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    Sleepwalking

    Introduction
    Causes
    Symptoms

    Diagnosis
    Treatment
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by Sleep Disorders Unit

    Introduction

    Sleepwalking appears to have a genetic link.

    Sleepwalking is characterised by complex behaviour (walking) while asleep. Nonsensical talking may accompany this at times. The eyes are usually open with a characteristic ’glassy’ look that appears to have a ‘going through you’ kind of appearance.

    It usually occurs in middle childhood and adolescence but can persist into adulthood. There appears to be a genetic tendency.

    Stage 1, 2 and 3 are described as nonrapid eye movement (NREM) sleep. Rapid eye movement (REM) sleep is the last cycle which is usually associated with dreaming. There are four to five complete sleep cycles per night, each cycle consisting of all three stages and REM.

    Sleepwalking usually occurs in the first or second cycle during stage 3. It is not usually seen during naps.

    The person is not aware and has no memory of his or her behaviour.

    Causes

    Genetic

    It occurs more frequently in identical twins. The risk is ten times higher if a first-degree relative has a history of sleepwalking.

    Environmental

    Sleepwalkers will not remember the event.The following factors can trigger sleepwalking:

    • Sleep deprivation
    • Chaotic sleep schedules
    • Fever
    • Stress
    • Magnesium deficiency
    • Alcohol intoxication
    • Sedative/hypnotic drugs
    • Stimulants
    • Antihistamines

    Physiologic

    Pregnancy and menstruation can increase the frequency of sleepwalking.

    Associated Medical Conditions

    • Arrhythmias
    • Fever
    • Gastroesophageal reflux
    • Night time asthma
    • Night seizures
    • Obstructive Sleep Apnoea
    • Psychiatric disorders

    Symptoms

    Episodes range from quiet walking to agitated running. Eyes are open with a glassy staring appearance. On questioning, responses are slow with simple thoughts. If returned to bed without awakening, the person does not usually remember the event.

    Diagnosis

    Usually no tests or exams are necessary but a medical evaluation may be done to rule out medical causes of sleepwalking. A psychological evaluation may also be done to exclude excessive stress or anxiety as a cause. Sleep tests may be done if the diagnosis is still unclear.

    Treatment

    The following treatment options can be undertaken for a person with sleepwalking disorder:

    General Measures

    • Go to bed at the same time each night
    • Attain adequate sleep
    • Avoid napping
    • Avoid stress, fatigue and sleep deprivation
    • Moderate or relaxation exercises
    • Avoid any kind of stimuli prior to bedtime
    • Environment must be safe from harmful or sharp objects
    • Sleep on the ground floor and avoid bunk beds
    • Lock windows and doors
    • Remove obstacles in the room
    • Cover glass windows with heavy drapes
    • Place alarm or bell on bedroom and windows, if necessary

    Medical Treatment

    The underlying cause should be treated, for example, gastroesophageal reflux, obstructive sleep apnoea, seizures and other causes mentioned. Medications may be necessary in the following situations:

    • The possibility of injury is real
    • Continued behaviours are causing significant family disruption or excessive daytime sleepiness
    • Other measures have proven to be inadequate
    • Benzodiazepines have been shown to be useful for three to six weeks and then discontinued without recurrence of symptoms but occasionally frequency can increase briefly after discontinuing the medication
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