By- Dr. Jonathan Wood
Parasomnias are "repetitive unusual behaviors or strange experiences that occur in relation to sleep." These include common occurrences like nightmares, night terrors, sleepwalking, teeth grinding, and bedwetting, but also the more unusual REM sleep behavior disorders and epileptic nighttime wandering. These can be confusing and sometimes quite dramatic. Fortunately, the most common parasomnias are generally the least worrisome. Sleepwalking is one of these common, but benign parasomnias.
Sleepwalking or "somnambulism" is common and most occurs predominantly in childhood. Up to 15% of children age 5-12 will sleepwalk at some point. Generally, the episodes become less common in adolescence, with the majority resolving before adulthood. That said, up to 10% sleepwalkers start in adolescence and 2-3% of adults will occasionally sleepwalk.
What is the pattern?
Sleepwalking occurs in deep non-REM sleep, a stage that occurs in the first third of the night. Eyes are often open and sleepwalkers will appear awake, albeit clumsy and generally purposeless in their movements. If they talk, their speech will often be slow, as will their responses to stimulation. Sleepwalkers generally have no memory of their escapades. These excursions are generally short and harmless, but occasionally have involved more complex and potentially dangerous behaviors like cooking or leaving the house.
What predisposes to sleepwalking?
Sleepwalking runs in families and there may be genetic factors. There also may be predisposing factors for sleepwalking, especially in teens and adults. These include use of alcohol or sedatives, emotional stress, anxiety, sleep deprivation, obstructive sleep apnea, infection, fever, and occasionally environmental stimuli. Contrary to older teachings, it is now known that there is no association between childhood sleepwalking and psychiatric disorders.
What should be done?
Be assured of the benign nature of sleepwalking. Be reassured that your child is not ill or disordered. Make the environment as safe as possible by removing obstructions in bedrooms, locking or alarming doors to the outside, etc. Generally, since sleepwalking occurs early in the sleep, parents are often awake when their children sleepwalk and can therefore help them back to bed. If sleepwalking occurs predictably and frequently, awakening your child 20-30 minutes prior to the expected event every night for a several months may extinguish the behavior. This should be discussed with your doctor. Medications are not recommended for sleepwalking. They are sometimes suggested, but the evidence for this is poor and generally comes with more risk than benefit.
What should not be done?
Don't try to awaken the sleepwalker! It is rarely successful and can result in the child becoming confused, agitated, or even violent. Waking the child is difficult, counterproductive and unnecessary. The best approach is to let the episode subside and then direct the sleepwalker gently back to bed and to sleep. There is no point in telling children about their sleepwalking episodes; in some children this can cause unnecessary anxiety.
What about sleepwalking adults?
Sleepwalking in adults, as mentioned, is much less common. If onset is in adulthood, sleepwalking also has a higher incidence of being associated with an underlying neurologic disorder. A physician should be consulted about adult-onset sleepwalking to assure its benign nature. Sleepwalking that occurs later in the night may not be true non-REM somnambulism, but rather a "REM sleep behavior disorder". This is more of an "acting out of dreams" disorder and is due the patient not having the usual semi-paralysis of muscles that normally accompanies REM sleep and dreaming. This can be dangerous to the patient and his/her sleep partner and needs to be investigated. It is particularly important to not try to arouse an adult from this type of disorder that occurs later in the night's sleep.
Sleepwalking in children and adolescents can be frightening, but does not mean your child is ill or disordered. They will virtually always "grow out of it." Avoid medications and complex work-ups for this benign condition. Be calm, establish regular sleep routines, make the environment safe, and gently guide your child back to sleep.
By- Dr. Jonathan Wood
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