What happens during the episode
Sleepwalking occurs in the first third of the night, when deep, slow-wave sleep predominates. The cerebral cortex, responsible for consciousness and memory, remains in a state of sleep, and the motor and emotional centers are activated. Therefore, a person performs habitual actions, but is not aware of them and does not remember them. His eyes are usually open, his movements are slow and awkward, and he answers questions in monosyllables and at random. The same group of disorders includes night terrors and confused awakenings - they often occur in the same child.
- The episode is more common in the first 1–3 hours after falling asleep
- The gaze is open, but “absent”
- Simple actions: walking, shifting things, trying to get dressed
- Difficult to wake up, confusion after waking up
- In the morning the event is not remembered
Causes and provoking factors
The tendency to sleepwalk is largely hereditary: if one of the parents had it, the child is much more likely to have it. The attack itself is triggered by factors that deepen slow-wave sleep or fragment it. Therefore, sleepwalking often first appears against the background of illness with a high fever, moving, exams, or after several nights of lack of sleep. In adults, a hidden reason for night awakenings is often discovered - for example, stopping breathing during sleep.
- Hereditary predisposition
- Lack of sleep and irregular schedule
- Fever, especially in children
- Stress and anxiety
- Obstructive sleep apnea syndrome, restless legs syndrome
- Alcohol, sleeping pills and some psychotropic drugs
- Full bladder, noise, bright lights in the bedroom
How does sleepwalking differ from nocturnal epilepsy?
Distinguishing arousal disorder from frontal nocturnal epilepsy using a single description is not easy, but there are guidelines. Sleepwalking lasts minutes, the movements are smooth and “everyday”, the attack usually occurs once a night and in the first half of sleep. Epileptic seizures are shorter, the movements are stereotypical and tense, they are repeated several times a night and can occur at any time. Doubts are resolved by video-EEG monitoring, so video recording of the episode on the phone is very helpful to the doctor.
- Sleepwalking: minutes, complex actions, episode amnesia
- Epilepsy: seconds - a minute, identical postures and movements
- Epilepsy: frequent recurrences during the night, possible tongue biting
- REM sleep behavior disorder: vivid dreams, “fighting” during sleep, more common in older people
- Night terrors: screaming and panicking without leaving bed
Diagnostics
In most cases, the diagnosis is made based on the story of the parents or partner, so the doctor asks in detail about the time, duration and content of the episodes. It is useful to keep a sleep diary for 2-3 weeks, indicating the time of going to bed, waking up and attacks. Not everyone needs instrumental studies: they are prescribed for traumatic behavior, daily episodes, onset in an adult, and suspected epilepsy or sleep apnea.
- Questioning and neurological examination
- Sleep diary and video recording of the episode
- Polysomnography for suspected apnea and frequent seizures
- EEG, if necessary - night video-EEG monitoring
- Assessment of thyroid gland, iron deficiency and medications as indicated
What to do and how to treat
Children with rare episodes do not require special treatment: it is enough to establish a routine and secure the apartment. There is no need to wake up a sleepwalker abruptly - this increases confusion and fear; It’s better to calmly, without loud words, escort him back to bed. If attacks occur regularly at the same time, the doctor may suggest a method of scheduled awakenings: the child is gently awakened about 15 to 20 minutes before the usual time of the episode. Medicines are prescribed rarely and only by a doctor when episodes are dangerous or very frequent. When sleep apnea is identified, treatment of the underlying disorder usually eliminates sleepwalking.
- Go to bed and get up at the same time, get enough sleep
- Close windows and front door, put away keys
- Remove wires, sharp and breakable objects from the floor
- Don't sleep on the top bunk of the bed
- Limit screens and active games before bed
- Avoid alcohol and unplanned sleeping pills in adults
- If you have frequent attacks, discuss scheduled awakenings with your doctor.