Sleepwalking and Sleep Terrors

What Are They?

A person who is sleepwalking walks or makes other movements that seem purposeful in a state of partial wakefulness from deep sleep. Contrary to popular belief, sleepwalkers don't act out their dreams. Sleepwalking doesn't take place during the dreaming stage of sleep.

Sleepwalking (also called somnambulism) is common in school-age children. One study estimates that as many as 15% of children ages 5 to 12 years walk in their sleep at least once. Repeated sleepwalking is more common in males and frequently is associated with nighttime bedwetting.

Experts believe that sleepwalking probably occurs because the brain's ability to regulate sleep/wake cycles is still immature. Most children outgrow the symptoms as their nervous systems develop. Sleepwalking that begins later in life or lasts into adulthood may have psychological causes, such as extreme stress or, rarely, medical causes such as epilepsy.

Sleep terrors (also called night terrors or pavor nocturnus) are a related disorder that usually occurs in young children. Sleepwalking and sleep terrors tend to run in families.

Symptoms

The key symptom of sleepwalking 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. Others carry out more complex tasks such as dressing and undressing, eating or urinating.

Sleepwalking 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.

In sleep terrors, a child suddenly sits up in bed one or two hours after falling asleep, exhibits intense fear or agitation, and may scream or cry out that others are in the room, and cannot be comforted or awakened. As the disturbance subsides, the child returns to deep sleep. When the child wakes up in the morning, he or she cannot recall the sleep terrors.

Sleep terrors are different from nightmares, which are frightening dreams that often can be recalled the next morning in vivid detail.

Diagnosis

A person's history usually provides enough information for a doctor to diagnose sleepwalking, 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 ordered to rule out seizures.

Expected Duration

Children usually stop sleepwalking during adolescence. However, sleepwalking continues beyond puberty in 1% to 6% of the population.

Sleep terrors are most common between the ages of 1 and 8, but may begin as early as 6 months and occasionally last into adulthood.

Prevention

Children are more likely to sleepwalk or experience sleep terrors when they are overtired or anxious. Providing an early bedtime with relaxing activities before bedtime may help to prevent sleep disturbances.

Avoid sleepwalking injuries by making the bedroom and house as safe as possible. Consider the following precautions:

• Don't let the child sleep in a bunk bed.
• Make sure there are no sharp or breakable objects near the bed.
• Install gates on stairways.
• Lock doors and windows.

Treatment

Usually, treatment is not necessary. Most episodes of sleepwalking or sleep terrors go away on their own. A parent or caretaker should focus on keeping the sleepwalking child safe.

To help a sleepwalking child return to normal sleep, gently lead the child back to bed. During an episode of sleep terrors, offer reassurance with repeated, soothing statements such as, "You are safe. You are home in your own bed." You don't need to wake the child, and you may not even be able to.

For children with frequent sleepwalking or night terrors, a technique called prompted awakenings may help to prevent future episodes. For several nights, record the length of time between when the child falls asleep and the beginning of the sleepwalking or night terrors. Then for seven nights in a row, awaken the child 15 minutes before the expected time of the episode. Tell the child at bedtime that you will try to wake him or her quickly, and keep him or her fully awake for five minutes.

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

In some cases, a doctor may prescribe short-acting sleep or antianxiety medications such as diazepam (Valium) or lorazepam (Ativan) to reduce or eliminate episodes.

When To Call A Professional

Seek professional help if:

• Episodes are frequent or severe.
• The sleepwalker gets injured during episodes.
• The sleepwalker leaves the house.
• Episodes last beyond puberty.
• Nighttime episodes are accompanied by daytime sleepiness.
• Stress, anxiety or other psychological factors may be contributing to sleep disturbances.

Prognosis

Although sleepwalkers occasionally injure themselves or others, most episodes of sleepwalking and sleep terrors are brief and harmless. Episodes tend to stop before adulthood.

Additional Info

American Academy of Sleep Medicine

One Westbrook Corporate Center

Suite 920

Westchester, IL 60154

Phone: (708) 492-0930

Fax: (708) 492-0943

http://www.aasmnet.org/