Somnambulism. Clinical manifestations and therapy
Keywords:
somnambulism; sleepwalking; parasomias; sleep disorders
Abstract
Somnambulism (sleepwalking) is a non-organic sleep disorder of the parasomnia type with estimated prevalence of 15% in children and 3% in adults. Its clinical symptoms include performing complex motor activities (e.g. walking, eating) during the non-REM sleep stage, without full awakening and with amnesia of the event on the following morning. The knowledge about somnambulism is usually fragmentary both among psychologists and physicians, and the significance of this disorder tends to be neglected in clinical practice. The objective of this paper is, therefore, to provide psychologists and other professionals with an update on recent developments in the knowledge of somnambulism. The paper addresses the issues of prevalence of sleepwalking, its clinical manifestations, pathophysiology, diagnostic criteria, comorbidity, etiology, pathomechanisms, diagnostic methods and attempts of treatment. Finally, based on the presented review, clinical and research implications for psychologists are outlined.
References
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Text revised. Washington: American Psychiatric Publishing, Inc.
Bernasconi, A., Andermann, F., Cendes, F., Dubeau, F., Andermann, E., Olivier, A. (1998). Nocturnal temporal lobe epilepsy. Neurology, 50, 1772-1777.
Bonkalo, A. (1974). Impulsive acts and confesional states during incomplete arousal from sleep: Criminological and forensic implications. Psychiatric Quarterly, 48, 400-409.
Broughton, C. (1968). Sleep disorders: Disorders of arousal. Science, 159, 1070-1077.
Cartwright, R. (2004). Sleepwalking violence: A sleep disorder, a legal dilemma, and psychological challenge. American Journal of Psychiatry, 161, 1149-1158.
Casez, O., Dananchet, J., Besson, G. (2005). Migraine and somnambulism. Neurology, 65, 13341335.
Crisp, A. H. (1996). The sleepwalking/night terrors syndrome in adults. Postgraduate Medicine Journal, 72, 599-604.
Cronlein, T., Geisler, P., Mueller, U., Hajak, G., Zulley, J. (2007). A pilot study on the effect of progressive muscle relaxation on frequency of sleepwalking and nightmares. Sleep and Biological Rhythms, 5, A178.
Eisenman, L. N., Attarian, H. P. (2003). Sleep epilepsy. The Neurologist, 9, 200-206.
Espa, F., Dauvilliers, Y., Ondze, P., Billiard, M., Besset, A. (2002). Arousal reactions in sleepwalking and night terrors in adults: The role of respiratory events. Sleep, 25, 871-875.
Espa, F., Ondze, P., Billiard, M., Besset, A. (2000). Sleep architecture, slow wave activity, and sleep spindles in adult patients with sleepwalking and sleep terrors. Clinical Neurophysiology, 111, 929-939.
Garcia, J., Wills, L. (2000). Zaburzeniu snu u dzieci i młodzieży. Medycyna po Dyplomie, 10, 57-67.
Giglio, P., Undevia, N., Spire, J. P. (2005). The primary parasomnias. A review for neurologists. The Neurologist, 11, 90-97.
Guilleminault, C., Biol, D., Palombini, L., Pelayo, R., Chervin, R. D. (2003). Sleepwalking and sleep terrors in prepubertal children: What triggers them? Pediatrics, 111, 17-25.
Guilleminault, C., Kirisoglu, C., Bao, G, Arias, V., Chan, A., Li, K. K. (2005). Adult chronic sleepwalking and its treatment based on polysomnography. Brain, 128, 1062-1069.
Guilleminault, C., Kirisoglu, C., da Rosa, A. C., Lopes, C., Chan, A. (2006). Sleepwalking, a disorder of NREM sleep instability. Sleep Medicine, 7, 163-170.
Guilleminault, C., Moscovitch, A., Poyares, D. (2002). Atypical sexual behavior during sleep. Psychosomatic Medicine, 64, 328-336.
Guilleminault, C., Poyares, D., Abat, F., Palombini, L. (2001). Sleep and wakefulness in somnambulism. A spectral analysis study. Journal of Psychosomatic Research, 51, 411-416.
Halasz, P., Terzano, M., Parrino, L., Bódizs, R. (2004). The nature of arousal in sleep. Journal of Sleep Research, 13, 1-23.
Hartman, D., Crisp, A. H., Sedgwick, P., Borrow, S. (2001). Is there a dissociative process in sleepwalking and night terrors? Postgraduate Medicine Journal, 77, 244-249.
Howard C., d’Orban, P. T. (1987). Violence in sleep: Medico-legal issues and two case reports. Psychological Medicine, 17, 915-925.
Hublin, C., Kaprio, J., Partinen, M., Heikkila, K., Koskenvuo, M. (1997). Prevalence and genetics of sleepwalking: A population-based twin study. Neurology, 48, 171-181.
Izac, S. M. (2006). Basic anatomy and physiology of sleep. American Journal of Electroneurodiagnostic Technology, 46, 18-38.
Jakitowicz, J. (2003). Skuteczne leczenie somnambulizmu i lęku nocnego za pomocą selektywnych inhibitorów wychwytu zwrotnego serotoniny. Sen, 3, 95-101.
Jan, J. E., Frejman, R. D., Wasdell, M. B., Bomben, M. M. (2004). A child with severe night terrors and sleep-walking responds to melatonin therapy. Developmental Medicine & Child Neurology, 2004, 46, 789.
Joncas, S., Zadra, A., Paquet, J., Montplaisir, J. (2002). The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology, 58, 936-940.
Jurkowlaniec, E. (2002). Podstawowe mechanizmy snu i czuwania: udział głównych układów neurotransmiterowych mózgu. Sen, 2, 21-32.
Juszczak, G. R., Swiergiel, A. H. (2005). Serotonergic hypothesis of sleepwalking. Medical Hypotheses, 64, 28-32.
Kales, A., Soldatos, C. R., Caldwell, A. B., Kales, J. D., Humphrey, F. J., Charney, D. S., Schweitzer, P. K. (1980). Somnambulism: Clinical characteristics and personality patterns. Archives of General Psychiatry, 37, 1406-1410.
Kawashima, T., Hamada, S. (2003). Paroxetine-induced somnambulism. Journal of Clinical Psychiatry, 64, 483.
Laberge, L., Tremblay, R. E., Vitaro, F., Montplaisir, J. (2000). Development of parasomnias from childhood to early adolescence. Pediatrics, 106, 67-74.
Lange, C. (2005). Medication-associated somnambulism. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 211-212.
Lavigne, G J., Kato, T., Kolta, A., Sessle, B. J. (2003). Neurobiological mechanisms involved in sleep bruxism. Critical Reviews in Oral Biology and Medicine, 14, 30-46.
Lecendreux, M., Bassetti, C., Dauvilliers, Y., Mayer, G, Neidhart, E., Tafti, M. (2003). HLA and genetic susceptibility to sleepwalking. Molecular Psychiatry, 8, 114-117.
Liskow, B., Pikalov, A. (2004). Zaleplon overdose associated with sleepwalking and complex behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 927-928.
Mahowald, M. (2000). Przyczyny nadmiernej senności w ciągu dnia. Medycyna po Dyplomie, 10, 34-41.
Miller, V. A., Palermo, T. M., Powers, S. W., Scher, M. S., Hershey A. D. (2003). Migraine headaches and sleep disturbances in children. Headache, 43, 362-368.
Ohayon, M. M., Guilleminault, C., Priest, R. G. (1999). Night terrors, sleepwalking, and confusional arousals in the general population: Their frequency and relationship to other sleep and mental disorders. Journal of Clinical Psychiatry, 60, 268-276.
Oswald, I., Evans, J. (1985). On serious violence during sleep-walking. British Journal of Psychiatry, 147, 688-691.
Pilon, M., Zadra, A., Joncas, S., Montplaisir, J. (2006). Hypersynchronous delta waves and somnambulism: Brain topography and effect of sleep deprivation. Sleep, 29, 77-84.
Pracki, T., Pracka, D. (2003). Polisomnografia cyfrowa. Sen, 3, 13-18.
Pressman, M. (2007). Factors that predispose, prime and precipitate NREM parasomnias in adults: Clinical and forensic implications. Sleep Medicine Reviews, 11, 5-30.
Prusiński, A. (2001). Parasomnie: obraz kliniczny, diagnostyka i postępowanie. Sen, 1, 33-39.
Roberts, R. (1998). Differential diagnosis of sleep disorders, non-epileptic attacks and epileptic seizures. Current Opinion in Neurology, 11, 135-139.
Rosenfeld, D. S., Elhajjar A. J. (1998). Sleepsex: A variant of sleepwalking. Archives of Sexual Behavior, 27, 269-278.
Schenck, C. H., Hurwitz, T. D., Bundlie, S. R., Mahowald, M. W. (1991). Sleep-related eating disorder: Polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorder. Sleep, 14, 419-431.
Schenck, C. H., Mahowald, M. W. (1995). A polysomnographically documented case of adult somnambulism with long-distance automobile driving and frequent nocturnal violence: Parasomnia with continuing danger as a noninsane automatism. Sleep, 18, 765-772.
Schenck, C. H., Pareja, J. A., Patterson, A. L., Mahowald, M. W. (1998). Analysis of polysomno- graphic events surrounding 252 slow-wave sleep arousals in thirty-eight adults with injurious sleepwalking and sleep terrors. Journal of Clinical Neurophysiology, 15, 159-166.
Shapiro, C. M., Trajanovic, N. N., Fedoroff, J. P. (2003). Sexomnia - a new parasomnia? Canadian Journal of Psychiatry, 48, 311-317.
Siddiqui, F., Osuna, E., Shah, N., Chowdhery, N., Chokroverty, S. (2006). Writing emails as a form of complex cognitive activity during sleepwalking. Neurology, 66 (Suppl. 2), A76.
Soldatos, C. R., Paparrigopoulos, T. J. (2005). Sleep physiology and pathology: Pertinence to psychiatry. International Review of Psychiatry, 17, 213-228.
Stores, G. (2003). Misdiagnosing sleep disorders as primary psychiatric conditions. Advances in Psychiatric Treatment, 9, 69-77.
Szelenberger, W., Niemcewicz, S., Dąbrowska, A. J. (2005). Sleepwalking and night terrors: Psychopathological and psychophysiological correlates. International Review of Psychiatry, 17, 263-270.
Vgontzas, A. N., Kales, A. (1999). Sleep and its disorders. Annual Review of Medicine, 50, 387-400.
Walters, A. (2007). Clinical identification of the simple sleep-related movement disorders. Chest, 131, 1260-1266.
Wills, L., Garcia, J. (2002). Parasomnias. Epidemiology and management. CNS Drugs, 16, 603-610.
WHO (1992). The ICD-10 classification of mental and behavioural disorders: Clinical description and diagnostic guidelines. Geneva.
Yellowless D. (1878). Homicide by a somnambulist. Journal of Mental Sciences, 24, 451-458.
Zucconi, M., Ferini-Strambi, L. (2000). NREM parasomnias: Arousal disorders and differentiation from nocturnal frontal lobe epilepsy. Clinical Neurophysiology 111, Suppl. 2, S129-S135.
Text revised. Washington: American Psychiatric Publishing, Inc.
Bernasconi, A., Andermann, F., Cendes, F., Dubeau, F., Andermann, E., Olivier, A. (1998). Nocturnal temporal lobe epilepsy. Neurology, 50, 1772-1777.
Bonkalo, A. (1974). Impulsive acts and confesional states during incomplete arousal from sleep: Criminological and forensic implications. Psychiatric Quarterly, 48, 400-409.
Broughton, C. (1968). Sleep disorders: Disorders of arousal. Science, 159, 1070-1077.
Cartwright, R. (2004). Sleepwalking violence: A sleep disorder, a legal dilemma, and psychological challenge. American Journal of Psychiatry, 161, 1149-1158.
Casez, O., Dananchet, J., Besson, G. (2005). Migraine and somnambulism. Neurology, 65, 13341335.
Crisp, A. H. (1996). The sleepwalking/night terrors syndrome in adults. Postgraduate Medicine Journal, 72, 599-604.
Cronlein, T., Geisler, P., Mueller, U., Hajak, G., Zulley, J. (2007). A pilot study on the effect of progressive muscle relaxation on frequency of sleepwalking and nightmares. Sleep and Biological Rhythms, 5, A178.
Eisenman, L. N., Attarian, H. P. (2003). Sleep epilepsy. The Neurologist, 9, 200-206.
Espa, F., Dauvilliers, Y., Ondze, P., Billiard, M., Besset, A. (2002). Arousal reactions in sleepwalking and night terrors in adults: The role of respiratory events. Sleep, 25, 871-875.
Espa, F., Ondze, P., Billiard, M., Besset, A. (2000). Sleep architecture, slow wave activity, and sleep spindles in adult patients with sleepwalking and sleep terrors. Clinical Neurophysiology, 111, 929-939.
Garcia, J., Wills, L. (2000). Zaburzeniu snu u dzieci i młodzieży. Medycyna po Dyplomie, 10, 57-67.
Giglio, P., Undevia, N., Spire, J. P. (2005). The primary parasomnias. A review for neurologists. The Neurologist, 11, 90-97.
Guilleminault, C., Biol, D., Palombini, L., Pelayo, R., Chervin, R. D. (2003). Sleepwalking and sleep terrors in prepubertal children: What triggers them? Pediatrics, 111, 17-25.
Guilleminault, C., Kirisoglu, C., Bao, G, Arias, V., Chan, A., Li, K. K. (2005). Adult chronic sleepwalking and its treatment based on polysomnography. Brain, 128, 1062-1069.
Guilleminault, C., Kirisoglu, C., da Rosa, A. C., Lopes, C., Chan, A. (2006). Sleepwalking, a disorder of NREM sleep instability. Sleep Medicine, 7, 163-170.
Guilleminault, C., Moscovitch, A., Poyares, D. (2002). Atypical sexual behavior during sleep. Psychosomatic Medicine, 64, 328-336.
Guilleminault, C., Poyares, D., Abat, F., Palombini, L. (2001). Sleep and wakefulness in somnambulism. A spectral analysis study. Journal of Psychosomatic Research, 51, 411-416.
Halasz, P., Terzano, M., Parrino, L., Bódizs, R. (2004). The nature of arousal in sleep. Journal of Sleep Research, 13, 1-23.
Hartman, D., Crisp, A. H., Sedgwick, P., Borrow, S. (2001). Is there a dissociative process in sleepwalking and night terrors? Postgraduate Medicine Journal, 77, 244-249.
Howard C., d’Orban, P. T. (1987). Violence in sleep: Medico-legal issues and two case reports. Psychological Medicine, 17, 915-925.
Hublin, C., Kaprio, J., Partinen, M., Heikkila, K., Koskenvuo, M. (1997). Prevalence and genetics of sleepwalking: A population-based twin study. Neurology, 48, 171-181.
Izac, S. M. (2006). Basic anatomy and physiology of sleep. American Journal of Electroneurodiagnostic Technology, 46, 18-38.
Jakitowicz, J. (2003). Skuteczne leczenie somnambulizmu i lęku nocnego za pomocą selektywnych inhibitorów wychwytu zwrotnego serotoniny. Sen, 3, 95-101.
Jan, J. E., Frejman, R. D., Wasdell, M. B., Bomben, M. M. (2004). A child with severe night terrors and sleep-walking responds to melatonin therapy. Developmental Medicine & Child Neurology, 2004, 46, 789.
Joncas, S., Zadra, A., Paquet, J., Montplaisir, J. (2002). The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology, 58, 936-940.
Jurkowlaniec, E. (2002). Podstawowe mechanizmy snu i czuwania: udział głównych układów neurotransmiterowych mózgu. Sen, 2, 21-32.
Juszczak, G. R., Swiergiel, A. H. (2005). Serotonergic hypothesis of sleepwalking. Medical Hypotheses, 64, 28-32.
Kales, A., Soldatos, C. R., Caldwell, A. B., Kales, J. D., Humphrey, F. J., Charney, D. S., Schweitzer, P. K. (1980). Somnambulism: Clinical characteristics and personality patterns. Archives of General Psychiatry, 37, 1406-1410.
Kawashima, T., Hamada, S. (2003). Paroxetine-induced somnambulism. Journal of Clinical Psychiatry, 64, 483.
Laberge, L., Tremblay, R. E., Vitaro, F., Montplaisir, J. (2000). Development of parasomnias from childhood to early adolescence. Pediatrics, 106, 67-74.
Lange, C. (2005). Medication-associated somnambulism. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 211-212.
Lavigne, G J., Kato, T., Kolta, A., Sessle, B. J. (2003). Neurobiological mechanisms involved in sleep bruxism. Critical Reviews in Oral Biology and Medicine, 14, 30-46.
Lecendreux, M., Bassetti, C., Dauvilliers, Y., Mayer, G, Neidhart, E., Tafti, M. (2003). HLA and genetic susceptibility to sleepwalking. Molecular Psychiatry, 8, 114-117.
Liskow, B., Pikalov, A. (2004). Zaleplon overdose associated with sleepwalking and complex behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 927-928.
Mahowald, M. (2000). Przyczyny nadmiernej senności w ciągu dnia. Medycyna po Dyplomie, 10, 34-41.
Miller, V. A., Palermo, T. M., Powers, S. W., Scher, M. S., Hershey A. D. (2003). Migraine headaches and sleep disturbances in children. Headache, 43, 362-368.
Ohayon, M. M., Guilleminault, C., Priest, R. G. (1999). Night terrors, sleepwalking, and confusional arousals in the general population: Their frequency and relationship to other sleep and mental disorders. Journal of Clinical Psychiatry, 60, 268-276.
Oswald, I., Evans, J. (1985). On serious violence during sleep-walking. British Journal of Psychiatry, 147, 688-691.
Pilon, M., Zadra, A., Joncas, S., Montplaisir, J. (2006). Hypersynchronous delta waves and somnambulism: Brain topography and effect of sleep deprivation. Sleep, 29, 77-84.
Pracki, T., Pracka, D. (2003). Polisomnografia cyfrowa. Sen, 3, 13-18.
Pressman, M. (2007). Factors that predispose, prime and precipitate NREM parasomnias in adults: Clinical and forensic implications. Sleep Medicine Reviews, 11, 5-30.
Prusiński, A. (2001). Parasomnie: obraz kliniczny, diagnostyka i postępowanie. Sen, 1, 33-39.
Roberts, R. (1998). Differential diagnosis of sleep disorders, non-epileptic attacks and epileptic seizures. Current Opinion in Neurology, 11, 135-139.
Rosenfeld, D. S., Elhajjar A. J. (1998). Sleepsex: A variant of sleepwalking. Archives of Sexual Behavior, 27, 269-278.
Schenck, C. H., Hurwitz, T. D., Bundlie, S. R., Mahowald, M. W. (1991). Sleep-related eating disorder: Polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorder. Sleep, 14, 419-431.
Schenck, C. H., Mahowald, M. W. (1995). A polysomnographically documented case of adult somnambulism with long-distance automobile driving and frequent nocturnal violence: Parasomnia with continuing danger as a noninsane automatism. Sleep, 18, 765-772.
Schenck, C. H., Pareja, J. A., Patterson, A. L., Mahowald, M. W. (1998). Analysis of polysomno- graphic events surrounding 252 slow-wave sleep arousals in thirty-eight adults with injurious sleepwalking and sleep terrors. Journal of Clinical Neurophysiology, 15, 159-166.
Shapiro, C. M., Trajanovic, N. N., Fedoroff, J. P. (2003). Sexomnia - a new parasomnia? Canadian Journal of Psychiatry, 48, 311-317.
Siddiqui, F., Osuna, E., Shah, N., Chowdhery, N., Chokroverty, S. (2006). Writing emails as a form of complex cognitive activity during sleepwalking. Neurology, 66 (Suppl. 2), A76.
Soldatos, C. R., Paparrigopoulos, T. J. (2005). Sleep physiology and pathology: Pertinence to psychiatry. International Review of Psychiatry, 17, 213-228.
Stores, G. (2003). Misdiagnosing sleep disorders as primary psychiatric conditions. Advances in Psychiatric Treatment, 9, 69-77.
Szelenberger, W., Niemcewicz, S., Dąbrowska, A. J. (2005). Sleepwalking and night terrors: Psychopathological and psychophysiological correlates. International Review of Psychiatry, 17, 263-270.
Vgontzas, A. N., Kales, A. (1999). Sleep and its disorders. Annual Review of Medicine, 50, 387-400.
Walters, A. (2007). Clinical identification of the simple sleep-related movement disorders. Chest, 131, 1260-1266.
Wills, L., Garcia, J. (2002). Parasomnias. Epidemiology and management. CNS Drugs, 16, 603-610.
WHO (1992). The ICD-10 classification of mental and behavioural disorders: Clinical description and diagnostic guidelines. Geneva.
Yellowless D. (1878). Homicide by a somnambulist. Journal of Mental Sciences, 24, 451-458.
Zucconi, M., Ferini-Strambi, L. (2000). NREM parasomnias: Arousal disorders and differentiation from nocturnal frontal lobe epilepsy. Clinical Neurophysiology 111, Suppl. 2, S129-S135.
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