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If he does this when he sleeps, there are a variety of movements associate
with sleep called parasomnias. That is the general topic we are discussing today
(sleepwalking or somnambulism). The twitching is hard to envision, as it is not
actually something I am seeing and this is one of the difficulties with sleep
medicineɠin that the history given to the physician is often relatively vague.
But as they say, seeing is believing or in Missouri, the show me state, one
picture is worth a thousand words. If on occasion a physician performs a full
examination and listens to the history and a diagnosis is not clear, then I
would recommend and overnight sleep study to analyze the episode as it occurs.
If in the laboratory setting, you can actually see the spell and look at all the
physiologic associates we monitor in the laboratory, we can rule out a sleep
related parasomnia and other disorders such as seizures in sleep which you
allude to when you describe your son's eyes rolling back. It appears that there
is enough concern should this be an otherwise normal parasomnia to rule out a
seizure and to give comfort to the family; a sleep study could be justified.
What causes sleepwalking? Is it a "learned" behavior and/or something
that's in response to a person's waking environment, or is it biological in
origin?
It is possibly a combination of things. Anna Freud, Sigmundճ daughter did a
lot of investigative work on this subject and sleepwalking is a relatively
"normal" finding in the pediatric population. There appears to be a genetic or
inherited factor as it often runs in families, but as we age, the phenomena of
sleep walking generally resolves. Psychologists and other investigators have
shown that children who sleep walk are usually normal in every respect but a few
studies have suggested that in some of the parasomnias some children may have
inner conflicts that they are not able to verbalize. And in a few cases, family
counseling and reassurance have been all the therapy necessary in patients with
frequent parasomnias. So there appears to be a tendency for children to have
this, a tendency for an inherited component, and especially as the patient
becomes older, a possible psychological element. And as such all the factors you
mentioned may come into play to some degree.
Can sleepwalking be caused by a person going through emotional trauma?
Normal children can sleep walk and they generally outgrow the problem by age
15. The old literature suggested that when the few children who persisted in
having sleep walking episodes as adults, that there may be strong psychological
problems that may make the problem worse. My anecdote, my impression is that
this is often overstated. Nevertheless, in an adult with sleepwalking, I
routinely have my group of neuropsychologists who specialize in insomnia (sleep
disorders) perform a Minnesota Multiphasic Personality Inventory (MMPI) to look
for underlying psychological personality and social factors which might be
contributing to the disorder. My anecdote is that I have had a world-class
athlete who had significant sleep walking to the point of jumping out a window
and separating his shoulder during the height of the basketball season. When the
stress associated with the season was reduced during the summer months improved
but did not completely resolve.
When should sleep walking been seen as a problem? If my son sleepwalks
once/year, should I be worried?
We generally, according to standards set in the International Classification
of Sleep Disorders, consider severe sleep walking as occurring greater than or
equal to 1 time per week. As such one even per year seems relatively minimal.
Nevertheless, my anecdote comes back to haunt us, and I personally have had only
two sleep walking events as a child, one of which led to my tripping over a
glass table, which subsequently left a permanent scar on my shoulder. Rarely, as
our good friend Dr. Gerald Rosen, the pediatric sleep expert from Minneapolis,
Minnesota, reports that there are rare but probable yearly events reported
during the winter where children have sleep walking events which led them
outside and they subsequently could not find their way back inside and freeze to
death. The point I want to make is that although this is a relatively benign
problem in most instances, the children have a potential for harming themselves.
As such preventative medicine is recommended and that involves protecting their
sleeping environment.
Is there any connection with sleep apnea and sleepwalking?
Sleep apnea can on occasion be misdiagnosed as sleepwalking. A person with
severe sleep apnea, that is where an individual stops breathing for prolonged
periods as night while sleeping, may drop their oxygen levels so low that it
affects their thinking and behavior, essentially a "sleep drunk" like state
which might be misinterpreted as sleepwalking. Otherwise the two have no real
connection at all.
Are sleep terrors and sleepwalking similar?
Yes. These are parasomnias of similar origin in that they both generally come
out of a specific sleep stage that many refer to as deep delta sleep. This stage
of sleep generally occurs in the first one third of the patient's nighttime
sleeping period. In some cases there appears to be a spectrum of activity which
ranges from confusional arousals to night terrors to actual sleep walking all or
few of which behaviors we might capture during a sleep study. If there is a
clinical report of sleep walking, and we perform a sleep study and capture only
a confusional arousal, it suggests to us that there somnambulism is the major
problem and not a seizure or sleep apnea with a relative sleep drunk state that
we talked about earlier and which represent part of the differential diagnosis.
Rarely do we actually capture a sleepwalking event in the lab, but it is not
unusual for us to capture confusional arousal from deep delta sleep in patients
with suspected sleep walking in the lab.
Do children grow out of sleepwalking?
Anna Freud reported that according to Piaget there are major developmental
stages throughout all age groups. In these terms she implied that sleepwalking
in children in most part represented one of these normal developmental stages,
which would eventually be outgrown in most stages.
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