Sleep Walking
(Somnambulism)
Sleep
walking is quite common. Medical reports show that about 18% of
the population are prone to sleep walking. It is more common in
children than in adolescents and adults. Boys are more likely to
sleepwalk than girls. There seems to be some inherited component;
children are more likely to sleep walk if their parents did. If a
child begins sleepwalking at the age of 9, it often lasts into
adulthood.
Sleepwalking is a series of complex behaviors that are initiated
during slow wave sleep and result in walking during sleep. It
usually happens in the first third of the night. During a
sleepwalking episode, the brain is half-awake and half-asleep.
Occasionally it can carry out simple tasks like avoiding
obstacles, but sleepwalkers can be confused. They may fall down
the stairs or mistake a window for a door. There are stories of
sleep walkers driving cars, boarding planes, going swimming, and
performing other complex actions. This is unlikely. Sleepwalkers
do not have the fast reflexes and the comprehension needed for
such complicated actions.
Symptoms:
Walking during sleep (typically in the first third of sleep
episode)
Difficulty in arousing the patient during an episode
Amnesia following an episode
Sleep study demonstrates the onset during deep sleep (stage 3
and 4)
Usually, children who sleepwalk are psychologically as healthy
as children who do not. However, medical and psychiatric disorders
can be present.
Children usually outgrow the problem as they get older
How serious is sleep walking?
Most patients experience sleep walking infrequently (less than
once per month) and those episodes do not result in harm to the
patients. Others experience episodes more frequently. In its most
severe form, the episodes occur almost nightly or are associated
with physical injury. Sleepwalking may cause embarrassment, shame,
guilt, anxiety and confusion to the patient. If the sleepwalker
exits the house, or is having frequent episodes and injuries are
occurring, it is time to seek professional help. There have been
some tragedies with sleepwalkers; do not let it happen to your
loved one. Sleepwalking in adults is more worrisome. Extreme
anxiety, stress and occasionally epilepsy are possible causes.
Therefore, adults with this problem should seek medical help.
What can be done about sleep walking?
There are general advises to be told to the sleepwalker:
Tiredness can trigger sleepwalking, therefore, make sure you get
plenty of rest
Anxiety, tension and stress are other triggers for sleepwalking,
therefore, try to develop a calming ritual or do relaxation
exercises
Put away dangerous and sharp objects and car keys and consider
putting a bell on the bedroom door and a grill on the windows
The sleepwalkers bedroom should be on the ground floor of the
house and he/she should not have a high bed (to avoid falling)
If you have to spend some nights outside your house consider the
same precautions and notify the people you are staying with (or
the hotel receptionist) about your sleep problem
An accurate psychiatric and medical evaluation could help to
decide the need for psychiatric or medical intervention. The
patient should reassured about the benign nature of the problem if
the above precautions are applied
In severe cases, some medications can be used to reduce the
frequency of the episodes
Ahmed BaHammam, FRCP, FCCP
Professor of Medicine
Director, Sleep Disorders Center
College of Medicine, King Saud University
Associate Editor, Ann Thoracic Med
