Somnambulism

Somnambulism Definition

Somnambulism is a Sleep Disorder characterized by walking or other activity while in a state of partial wakefulness from deep sleep.

Somnambulism (also called Sleepwalking) is common in school-age children.

Somnambulism (Sleepwalking) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep. Sleepwalking is a rapid eye movement (REM) behavior disorder occurring in the dream stage of sleep.

During this phase, the body releases a chemical that paralyzes the body. However, those who sleepwalk do not have this chemical trigger, hence the behavior.

Somnambulism occurs because the brain's ability to regulate sleep/wake cycles is still immature. Most children outgrow the symptoms as their nervous systems develop.

Somnambulism that begins later in life or lasts into adulthood may have psychological causes, such as extreme strain or, rarely, medical causes such as epilepsy.

Normal Sleep Cycle

The normal sleep cycle involves different 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. Somnambulism (Sleep walking) 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.

For some, the episodes of sleepwalking occur less than once per month and do not result in injury to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in injury to the patient or others.

In its most severe form, the episodes occur almost nightly or are associated with physical injury.  The sleepwalker may feel awkwardness, shame, guiltiness, anxiety and confusion when they are told about their sleepwalking behavior.

Somnambulism Symptoms

The key symptom of somnambulism is purposeful movements done while in a state of partial awakening from deep sleep. Some sleepwalkers simply sit up in bed and move their legs.

Somnambulism episodes usually occur one to two hours after going to sleep, and last from one to 30 minutes. A sleepwalker has open eyes and a blank expression, and is usually difficult, if not impossible, to awaken. The next morning, he or she won't remember the episode.

Features include:

• Ambulation (walking or moving about) that occurs during sleep. The onset typically happens in pre-pubertal children.
• Polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
• Other medical and psychiatric disorders can be present but do not account for the symptom
• Episodes typically occur in the first third of the sleep episode
• Difficulty in arousing the patient during an episode
• The ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors.
• Amnesia following an episode
• Fatigue
• Stress and 
• Anxiety 

Somnambulism Diagnosis:

A person's history regularly provides enough information for a doctor to diagnose somnambulism, especially in children. More difficult cases may require a consultation with a sleep specialist and an overnight sleep test called polysomnography.

During this test, various body functions are recorded while the person is sleeping. In rare cases, a brainwave recording (electroencephalogram, or EEG) may be prepared to rule out seizures.

Somnambulism Treatment

Treatment is not necessary if it does not result in harm to the patient suffering from somnambulism.

The sleepwalker can follow these things given below:

• Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; strain can be another trigger for sleepwalking.

• Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
• Remove anything from the bedroom that could be dangerous or harmful.
• The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.

In its most severe form, the episodes happen almost nightly or are associated with physical injury.  The sleepwalker may feel awkwardness, shame, guiltiness, anxiety and confusion when they are told about their sleepwalking behavior.

Therefore it is very important that if the sleepwalker exits the house, or is having frequent episodes and injuries then he should seek professional help from a sleep disorders center.

An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.

Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or significantly reduces them.

If psychological stress contributes to disordered sleep, counseling may help. Both children and adults may profit from hypnosis or biofeedback.

Self care for somnambulism:

There are some things a sleepwalker can do:

• Develop a calming bedtime routine. Some people meditate or do relaxation exercises; strain can be another trigger for sleepwalking.
• Remove anything from the bedroom that could be dangerous or harmful.
• The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.
• An assessment of the sleepwalker should include a careful review of the current medication so that alterations can be made if necessary.
• Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
• An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.
• Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or significantly reduces them.
• Hypnosis has been found to be helpful for both children and adults.