Sleepwalking (somnambulism)
Sleepwalking (somnambulism) involves complex behaviors like walking or rearranging furniture during sleep, often with amnesia. Prevention includes maintaining regular sleep schedules, a safe sleep environment, and sometimes cognitive-behavioral therapy. Medications like clonazepam or melatonin are reserved for severe cases. Safety education is essential to avoid injury during episodes.
2023-12-31 23:44:06 - Editor
Sleepwalking (Somnambulism) Overview
Sleepwalking is a complex sleep-related behavior, often beginning with confusional arousal and leading to activities like walking, rearranging objects, or even more elaborate actions. The person’s eyes are typically open during episodes, and they may exhibit behaviors ranging from quiet walking to more agitated actions. Sleepwalking is often linked to various activities and can end with the individual waking in a different location or returning to bed. Amnesia regarding the events is common, and episode frequency can vary greatly. (1, 2, 3)
Management Strategies for Sleepwalking
Behavioral and Preventive Measures
- Environmental Safety: Ensuring the safety of the environment for the sleepwalker and others is crucial. This might involve padding furniture, lowering the mattress, securing doors and windows, and removing hazardous objects from the bedroom.
- Education: Patients should be informed about factors that can trigger sleepwalking, such as sleep deprivation, alcohol use, and certain medications.
- Sleep Hygiene: Regular sleep patterns and a consistent sleep environment are important. Minimizing changes in the sleep setting can help reduce episodes.
- Cognitive Behavioral Therapy (CBT): Techniques like guided imagery, relaxation training, and mindfulness-based stress reduction can be beneficial for some individuals. (4, 5)
Pharmacotherapy
Pharmacological treatment is considered for severe cases or when there is a risk of injury.
- Benzodiazepines: Clonazepam (0.5-1 mg at bedtime) is a commonly used medication for sleepwalkers who don't respond to behavioral strategies.
- Melatonin: Over-the-counter melatonin, starting at 0.5 mg, can also be effective for those who don't initially respond to other interventions. (6, 7)
In treating sleepwalking, the primary focus is on preventive measures to ensure safety and minimize the risk of injury. Pharmacotherapy is a secondary option when non-pharmacological interventions are insufficient.
References
1- American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
2- Chung SA, Yegneswaran B, Natarajan A, et al. Frequency of sexsomnia in sleep clinic patients. Sleep 2010; 33:A226.
3-Lopez R, Jaussent I, Scholz S, et al. Functional impairment in adult sleepwalkers: a case-control study. Sleep 2013; 36:345.
4-Arnulf I, Rico TJ, Mignot E. Diagnosis, disease course, and management of patients with Kleine-Levin syndrome. Lancet Neurol 2012; 11:918.
5- US Food and Drug Administration (FDA). FDA adds boxed warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines. FDA Drug Safety Communication, April 30, 2019.
Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-risk-serious-injuries-caused-sleepwalking-certain-prescription-insomnia.
6-Attarian H, Zhu L. Treatment options for disorders of arousal: a case series. Int J Neurosci 2013; 123:623.
7-Hurwitz TD, Mahowald MW, Schenck CH, et al. A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror. J Nerv Ment Dis 1991; 179:228.