Sleepwalking(Somnambulism)

Definition:
Sleepwalking (also called somnambulism or noctambulism) is a parasomnia or sleep disorder where the sufferer engages in activities that are normally associated with wakefulness while he or she is asleep or in a sleep-like state. Sleepwalking is usually defined by or involves the person affected apparently shifting from his or her prior sleeping position and moving around and performing normal actions as if awake (cleaning, walking and other activities). It is a disorder characterized by walking or other activity while seemingly still asleep.Sleepwalkers are not conscious of their actions on a level where memory of the sleepwalking episode can be recalled, and because of this, unless the sleepwalker is woken or aroused by someone else, this sleep disorder can go unnoticed. Sleepwalking is more commonly experienced in people with high levels of stress, anxiety or psychological factors and in people with genetic factors (family history), or sometimes a combination of both.

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A common misconception is that sleepwalking is acting out the physical movements within a dream, but in fact, sleepwalking occurs earlier on in the night when rapid eye movement (REM), or the “dream stage” of sleep, has not yet occurred.

A majority of people move their legs while sleeping; however, sleepwalking occurs when both legs move in synchronization[citation needed], which is much less common.

Sleepwalking can affect people of any age. It generally occurs when an individual moves during slow wave sleep (during stage 3 or 4 of slow wave sleep—deep sleep) (Horne, 1992; Kales & Kales, 1975). In children and young adults, up to 80% of the night is spent in SWS (50% in infants). However, this decreases as the person ages, until none can be measured in the geriatric individual. For this reason, children and young adults (or anyone else with a high amount of SWS) are more likely to be woken up and, for the same reasons, they are witnessed to have many more episodes than the older individuals.

Causes:
This causes REM atonia, a state in which the motor neurons are not stimulated, and thus the body’s muscles do not move. Lack of such REM atonia causes REM Behavior Disorder.

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. Rapid eye movement (REM) sleep is a different type of sleep, in which the eyes move rapidly and vivid dreaming is most common.

During a night, there will be several cycles of non-REM and REM sleep. Sleep walking (somnambulism) most often occurs during deep non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning.

 

In children, the cause is usually unknown but may be related to fatigue, prior sleep loss, or anxiety. In adults, sleepwalking is usually associated with a disorder of the mind but may also be seen with reactions to drugs and alcohol, and medical conditions such as partial complex seizures. In the elderly, sleepwalking may be a symptom of an organic brain syndrome or REM behavior disorders.

Incidence:

The sleepwalking activity may include simply sitting up and appearing awake while actually asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer.

One common misconception is that a sleep walker should not be awakened. It is not dangerous to awaken a sleep walker, although it is common for the person to be confused or disoriented for a short time on awakening. Another misconception is that a person cannot be injured when sleep walking.

Sleep walking occurs at any age, but it occurs most often in children aged 6 to 12. It may occur in younger children, in adults, or in the elderly, and it appears to run in families.

Risk Factors:

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Sleepwalkers are more likely to endanger themselves than anyone else.Actually, injuries caused by such things as tripping and loss of balance are common for sleep walkers. When sleepwalkers are a danger to themselves or others (for example, when climbing up or down steps or trying to use a potentially dangerous tool such as a stove or a knife), steering them away from the danger and back to bed is advisable. It has even been reported that people have died or were injured as a result of sleepwalking. Sleepwalking should not be confused with psychosis.

Sleepwalking has in rare cases been used as a defense (sometimes successfully) against charges of murder.

Symptoms:

* eyes open during sleep
* may have blank facial expression
* may sit up and appear awake during sleep
* walking during sleep
* other detailed activity during sleep, any sort
* no recall of the event upon awaking
* confusion, disorientation on awakening
* sleep talking is incomprehensible and non-purposeful

Diagnosis:

Usually, no further examination and testing is necessary. If sleepwalking is frequent or persistent, examination to rule out other disorders (such as partial complex seizures) may be appropriate. It may also be appropriate to undergo a psychologic evaluation to determine causes such as excessive anxiety or stress, or medical evaluation to rule out other causes.

Treatment:

Usually no specific treatment for sleepwalking is needed.

Safety measures may be necessary to prevent injury. This may include modifying the environment by moving objects such as electrical cords or furniture to reduce tripping and falling. Stairways may need to be blocked off with a gate.

In some cases, short-acting tranquilizers have been helpful in reducing the incidence of sleepwalking.

For kids who sleepwalk often, doctors may recommend a treatment called scheduled awakening. This disrupts the sleep cycle enough to help stop sleepwalking. In rare cases, a doctor may prescribe medication to help someone sleep.

Prognosis:
Sleepwalking may or may not reduce with age. It usually does not indicate a serious disorder, although it can be a symptom of other disorders.

Prevention:
# Relax at bedtime by listening to soft music or relaxation tapes.
# Have a regular sleep schedule and stick to it.
# Keep noise and lights to a minimum while you’re trying to sleep.
# Avoid the use of alcohol or central nervous system depressants if prone to sleepwalking.
# Avoid fatigue or insomnia, because this can instigate an episode of sleepwalking.
# Avoid or minimize stress, anxiety, and conflict, which can worsen the condition

Statistics:-

* Eighteen percent of the world’s population is prone to sleepwalking.
* Somewhere between 1% and 16.7% of U.S. children sleepwalk, and juveniles are more prone to the activity.[citation needed]
* One study showed that the highest prevalence of sleepwalking was 16.7% for children of 11–12 years of age.[citation needed]
* Males are more likely to sleepwalk than females.[citation needed]

Activities such as eating, bathing, urinating, dressing, driving cars, whistling, and committing murder have been reported or claimed to have occurred during sleepwalking. Contrary to popular belief, most cases of sleepwalking do not consist of walking around (without the conscious knowledge of the subject). Most cases of somnambulism occur when the person is awakened (something or someone disturbs their SWS); the person may sit up, look around and immediately go back to sleep. But these kinds of incidences are rarely noticed or reported unless recorded in a sleep clinic.[citation needed]

Sleepwalkers engage in their activities with their eyes open so they can navigate their surroundings, not with their eyes closed and their arms outstretched, as often parodied in cartoons and films. The subject’s eyes may have a glazed or empty appearance, and if questioned, the subject will be slow to answer and may be unable to respond in an intelligible manner.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.medicinenet.com/sleepwalking/article.htm
http://en.wikipedia.org/wiki/Sleepwalking
http://kidshealth.org/kid/stay_healthy/body/sleepwalking.html

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