Somnambulism

Somnambulism

Somnambulism is a sleep disorder commonly known as sleepwalking. The cause of this disorder is largely unknown. Mainly children are affected.

What is somnambulism?

Somnambulism is a condition in which the sufferer moves about while sleeping, possibly performing complex actions. As a sleep disorder, this disorder belongs to the group of parasomnias. As a rule, the person concerned does not remember it at all later or only scraps of memory exist. Colloquially, somnambulism is referred to as sleepwalking or moon addiction. For hypersalivation explanations, please visit aviationopedia.com.

In the past, the full moon was seen as the trigger for nocturnal activity due to its brightness. The event of sleepwalking usually lasts only a few minutes. Mainly children (10 to 30 percent) are affected. After puberty, the tendency to sleepwalk disappears in most cases. In adults, there are only one to two percent chronic sleepwalkers. Somnambulism is not a serious illness, but mostly a harmless disturbance of waking up. In persistent cases, however, there is a risk of injury from falls.

Causes

Not much is known about the causes of somnambulism. The finding that mainly children are affected suggests a maturation problem in the central nervous system. During childhood and adolescence, the maturation process within the nervous system is not yet complete. With the end of puberty, the somnambulism that is still typical for many children and adolescents usually also ends.

In only one to two percent of cases does it continue to appear in adulthood. Sometimes the condition becomes chronic. In some cases it is rare. There are even cases where somnambulism first appears in adulthood. It has been established with certainty that the cause of sleepwalking has a genetic component. Somnambulism tends to run in some families. Stress and other stressful situations are also assumed to be triggering factors.

Sedative medication, fever, sleepless nights or alcohol consumption can also trigger the sleep disorder. Somnambulism never occurs during dream sleep (REM sleep) but always during deep sleep or normal sleep. There is the assumption that after an internal or external stimulus, the waking up process is not complete.

This creates an intermediate state in which part of the brain is awake while the other areas of the brain are still asleep. Complex actions can be taken in this situation. It has not yet been possible to clarify why the awakening process is not complete.

Symptoms, Ailments & Signs

Somnambulism is manifested by pacing during deep sleep, unresponsiveness to external stimuli, rigid facial expression, and difficulty being aroused. In rare cases, aggressive behavior may occur. After a few minutes, the sleepwalker usually returns to bed and continues to sleep. Sleepwalking usually occurs in the first third of the night. The activity is intensified by stimuli such as light or noise.

A distinction must be made between four forms of somnambulism:

  • Activity does not always occur in the subclinical form. However, corresponding brain activities can be detected in the electroencephalogram (EEG), in the electrocardiogram (ECG) and in the electromyogram (EMG).
  • In the so-called abortive form of somnambulism, activities are limited to bed. The person either just sits down or talks slurred in their sleep.
  • In classic somnambulism, the sufferer wanders about during sleep, may perform complex actions, and puts themselves at risk of injury by not responding to external stimuli.
  • In rare cases, an aggressive to violent course occurs. However, it is precisely here that there is a risk of confusion with other forms of sleep disorders, which are often based on much more serious psychological diseases.

Diagnosis & course of disease

Somnambulism is usually a harmless sleep disorder. However, it must be differentiated from other, much more serious sleep disorders in terms of differential diagnosis. There are certain forms of epilepsy that occur at night and can be confused with somnambulism. Furthermore, certain REM sleep disorders (Schenck syndrome) can mimic the aggressive form of somnambulism.

Here, however, the activities occur during dream sleep, with the patient reacting aggressively to dream content and later being able to partially remember it. Other exclusion diagnoses are states of confusion in dementia and mental states of emergency. A reliable diagnosis of somnambulism can be made using an electroencephalogram, electrocardiogram or electromyogram.

Complications

Somnambulism itself is unproblematic in most cases. However, sleepwalking increases the risk of accidents and falls. For example, during nocturnal activities, the affected person may fall off the stairs, trip or turn on the stove.

If the sleepwalker is woken up, this can trigger a shock and a heart attack may occur. Occasionally those affected become violent because they cannot distinguish between dream and reality. In adults, somnambulism can indicate brain disorders. It cannot be ruled out that sleepwalking is due to a neurological disorder or even a brain tumor – both of which must be treated before further complications can develop.

Most sleepwalkers are prescribed sedatives or sleeping pills, which are always associated with side effects and interactions. Benzodiazepines and antidepressants also pose risks. If a mental illness that may be present is not recognized, the medication can lead to an increase in symptoms. In most cases, well-being then also decreases and the quality of life decreases. Behavioral therapy is usually without complications, but should still be carried out under the guidance of an expert.

When should you go to the doctor?

In most cases, sleepwalking does not require a doctor. It is often a temporary or one-off phenomenon that does not require any action. If there are no other irregularities or behavioral problems, it is not always necessary to see a doctor. In a large number of cases, the affected person finds his way back to his bed without further complications and does not require any help.

Consultation of a doctor is indicated as soon as there are regular or recurrent nocturnal problems. Tiredness during the day, exhaustion or a decrease in mental and physical performance are indications that should be followed up. If sleep disorders, anxiety or inner restlessness occur, the symptoms should be clarified. If there are any abnormalities in behavior, an aggressive appearance or changes in personality, an assessment by a doctor or therapist is recommended.

If various stress factors are present, if the well-being is reduced or if the person concerned withdraws, the developments should be discussed with a doctor. In dangerous situations or self-destructive actions, consultation with a specialist is advisable. The person concerned and their relatives need information on how to deal with the sleepwalker correctly and should optimize their sleep hygiene so that everyone involved can relax.

Treatment & Therapy

During the active phase of somnambulism, the person concerned should not be awakened because disorientation increases the risk of injury. Panic reactions can even occur. Only in cases where the sleepwalker enters a danger zone should he be spoken to quietly and gently led to the bed. It is important to ensure that the bedroom is always dark, as sleepwalkers react to light.

If sleepwalking is common, locking windows and doors and removing sharp objects should minimize the risk of injury. There is no known therapy for the treatment of somnambulism.

Aftercare

Dealing with sleepwalkers is a particular challenge for relatives in everyday life. In order to protect those affected from possible accidents, it is important to prevent dangerous situations. On the one hand, you have to prevent the sleepwalker from running away in his sleep, but at the same time escape routes have to be kept open so that you can act quickly in case of danger.

Stress has a negative impact on sleepwalkers. It is therefore important for those affected to reduce stress factors in everyday life and, ideally, to minimize them in advance. Overwhelm and emotional distress often contribute to worsening somnambulism and must be overcome. Therapeutic support can be very helpful for the patient.

It is also important to familiarize those around you with the disease in order to avoid unnecessary complications. Optimal sleep hygiene also helps to improve the situation. Day and night rhythms should be routine and adapted to the needs of the sleepwalker.

In the phase of sleepwalking, the person concerned should under no circumstances be emphatically awakened. Often speaking to the sleepwalker gently is enough to get him to go back to bed and to keep him from further activities. Since those affected often have memory gaps, they should be informed about the event afterwards.

Prevention

There are some measures to prevent the active phases of somnambulism. The risk can be minimized by good sleep hygiene. The person concerned should keep to their sleeping rhythm, avoid sleeping deficits and avoid taking a nap in the afternoon. In the case of stress or existing conflicts, cognitive behavioral therapy has proven its worth. Certain relaxation techniques such as autogenic training or progressive muscle relaxation can also be used successfully in the treatment of somnambulism.

You can do that yourself

Dealing with sleepwalkers is a particular challenge in everyday life. On the one hand, sufficient protection against possible accidents or running away during sleep should be guaranteed. On the other hand, escape routes must be kept open and accessible for emergencies so that no dangerous situation arises. It is therefore often not easy to find a good middle ground for everyone involved.

The person concerned can reduce stressors in everyday life. These have a negative impact on the process of sleepwalking and should therefore be minimized. States of emotional stress or excessive demands must be overcome or should be treated therapeutically. In addition, the immediate environment must be informed about the processes and the possibilities of sleepwalking. Proper handling of the affected person is important so that no complications arise. It has been shown that optimizing sleep hygiene contributes to an improvement in the overall situation. Therefore, day and night rhythms should be adapted to the needs of the body and routine processes should take place.

In the situation, everyone involved must remain calm. Under no circumstances should the sleepwalker be forcefully awakened. Light communication and a request to go back to bed are often enough to dissuade the sleepwalker from further undertakings. Since the ability to remember is clouded in the connection, there is a need for clarification of the person concerned.

Somnambulism