Somnambulism is a peculiar condition of the nervous system in which a person experiences disinhibition of motor centers during sleep, and the mind has no control over them. In this state, patients perform automated actions; moreover, they can exhibit extraordinary agility and power. It is crucial to note that somnambulism often does not require medical treatment, but a specialist might need to prescribe a course of antidepressants and antipsychotic drugs in severe cases (Kushida, 2014). A distinctive feature of this condition is that the patient performs complex movements in relation to the dream scenario, which he or she sees at this moment, and this particular sleep disorder may be called parasomnia. Cases of somnambulism are equally met in both men and women, and most often, it is experienced by children aged from 4 to 8, which is why they need particular control.
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Causes and Symptoms of Somnambulism
This condition occurs in the phase of REM sleep in the first half of the night and is manifested in the active bursts of electrical activity. Despite the fact that scientists have put forward many hypotheses, they are still not aware of the real reasons for the outbreaks. One of the most common hypothesis suggests that braking processes begin to prevail in the brain of a healthy person, and they cover all brain areas simultaneously (Kissin, 2012). At the same time, some neurons reveal non-standard electrical activity, and part of the brain structures becomes disinhibited. In accordance with this theory, a person sleeps only partially as part of the body is sleeping while some units of the nervous system are awake. Thus, the cerebral cortex purposefully programs the body to such a state at the expense of the lower nerve structures.
In adults, this condition may occur in various neurological diseases such as hysterical neurosis, obsessive-compulsive disorder, Parkinson’s disease, chronic fatigue syndrome, and so on (Jung, 2014). The strong nervous shock, including a positive one, prolonged stress, chronic sleep deprivation, and much more, can lead to somnambulism. Loud noise during sleep, a sudden flash of light, and bright light in the sleeping room (especially during the full moon) can trigger the mechanisms of somnambulism. The symptoms of somnambulism are:
- the absence of clear consciousness during the episode;
- open eyes;
- lack of emotion;
- inability to wake the sleeping person up easily during the episode of somnambulism;
- complete absence of memories of the committed actions after waking up;
- completion of sleepwalking with a deep sleep.
Diagnosis and Treatment
The basis of diagnosis is the clinical picture of the patient. The frequency and intensity of somnambulism cases are key indicators in terms of treatment if it is required. A neurologist should ask the witness about the features of the sleepwalking behavior of the patient, and it is also necessary to ask the patient about his or her memories at this moment. As stated above, sleepwalking can happen in healthy people, but it can also be a symptom of nervous diseases (Myland Kaufman & Milstein, 2012). In this connection, it is necessary to carry out additional lab tests such as a full neurological and psychiatric examination, brain CT or MRI, and EEG. Cases of somnambulism may occur in children with an immature brain, as well as in patients with temporal lobe epilepsy, brain tumors, schizophrenia, and dementia. In such cases, the cause of somnambulism should be determined through EEG.
In terms of plan of treatment, if the patient is a child with rare cases and low activity during the episodes, it is recommended not to prescribe any medication (Myland Kaufman & Milstein, 2012). It is advisable to use thermal stimuli (for example, a wet towel) to wake the sleeping person. In long-term and recurrent episodes of sleepwalking, which include complex actions and are accompanied by danger to life and health of the patient, the use of drug therapy is mandatory (antidepressants, antipsychotics, sedatives). However, the choice of a particular drug is determined individually.
Jung, C. (2014). Psychiatric studies. Abingdon, UK: Routledge.
Kissin, B. (2012). Conscious and unconscious programs in the brain. New York, NY: Springer.
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Kushida, C. (2014). Evaluation of sleep complaints, an issue of sleep medicine clinics. New York, NY: Elsevier.
Myland Kaufman, D., & Milstein, M. (2012). Kaufman’s clinical neurology for psychiatrists. New York, NY: Elsevier.