Sleeping Disorders

Sleepwalking (Noctambulism or Somnambulism)

Sleepwalking (also written as Sleep Walking and also called Noctambulism and Somnambulism) is a parasomnia sleep disorder where the sufferer engages in activities that are normally associated with wakefulness (such as eating, dressing, or walking) while asleep or in a sleep-like state, without the conscious knowledge of the person.
Most cases of Sleepwalking occur when the person is woken up as a result of something or someone disturbing their Short Wave Sleep (SWS).  In the vast majority of these cases, the person may sit up, look around, and immediately go back to sleep.  It is much rarer for a person to perform various activities before returning to sleep.

Symptoms

The main symptom of Sleepwalking is engaging in activities that are normally associated with wakefulness (such as eating, dressing, or walking) while asleep or in a sleep-like state, without the conscious knowledge of the person.
Sleepwalkers engage in these activities with their eyes open, meaning that they can navigate in their surroundings.
A Sleepwalker's eyes may have a glazed or empty appearance, and if they are spoken to or questioned, then the Sleepwalker will be slow to answer and will be unable to respond in an intelligible manner.
Please Note: Sleepwalkers do not walk around or perform activities with their eyes closed and their arms outstretched as parodied in cartoons and various Hollywood productions.

Causes

Sleepwalking is affected by the following factors:
- Age
- Sex
Sleepwalking can affect people of any age, and usually occurs when an individual awakes suddenly from Slow Wave Sleep (SWS), also called Stage 3 and 4 Sleep, triggering the sleepwalking episode.
In children and young adults, up to 25% of the night is spent in SWS. However this decreases as the person ages until none can be measured in the elderly people.
For this reason, children and young adults (or anyone else who achieves high amounts of SWS), are more likely to be woken up and, for the same reasons, they tend to have more Sleepwalking episodes than older people.
Some research suggests that the highest prevalence of sleepwalking occurs in children of 11 to 12 years of age, and affects 16% of children in this age group.
Boys are more likely to sleepwalk than girls.

Diagnosis

In the vast majority of cases, Sleepwalking is identified by the family or bed partner of the person who suffers from Sleepwalking.
Sleepwalking can also be observed and confirmed by a doctor at a sleep clinic.

Complications / Issues

Sleepwalking does not directly pose any health concerns.  However, accidents may happen as the Sleepwalker attempts to perform actions without the control of their conscious mind.
If the sleepwalker commits a criminal offence while asleep, or while they claim they were asleep, then a defense of automatism may be available to them, allowing them to get away with lesser or no charges.
A common myth surrounding this disorder is that one should never wake sleepwalkers while they are engaged in the activity. In truth, there is no implicit danger in waking sleepwalkers, though the subjects may be disoriented or embarrassed when awakened. The danger lies not in the fact that something might happen to the sleepwalker, but to the individual doing the waking, as occasionally the sleepwalkers get aggressive when interrupted. Although the majority of the time, nothing happens, it is not unheard of for assaults or even homicide to occur (though the latter is extremely rare). However sleepwalkers are much more likely to endanger themselves than anyone else. 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 or even waking them is advisable. It has even been reported that people have fallen out of windows while sleepwalking and died as a result.

Treatment

Treatment for Sleepwalking is often unnecessary, especially if episodes are infrequent and uncomplicated.
Safety issues are of prime importance for someone who sleepwalks and to others who are involved with managing the condition.  The following measures are usually recommended:
- Locate the bedroom on the main floor, if possible.
- Lock the windows and cover them with large, heavy drapes.
- Keep the floor and room clear of potentially harmful objects.
- Remove any hazardous materials and sharp objects from the room and secure them in the house.
- Stay on the first floor when visiting others and when sleeping at a hotel.
Medication may be used to treat Sleepwalking sufferers, especially where episodes are violent, injurious, frequent, or disruptive.
Therapy usually consists of the following class of medications:
- Benzodiazepines: These drugs suppress muscle contractions and assist people in staying asleep.  Diazepam, Alprazolam, or other tricyclic antidepressant may be used.  Among other things, these drugs inhibit chemical processes associated with sleep regulation, which, depending on the patient, may result in effective treatment and fewer sleepwalking episodes.
Please Note: Benzodiazepines are also used to treat Periodic Limb Movement Disorder (PLMD) and Restless Leg Syndrome (RLS).
Biofeedback and hypnosis have also been used effectively with some sleepwalking sufferers.

Prevention

The best way to prevent or reduce the onset of the symptoms and complications of Sleepwalking is for the sufferer to work with their doctor so that the causes can be treated, removed, or reduced.
In addition, various simple safety measures may also recommended to protect those who sleep walk and their partners / families.
See section 4.15.5 Treatment above.

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