Sleep Walking

Aka: Sleep Walking, Sleepwalking, Somnambulism, Sleep Talking, Somniloquy, Nocturnal Wandering

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II. Epidemiology

  1. Prevalence
    1. Children: 15-17% of normal children ages 4 to 15 years (peaks at ages 8-12 years)
    2. Adults: 4%
  2. Gender Predominance
    1. More common in boys than in girls
  3. Inherited
    1. One parent with Sleep Walking history confers 45% risk for a child
    2. Two parents with Sleep Walking history confers 45% risk for a child

III. Definitions

  1. Somnambulism: Sleep Walking
  2. Somniloquy: Sleep Talking

IV. Pathophysiology

  1. Occurs during first 3 hours of sleep
  2. Occurs during non-REM Sleep: Stages 3 and 4

V. Risk Factors

  1. Family History in first degree relative (see above)
  2. Obstructive Sleep Apnea
  3. Sleep deprivation
  4. Gastroesophageal Reflux disease
  5. Acute stress

VI. Signs

  1. Eyes are open but stare is blank
  2. Speech is mumbled, slurred and unintelligible
  3. Unable to awaken during episode
  4. Patient has no memory of the event
  5. Not well coordinated, but can do semi-purposeful acts
    1. Dressing
    2. Open and close doors
    3. Turn on and off lights
  6. Timing
    1. Onset during first half of sleep
    2. Lasts for 30 seconds to 30 minutes
    3. Rapidly returns to sleep

VII. Associated Conditions: Other Parasomnias

  1. Night Terrors
  2. Nocturnal Enuresis
  3. Nightmares
  4. Confusional Arousals

VIII. Differential Diagnosis

  1. Partial complex Seizures occurring during sleep
  2. REM behavior disorder
  3. Night Terrors
  4. Malingering
  5. Dissociative phenomena
  6. Medication adverse effect
  7. Illicit Drug use

IX. Management

  1. See Prompted Sleep Awakening Technique
  2. Reassure parents (See Course below)
  3. Avoid Fatigue (leads to Sleepwalking)
    1. Ensure sufficient sleep
    2. Provide regular sleep-wake schedule
      1. Maintain a consistent bedtime and awakening time
  4. During episode
    1. Lead child back to bed
    2. Minimize interventions with child
      1. Do not shake or slap child
      2. Do not shout at child
    3. Stop by bathroom if needed
    4. Once in bed, episode may end
  5. Protect from accidents
    1. Gates across stairs
    2. Special locks on outside doors and windows
    3. No bunk-bed sleeping
    4. Situate bedroom on first floor of home

X. Course

  1. Sleep Walking spontaneously stops with adolescence

XI. Followup: Indications to call or return to clinic

  1. Signs of Seizure during episode
    1. Drooling
    2. Jerking or stiffening
  2. Persistent frequent or prolonged episodes
    1. Twice weekly despite prompted awakenings for 7 days
    2. Episodes last longer than 30 minutes
  3. Child does something dangerous during episode
  4. Episodes occur during second half of night
  5. Child with daytime fears

XII. References

  1. Carter (2014) Am Fam Physician 89(5): 368-77 [PubMed]
  2. Masand (1995) Am Fam Physician 51(3):649-54 [PubMed]
  3. Thiedke (2001) Am Fam Physician 63(2):277-84 [PubMed]

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