRED should be completely distinguishable from night eating syndrome (NES), where the person is conscious and aware of what they are doing.
In NSRED, the patients are unaware and asleep as they consume large amounts of food uncontrollably. They don’t remember any of their actions when they are awake and usually complain of unexplained injuries.
Many NSRED patients also create harmful or bizarre food combinations. Some attempt to eat spoiled or rotten food, some eat from the wastepaper basket and another attempt to swallow potentially harmful substances like wood, ashes, glue or soap.
Some NSRED patients attempt to blend weird food mixtures or use knives and forks to eat their food, harming themselves in the process. It is especially dangerous when people with diabetes attempt to consume pint after pint of sugar or hypertensives scourge salt.
This parasomnia is most common in women, especially those who undergo extreme dieting, are alcoholics, drug addicts or have other sleep disorders. Symptoms include significant weight gain over a short period, depression, irritability during daytime and sleep disruption with vivid dreaming.
The prevalence of sleepwalking is very high in children ages 3-8. It often occurs in children suffering from sleep apnea or bedwetting (nocturnal enuresis). Sleep apnea is a dyssomnia (abnormal behaviour or psychological event that occurs during sleep) where the patient pauses breathing during sleep.
These pauses cause the person to wake up to breathe in air and counteract the carbon dioxide built up in the bloodstream due to irregular breathing. Night terrors are related to sleepwalking, and sometimes they run concomitantly in families with hereditary sleep disorders.
Sleepwalking is less common in adults than children. Therefore, it is not always a sign of psychological disorder.
Psychological disorders like schizophrenia, post-traumatic stress disorder (PTSD), hysteria, depression, obsessive-compulsive disorder (OCD), and anxiety neuroses are predisposing factors for sleepwalking.
Also, patients with migraine headaches or Tourette syndrome (a neurological disorder that causes a person to make repetitive, stereotyped, involuntary movements and vocalizations commonly known as tics) are 4-6 more likely to sleepwalk than people without those diseases.
In addition, most antidepressants, antihistamines, anxiolytics, anti-Parkinsonism drugs and mood stabilizers are known to include sleepwalking as a side effect.
Causes and Predisposing Factors to Sleepwalking:
Many people ask, “Why do people sleepwalk?” Some even ask, “Why do I sleepwalk?” A lot of people who sleepwalk don’t know the cause of their distress. The exact reason behind sleepwalking is unknown, especially since scientists stopped looking into this phenomenon for a very long time, until very recently when nocturnal polysomnography came into the picture. There are many contributing factors to sleepwalking, though.
It differs from children to adults. Many sociologists believe that some children suffer sleepwalking due to delays in maturation, especially in the central nervous system. Hereditary sleepwalking is very evident in children who have at least one parent who was affected with sleepwalking (45%) and even greater when both parents were affected (60%).
Identical twins are ten times more likely to sleepwalk than regular siblings. Sleepwalking is not related to sex or race. Apart from the inherited trait, sleepwalking could be attributed to medical conditions such as arrhythmias, head injuries, hyperthyroidism, stroke, fever, gastroesophageal reflux disease (GERD), nighttime asthma, nighttime seizures and various psychotic disorders.
Environmental factors that cause sleepwalking include:
- Sleep deprivation.
- Chaotic sleep schedules/ Interrupted sleep.
- Noisy sleep environment.
- Going to bed with a full bladder.
- Stress: It causes the body to act up to go back to normal, so when the person goes to sleep, the body systems haven’t recovered from their stressed condition and thus cannot function properly during a state of sleep.
- Alcohol: Even though it acts as a sedative, sleep resulting from alcohol is usually poor in quality. When the sleeper is intoxicated, the problem of increased clumsiness is present. Sleepwalking will be risky because the sleepwalker may stumble or fall into things, which further complicates the process.
In psychoanalysis, sleepwalking has been interpreted through varying contexts. Sigmund Freud, the founding father of psychoanalysis, believed that sleepwalking was connected to fulfilling repressed sexual wishes.
He further studied it in his essay “A Metapsychological Supplement to the Theory of Dreams”, stating that sleepwalking results from the clash between preconscious daytime thoughts and repressed unconscious impulses, expressed as mobility during sleep.
Symptoms of Sleepwalking:
In addition to walking during sleep, other symptoms of sleepwalking include (in a varying degree of complexity):
- Automatic behaviours: Chewing, lip-smacking, rubbing their eyes, pulling at clothing, wandering around looking confused.
- Simple behaviors: Sleep-talking, sitting up in bed, cleaning or standing in the dark staring at nothing.
- Complex, dangerous behaviors: Cooking, driving, screaming, violent gestures, grabbing at hallucinated objects, attacking the person attempting to wake them up.
- Inappropriate behaviors: This occurs in the case of children. Behaviors like this include walking into parents’ room while they’re having sex or urinating in closets. When a child awakes and discovers what they have done, this might add to their embarrassment or cause significant psychological distress.
Should I Wake a Sleepwalker?
Waking a sleepwalker is one of the most controversial scientific topics. Many scientists suggest that it is better to guide them back to bed gently instead of waking them. Who commonly believed that if you wake a sleepwalker, you might put that person into shock, and they would suffer a heart attack or go into a coma.
Sleep scientists have disproved this, who warn that waking up sleepwalkers may not put them in the best shape, but it won’t kill them.
Sleep experts have hinted that waking a sleepwalker would result in them being disoriented, confused and agitated. A sleepwalker once described it on an online blog as something similar to “the distress you feel when woken up by the alarm in the middle of the night”.
Feelings of distress, grogginess and confusion, and the inability of the sleepwalker to remember anything from their nighttime experience, are often the results of waking up a sleepwalker. However, there’s a potential for the person doing the waking to get hurt. Therefore, it is advised to avoid approaching the sleepwalker if they are in a violent state. The greatest aim at that point would be to put them out of harm’s way.
Sleepwalking Treatment and Prevention:
Treatment for sleepwalking differs from adults to children. In the case of children, sleepwalking is usually outgrown over time. However, it might be best to treat the underlying causes to prevent sleepwalking in the case of underlying parasomnias.
In recent studies, scientists discovered that most children who suffer from either restless legs syndrome (RLM) or periodic limb movements (PLM) or sleep-disorder breathing (SDB) regularly sleepwalk. After RLM or SDB, sleepwalking symptoms usually disappeared, thus indicating that the former usually trigger the latter.
To overcome sleepwalking as a side effect of sleep apnea, Who should monitor children’s respiration during sleep. Treatment methods include introducing nasal cannula/pressure transducer system and oesophagal manometry to the child during sleep.
The most important aspect of treating sleepwalking is dealing with it while trying to minimize the damages involved. Creating a safe, contained sleeping environment for your kid is a must. Locking all doors and windows is unavoidable and removing all sharp objects from the sleeping area.
Doctors rarely prescribe medications to treat sleepwalking. It is usually the result of an underlying illness and stops when the illness is cured. If it is a side effect of certain drugs, sleepwalking will cease automatically after the drug course is over.
Sometimes doctors prescribe low dose benzodiazepines and tricyclic antidepressants to treat severe cases of somnambulism; however, in most cases, Who should follow one of two measures either separately or simultaneously. These two measures are sleep hygiene and hypnosis.
Sleep hygiene is a series of different practices and regulations to ensure sound and healthy sleep. To achieve the required sleep hygiene measures, Who should follow several steps:
- Maintaining a regular wake and sleep pattern.
- Spending an appropriate time in bed.
- Don’t exceed sleeping hours to more than 8 hours/day.
- Avoid napping during the day.
- Avoid stimulants such as nicotine, caffeine too close to bedtime.
- Avoid alcohol (a sedative, but it disrupts the quality of sleep) too close to bedtime.
- Exercise regularly.
- Stay away from large meals before bedtime.
- Ensure adequate exposure to sunlight.
- Associate your bed with sleep.
- Maintain a relaxing and pleasant sleeping environment.
Hypnosis is a state of deep physical relaxation but with the retention of an active and focused mind. As a preventive measure for sleepwalking, hypnosis has been proved valid by many psychotherapists. In small-scale studies conducted by researchers, results have shown that properly screened sleepwalkers experienced significant improvement with clinical hypnosis.
Furthermore, hypnosis has shown positive results for other parasomnias, such as night terrors and nightmares. The theory behind this comes from the positive effect that hypnosis has on relaxing the body. When this occurs, the sleeper enjoys less disrupted sleep and a decrease in the frequency and severity of the sleepwalking episodes.
Sleepwalking Validity from a Legal Point of View:
While many argue that extreme behaviours rarely occur during a sleepwalking episode, some people go as far as a homicide while sleepwalking. Homicidal sleepwalking has more than once raised the question of whether sleepwalking is real or not. About 68 cases of murder during a sleepwalking act had been reported in the literature up to the year 2005.
Most homicidal sleepwalking cases have been highly complicated, especially when the sanity of the accused is questionable. In the 2013 psychological thriller “Side Effects”, the heroine is a woman who murders her husband while sleepwalking due to a side effect of the antidepressant she is taking.
Many real-life homicides took place during a sleepwalking episode. The defendants were either acquitted on the grounds of temporary insanity or ruled out as not guilty on the condition that they would be admitted to a mental institution.
Various articles give detailed descriptions of how to fake sleepwalking. They describe the sleepwalker’s state as realistically as possible, steering away from the comical way they present it on TV. However, some people have been discussing how it would be really “cool” to sleepwalk for real. Many try to associate it with lucid dreaming, despite dreams and sleepwalking being in completely different sleep stages.
Sleepwalking is no game. It is a tough and dangerous process for the sleeper and those living with them. So who should provide special treatment to those suffering from sleepwalking along with methods of coping and prevention? Many sleep research centres provide all the required information and consultation for night wanderers who can’t seem to grasp the cause behind their misery.