Sleepwalking (somnambulism)

In the case of parasomnias, however, the symptoms occur during sleep or during the transition from wakefulness to sleep or from sleep to sleep. from sleep to wakefulness.

In this sleep disorder, there is a partial awakening from deep sleep. In this state, the affected person has little consciousness, but performs actions that one normally does only when awake. Often these are simple, repetitive movements, z. B. Sitting up in bed, chewing or picking at clothes. However, complex actions can also occur, such as walking around, cleaning or cooking. When doing this, the sufferers have their eyes open, but their facial expression is rigid, they hardly react to environmental stimuli and are difficult to wake up. After waking up, they have no memory of the episode. Sleepwalking usually occurs in the first third of the night, which is also when most deep sleep occurs.

Frequency and course

Ten to 30 percent of children and adolescents have a period of sleepwalking at least once. For 15 percent, the disorder occurs occasionally. As a rule, sleepwalking begins in the fourth to eighth year of life and usually subsides again on its own in adolescence. Approximately equal numbers of boys and girls are affected. In some cases, other sleep disorders occur in connection with sleepwalking. These include Pavor Nocturnus (see below), Restless Legs Syndrome (see below), breathing disorders during sleep (see below) and nocturnal enuresis.

Sleepwalking occurs much less frequently in adults. Here are affected approximately at one to seven percent of the population. When adults sleepwalk, the disorder usually lasts longer and sleepwalking occurs more frequently. In some cases, another mental disorder may be behind it, but this need not always be the case.

A 15-year-old girl sits up in bed at night, makes smacking noises, moves her arms and mumbles something to herself. After a short time, it lies down again and goes back to sleep.

An 11-year-old boy regularly gets up in the night, goes to another room, lies down there and goes back to sleep. The next morning, the family will find it under the ping-pong table, in the closet, or among his toys on the floor. He himself cannot remember how he got there.

A 31-year-old woman gets up in the middle of the night, goes to the closet in the hallway, takes out the cleaning stuff and starts cleaning the bathroom and kitchen. After some time, she lies back in bed and continues to sleep.

A 40-year-old man wakes up at night from his own cries for help on the roof of a house. How he got there, he doesn't know.

Causes and explanatory models

Sleepwalking occurs in clusters in some families, so genetic factors are thought to be important in the disorder. In addition, immaturity of the central nervous system is thought to play a role in sleepwalking. This assumption would also explain why the disorder usually stops on its own in adolescence, i.e. as the brain matures.

Triggers for episodes in which sleepwalking occurs are factors that increase deep sleep. These are z. B. persistent lack of sleep and feverish illnesses. Stress can also be a trigger for episodes of sleepwalking.

Treatment approaches and self-help options

In most cases, sleepwalking does not require special therapy. When awake, sufferers behave inconspicuously, and in the case of children and adolescents, the disorder usually disappears on its own. Therefore, it is usually sufficient to remove dangerous objects from the environment of the affected person and to close doors and windows well, so that the sleepwalker does not get into dangerous situations. In addition, sleepwalkers should not be awakened, as they are then usually confused and disoriented. Some experts also recommend gently returning the sleepwalker to his bed without waking him up.

Furthermore, it makes sense for those affected to maintain good sleep hygiene (see above). For example, sufficient and regular sleep can help prevent sleep deficit, which promotes sleepwalking. In some cases, relaxation techniques such as Jacobson's Progressive Muscle Relaxation or Autogenic Training can be helpful because they help reduce stress.

Exclude other conditions

Automatic movements such as repetitive chewing, smacking, or other movement patterns during sleep can in some cases also be behind brief epileptic seizures (so-called petit mal seizures). Therefore, if a child or family member exhibits noticeable nocturnal movements or behaviors, it is always a good idea to talk to a doctor about it. This may then lead to further clarification, z. B. Advise sleep lab testing (see above). Epileptic seizures can be detected or ruled out with this test. Are excluded. At the same time, other potential conditions that may be related to sleepwalking can be diagnosed here – z. B. restless legs syndrome (see below) or breathing disorders during sleep (see below).

Drug therapy

In most cases, sleepwalking does not require drug therapy. In rare cases where sleepwalking is very severe and very persistent, antidepressants or sleep medications from the benzodiazepine group are sometimes prescribed at low doses to. However, with the latter, there is a risk of dependence and other adverse effects with long-term use (see Drug Therapy section in the Nonorganic Insomnia chapter).

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