What causes sleepwalking?
Sleepwalking or somnambulism occurs when a person gets out of bed and proceeds to do daytime activities while appearing to be asleep. These activities are not remembered by the person and are reflective of their usual routine. These complex behaviors usually arise from slow wave sleep and can range from simply sitting up in bed to walking out a closed door or window into the street. This is quite different from acting out your dreams, which is a different disorder and covered in the next chapter (REM behavior disorder). Sleepwalking usually occurs in school aged children but can recur in sleep-deprived teenagers. It can also be provoked by illness and stress. It does tend to run in families; however, the exact cause is unknown.
How is sleepwalking diagnosed?
A sleep specialist usually diagnoses sleepwalking after reviewing the circumstances of the episodes, to separate them out from other sleep disorders (such as confessional arousals where the children are actually awake) or nocturnal seizures. A sleep study, or polysomnogram can be used to confirm the diagnosis and a bell or buzzer may be used to trigger the episode. Sometimes more than one night in the sleep lab is required to see an episode.
What can be done to treat sleepwalking?
Many children will have limited sleepwalking episodes to getting out of bed and going into their parents’ room or hallway. Usually, they will outgrow this by their teenage years, and require no further treatment. Some children, and adults, may require medical interventions. The most important aspects of the treatment of sleepwalking is prevention and safety. It is important for sleepwalkers to allow for adequate sleep time, avoid noises and avoid medications known to provoke sleep walking by promoting slow wave sleep (such as desipramine). Loud or sudden noises may disrupt sleep and trigger sleepwalking without fully awakening the child. In fact, most children sleep through loud noises and may even sleep through fire alarms. Other sleep disorders (such as sleep apnea or periodic limb movement syndrome) or medical disorders (such as reflux) which can lead to sleep deprivation should be treated. Sleepwalkers can be awakened immediately prior to their usual episode which may sometimes prevent it.
Once sleepwalking, the sleepwalker usually cannot be awakened during an episode and may become aggressive when deliberately awakened. It is better to allow them to sleepwalk and gently guide them back to bed. Prevention of injury is key. Some preventive measures may include moving the bedroom to the ground floor, putting a bell on doorways, locking windows, and removing obstructing objects from common pathways. If sleepwalking results in injury, medications may be required to suppress sleepwalking by suppressing slow wave sleep. These medications include benzodiazepines (like clonazepam) and antidepressants (such as trazodone). While these may successfully suppress slow wave sleep and sleepwalking, they can lead to increased sleepiness and drowsiness in the daytime.
Can someone have criminal activity during a sleepwalking episode?
In general, sleepwalkers do not have criminal activity in their sleep. This is mainly because sleepwalkers are asleep and their actions, while purposeful, are not motivated by personal gain or vengeance. Their activities are also often frequent and repeated activities that they normally engage in during the daytime. For instance, a sleepwalker can get up, take their keys, and open the front door and walk outside. On the other hand, they will not take a knife, drive to some else’s home, and stab them repeatedly.