Sleepwalking

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Diagnosis

It is often a sleep partner who alerts the sleepwalker to his or her behavior. Some sleepwalkers sense that they may be walking at night, but aren't certain. In some cases, sleepwalkers claim that their suspicions were confirmed by the presence of mysterious bruises on their arms or legs that result from collision with furniture and walls.

Occasionally, if sleepwalking is recurrent or if an individual experiences daytime fatigue and feelings of unrest, it becomes necessary to rule out other disorders that affect REM (rapid eye movement) sleep, like sleep seizures. Rapid eye movement sleep is a deep-sleep stage necessary for the completion of a healthy sleep cycle. Sleep disorders, including sleepwalking, that affect this sleep stage and others are often diagnosed by a polysomnogram. The polysomnogram offers a specialist a view of sleep function, from the physiological state of the airway to cerebral impulses. The procedure affords an assessment of sleep duration and quality, revealing specific aspects of a patient's sleep routine. This study is usually used to evaluate sleep conditions that have serious health implications.

Treatment and Management

Treatment for sleepwalking is often unnecessary, especially if episodes are infrequent and uncomplicated. Safety issues are of prime importance to someone who sleepwalks and to others who are involved with managing the condition. The following measures are usually recommended:

• Locate the bedroom on the main floor, if possible.
• Place an alarm or a bell on the door of the bedroom.
• Lock the windows and cover them with large, heavy drapes.
• Keep the floor clear of harmful objects.
• Remove any hazardous materials and sharp objects from the room and secure them in the house.
• Stay on the first floor when visiting others and when sleeping at a hotel.

Medication may be used in cases where episodes are violent, injurious, frequent, or disruptive. Therapy usually consists of either a benzodiazepine, such as Diazepam® or Alprazolam®, or a tricyclic antidepressant. Among other things, these drugs inhibit chemical processes associated with sleep regulation, which, depending on the patient, may or may not result in fewer episodes of sleepwalking. Biofeedback and hypnosis have also been used effectively with individual sleepwalking patients.

Many sleepwalkers claim the first step in management is to recognize that sleepwalking is not evidence of insanity. Because sleepwalking is an involuntary behavior, it separates people from most of the general public and is often wrongly associated with madness. As mysterious as its occurrence is, it does not indicate mental dysfunction and should not be treated as such.

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