Sleep Walking

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

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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Related Studies

Ontology: Somnambulism (C0037672)

Definition (MSHCZE) Stav, kdy jedinec během spánku chodí a nekontrolovaně vykonává různé činnosti (např. konzumuje potravu), aniž se na to po probuzení pamatuje. Postihuje převážně děti, nejvíce mezi 4. a 6. rokem. Druh parasomnie vázané na NREM spánek. Důležité je zabránit úrazu náměsíčného, někdy je třeba provést neurologické vyšetření pro odlišení epilepsie, popř. jiných chorob. Též lunatismus. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) A sleep disorder characterized by repeated episodes of rising from bed and walking about; while sleepwalking, the individual has a blank stare and can be awakened only with great difficulty. On awakening, the individual has amnesia for the episode.
Definition (MSH) A parasomnia characterized by a partial arousal that occurs during stage IV of non-REM sleep. Affected individuals exhibit semipurposeful behaviors such as ambulation and are difficult to fully awaken. Children are primarily affected, with a peak age range of 4-6 years.
Concepts Disease or Syndrome (T047)
MSH D013009
ICD10 F51.3
SnomedCT 80495009, 268775007, 192457006, 154927001
DSM4 307.46
English Sleep Walking, Somnambulism, Sleepwalking, LUNATISM, SLEEP WALKING, SOMNAMBULISM, Sleepwalking [somnambulism], SLEEP WALKING DIS, Lunatism, Somnambulation, sleep walking, sleepwalking (symptom), sleepwalking, Sleepwalking disorder, Sleep Walking Disorder, Sleep Walking Disorders, Nocturnal Wandering, Wandering, Nocturnal, Somnambulism [Disease/Finding], sleep walking disorder, sleepwalk, sleep walk, sleepwalked, somnanbulism, Disorder;sleepwalking, sleeping walking, somnambulation, Sleepwalking Disorder, Walking in sleep, Sleepwalking (disorder), nonorganic sleepwalking disorder, sleepwalking disorder nonorganic, nonorganic sleepwalking disorder (diagnosis), Sleep walking, Sleep walking disorder, Sleep walking disorder (disorder), somnambulism, Somnanbulism, sleepwalking disorder
French SOMNAMBULISME, Lunatisme, HUMEUR CHANGEANTE, Somnambulisme
Portuguese SONAMBULISMO, Lunatismo, LUNATICO, Sonambulismo, Ambulação Durante o Sono, Ambulação Noturna por Sonambulismo
Spanish SONAMBULISMO, Lunatismo, ANDAR DORMIDO, caminar dormido, sonambulismo (trastorno), sonambulismo, trastorno de caminar dormido, Sonambulismo, Ambulación Durante el Sueño, Deambulación Nocturna
German SOMNAMBULISMUS, Mondsuechtigkeit, MONDSUECHTIGKEIT, SCHLAFWANDELN, Schlafwandeln [Somnambulismus], Nachtwandeln, Noktambulismus, Schlafwandeln, Somnambulismus, Mondsüchtigkeit, Nächtliches Wandern
Swedish Sömngång
Czech somnambulismus, Chození ve spánku, Somnambulismus, Náměsíčnost, náměsíčnost, lunatismus
Dutch somnambulisme, krankzinnigheid, slaapwandelen, somnabulisme, Slaapwandelen [somnambulisme], Slaapwandelen, Somnambulisme
Italian Pazzia, Camminare nel sonno, Disturbo da sonnambulismo, Camminare durante il sonno, Sonnambulismo
Japanese 睡眠時遊行症, ｽｲﾐﾝｼﾞﾕｳｺｳｼｮｳ, ﾑﾕｳｼｮｳ, 夢中遊行, 夢遊症, 夢遊, 夢遊病
Finnish Unissakävely
Russian SOMNAMBULIZM, СОМНАМБУЛИЗМ
Korean 몽유병
Polish Lunatyzm, Somnambulizm, Sennowłóctwo
Hungarian Holdkórosság, Alvajárás, Somnambulismus
Norwegian Somnambulisme, Søvngjengeri
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Sleep Talking (C0542313)

Concepts Disease or Syndrome (T047)
MSH D020922
SnomedCT 36321004
Italian Parlare nel sonno, Sonniloquismo
English Sleep Talking, SLEEP TALKING, Talking, Sleep, sleep talking, sleeptalking, sleep talk, somniloquism, Sleeptalking, Somniloquism, Sleep talking, Sleeptalking (finding)
Japanese ねごと, ﾈｺﾞﾄ
Czech mluvení ze spánku, Mluvení ze spánku, Mluvení ve spánku, mluvení ve spánku, somnilogie
Portuguese Fala Durante o Sono, SOMNILOQUIO, Soniloquismo, Somnilóquio
Spanish Conversación en Sueño, Somnilocuismo, somniloquia (hallazgo), somniloquia, somniloquismo, Somniloquia
French Somniloquie, PARLER PENDANT LE SOMMEIL, Somniloquence, Parler pendant le sommeil
German Sprechen im Schlaf, Somniloquie
Dutch somniloquie, praten in slaap, Praten in de Slaap
Hungarian Somniloquia, Somniloquismus
Norwegian Snakking i søvne
Derived from the NIH UMLS (Unified Medical Language System)

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