sleepwalking episodes occur early in the night, about 1 to 3 hours after sleep onset.
A sleepwalking episode usually lasts less than 10 minutes.
During this period, patients generally have blank expressions, behave as if they are indifferent to the environment, and show low levels of awareness and reactivity, manifested by clumsiness and purposeless activity.
they usually have some skill in maneuvering around objects.
After awakening, they usually do not remember the events that occurred during the episode.
Genetic, developmental, organic, and psychologic factors have been identified in the cause of both sleepwalking and night terrors.
In a study of a large sample of patients, a family history for either or both conditions was present in 80% of probands with sleepwalking episodes.
Frequent onset of these disorders in childhood, with termination by late adolescence, strongly suggests the role of maturational factors.
Other organic factors such as brain tumor may also cause such episodes.
Somnambulistic-like episodes have been reported in patients receiving lithium and high doses of neuroleptic drugs (90) and in patients given triazolam, a hypnotic agent known to produce anterograde amnesia.
Psychological factors are not prominent in children who develop these disorders early in childhood. However, persons who develop the disorders late in childhood or in adolescence not infrequently continue to have them as adults, at which time they also show significant psychopathology. Often, patients report a significant life event at the onset of the episodes.
Important data are the age at onset ofthe disorder
related stressful life events
frequency and duration of the episodes
family history for sleepwalking and night terrors
and the patient's history of febrile episodes and other sleep disorders
It is important to differentiate night terrors, and particularly sleepwalking, from hysterical dissociative phenomena such as amnesia, fugue states, and multiple personalities. In the latter conditions, the patient is more alert and shows complex and purposeful behaviors; the episodes are also much longer in duration.
If activity resembling sleepwalking or night terrors occurs in middle or old age, an underlying organic disorder of the central nervous system, such as brain tumor, should be suspected and ruled out.
Finally, underlying psychiatric disturbance in the sleepwalker or patient with night terrors is suggested when the episodes start after age 12, are frequent, and persist for several years; the family history is negative for sleepwalking or night terrors; and the patient's daytime behavior is maladaptive.
Clinical Characteristics of Sleepwalking
Episodes occur early in night Confusion on waking
Family history of sleepwalking or night terrors
usually present Onset usually in childhood or early adolescence
Most often outgrown by late adolescence Psychopathology suspected if onset is in adulthood
The most important consideration in managing patients with sleepwalking or night terror episodes is protection from injury.
Attempts to interrupt sleepwalking and night terror episodes should be avoided because intervention often confuses and frightens the patient even more.
Specific safety precautions may include
special latches for outside doors and bedroom windows
sleeping accommodations on the ground floor
An important aspect of management is the counseling and reassuring of parents that children with these disorders will usually outgrow the conditions by late adolescence, if not sooner.
Because adult patients who sleepwalk or have night terrors are often emotionally disturbed, psychiatric evaluation and treatment is generally indicated.
Certain drugs that markedly suppress stages 3 and 4 sleep, primarily benzodiazepines such as diazepam and flurazepam, may be administered as adjunctive therapy in adults who have night terrors or sleepwalk. This treatment has not been systematically assessed in patients who sleepwalk, but its effectiveness has been shown in patients with night terrors .
Studies assessing imipramine's effectiveness in reducing the frequency of sleepwalking and night terror episodes have produced inconclusive results
The use of any psychotropic drug such as diazepam or imipramine in children is generally not recommended.
Kales, A., Soldatos, C. R., & Kales, J. D. (1987, April). Sleep Disorders: Insomnia, Sleepwalking, Night Terrors, Nightmares, and Enuresis. Annals of Internal Medicine, 106(4), 582-592. Retrieved November 17, 2015, from Academic Search Premier.
