Southeast Houston Sleep Medicine

SLEEP WALKING AND OTHER PARASOMNIAS


SOMNAMBULISM (SLEEPWALKING)

Sleep walking occurs in 10%-15% of children in the 5-12 year age
group. It most commonly occurs at age 5 or 6 and children usually
grow out of the problem by adolescence. Patients who sleepwalk demonstrate a low level of awareness. They usually have a blank expression on their face and do not respond well to stimuli. Their movements are slow and clumsy and are rarely purposeful.

Certain medications increase the likelihood of sleep walking. The nonbenzodiazepine benzodiazepine receptor agonists such as Ambien, Sonata, and Lunesta have been linked to sleepwalking. Adults as well as children taking these medications often have episodes of walking in their sleep and do things during sleep they cannot recall the next day, such as eating, talking on the phone, or having conversations.

Sleepwalking in itself is not dangerous. The biggest risk is trauma. In rare cases, patients have walked off ledges and fallen, or walked into objects. Consequently, bed railings help prevent patients from falling. Patients susceptible to somnambulism should sleep on the first floor and lock the windows as a safety measure. Sharp objects and firearms should be removed from the bedrooms of patients with a history of sleepwalking.

NIGHT TERRORS

Night terrors occur in preadolescent children. They usually occur in the early part of the night during deep slow wave sleep. The children often wake up agitated and sweating. The heart will often beat quickly and the pupils will dilate. The vast majority of the time, parents are not able to console children with sleep terrors. The children just fall back to sleep and have no recollection of the event the next day. If a child does wake up during a sleep terror, they usually cannot recall any type of dream. Sleep deprivation, stress, stimulants, antihistamines, and other medications sometimes make sleep terrors worse. Children should grow out of this problem by adolescence.

CONFUSIONAL AROUSALS

Confusional arousals are a common occurrence in preadolescent children. They usually occur in the early mornings in contrast to sleep terrors which occur in the late evening. Children with confusional arousals can usually be comforted by their parents. If awakened, they often remember a nightmare or a disturbing dream.

RHYTHMIC MOVEMENT DISORDERS

Repetitive movement disorders occur in children at times. They usually occur during sleep onset or upon awakening. The child usually has repetitive movements of the trunk or large muscles. Unlike seizures, bowel and bladder incontinence are not associated with rhythmic movement disorders. Moreover, children can sometimes be aroused during a movement disorder and will be alert as opposed to confused like a patient coming out of a seizure.

NOCTURNAL SEIZURES

There are many varieties of nocturnal and daytime seizures. Grand mal seizures are marked by repetitive movements of the large muscles, loss of consciousness, and bowel and bladder incontinence. This is the most easily identified type of seizure and has been recognized in medical literature and non-medical literature for centuries.

Grand mal seizures can be the result of an underlying injury to the brain such as a stroke or congenital disorder. They also occur with no underlying structural injury (sometimes this is referred to as epilepsy). Sleep deprivation sometimes triggers seizures, as does alcohol withdrawal, or benzodiazepine withdrawal.

Focal or partial seizures refer to the repetitive movement of one body part such as an arm or a part of the face. These seizures are not associated with loss of consciousness. If the patient is asleep during one of these seizures, they can often be aroused and will not be confused upon awakening.