Sleepwalking



Sleepwalking is a great lesson in how one splits their consciousness allowing them to navigate in several realities simultaneously. Indigenous people believe physical reality is "the dream" and we are all asleep somewhere, about to wake up. This goes along with my theory that reality is a consciousness hologram.




Sleepwalking, also known as somnambulism, is a sleep disorder belonging to the parasomnia family. Sleepwalkers arise from the slow wave sleep stage in a state of low consciousness and perform activities that are usually performed during a state of full consciousness. These activities can be as benign as sitting up in bed, walking to the bathroom, and cleaning, or as hazardous as cooking, driving, extremely violent gestures, grabbing at hallucinated objects, or even homicide.

Although generally sleepwalking cases consist of simple, repeated behavior, there are occasionally reports of people performing complex behavior while asleep, although their legitimacy is often disputed.

In 2004, sleep medicine experts in Australia claimed to have successfully treated a woman who claimed to have sex with strangers in her sleep.

In December 2008, reports were published of a woman who sent semi-coherent emails while sleepwalking, including one inviting a friend around for dinner and drinks. Sleepwalkers often have little or no memory of the incident, as they are not truly conscious. Although their eyes are open, their expression is dim and glazed over. Sleepwalking may last as little as 30 seconds or as long as 30 minutes.




Explanations


Sleep Stages

Sleep is categorized into stages of a cycle between REM sleep and NREM sleep. NREM sleep is further divided into four stages: stage 1 (a light sleep period), stage 2 (a consolidated sleep period), and stage 3 and 4 (slow wave sleep periods). This is followed by stage 3, stage 2, stage 1, and a REM period. In normal adults, a cycle will last about 1.5 hours. According to Lavie, Malhotra, and Pillar, "The length and content of sleep cycles change throughout the night as well as with age." Sleepwalking generally occurs during the first third of the night (between 11 p.m. and 1 a.m.) during the slow wave NREM sleep stage. High delta activity within the brain usually accompanies slow wave NREM sleep, and when 20-50% of all activity is delta activity, stage 3 is scored. When delta activity reaches 50% or higher, stage 4 is scored. Usually, if sleepwalking occurs at all, it will only occur once in a night.


Automatism

Researchers sometimes disagree about the classification of sleepwalking as an automatism. According to the popular source of MedicineNet, an automatism is "an unconscious movement that may resemble simple repetitive tics or may be a complex sequence of natural-looking movements." The individual often won't remember what he was doing or how he was doing it. These repetitive actions may include chewing, lip-smacking, pulling at clothing, or wandering around looking confused. Epileptic automatisms are also associated "with the absence attacks of petit mal epilepsy." In the case of the law, an individual can be accused of non-insane automatism or insane automatism. The first is used as a defense for temporary insanity or involuntary conduct, resulting in acquittal. The latter results in a "special verdict of not guilty by reason of insanity." This verdict of insanity can result in a court order to attend a mental institution. Some actions that take place during sleepwalking could be classified as automatisms.


Causes

Several experts theorize that the development of sleepwalking in childhood is due to a delay in maturation. There are also high-voltage delta waves in somnambulists up to 17 years of age. This presence might suggest an immaturity in the central nervous system, also a possible cause of sleepwalking. Sleepwalking is clustered in families, and the percentage of childhood sleepwalking increases to 45% if one parent was affected, and 60% if both parents were affected. However, there is no recorded preference to male or female individuals. Thus, heritable factors appear to predispose an individual to develop sleepwalking, but expression of the trait may be also influenced by environmental factors. Other precipitating factors to sleepwalking are those factors which increase the slow wave sleep stage. These most commonly include sleep deprivation, fever, and excessive tiredness. The use of some neuroleptics or hypnotics can also cause sleepwalking to occur.


Treatment

There are some drugs that can be prescribed for sleepwalkers such as a low dose benzodiazepine, tricyclic antidepressants, and clonazepam. However, for most sleepwalkers, many experts advise putting away dangerous items and locking doors and windows before sleep to reduce risks of harmful activity. Good sleep hygiene and avoiding sleep deprivation is also recommended.

There are conflicting viewpoints on whether it is harmful to wake a sleepwalker. Some experts say that sleepwalkers should be gently guided back to bed without waking them. Others counter that idea and state that waking a sleepwalker may result in their disorientation, but it is not harmful.




Epidemiology

According to the National Sleep Foundation, sleepwalking is prevalent in 1-15% of the general populace. Sleepwalking is most prevalent in children, and usually disappears by adolescence. Sleepwalking in adults is less common, but when it does occur, the events occur three times more often per year and last for more years than in children. Sleepwalking in old age is rare and usually indicates another disorder. Old age disorders may include delirium, drug toxicity or a seizure disorder.


Children

Sleepwalking events are common in childhood and decrease with age. According to Lavie, Malhotra and Pillar, the peak age is 4-8 years, when prevalence is 20% frequency of events. It is also known that "between 25-33% of somnambulists have nocturnal enuresis" (bed-wetting). Like sleepwalking, enuresis is more common in children and fades away as the child ages.

Some children who sleepwalk are also affected by night terrors. However, night terrors are much more common in adult sleepwalkers, up to 50% more common. Some parents worry about the psychological implications of sleepwalking on their child, but Larissa Hirsch, MD, editor of the website KidsHealth, says, "Sleepwalking is not usually a sign that something is emotionally or psychologically wrong with a child. And it doesn't cause any emotional harm."

In the study "sleepwalking and sleep terrors in prepubera children" they found that if a child had another sleepdisorder such as restless leg syndrome (RLS) or sleep-disorder breathing (SDB) that they had a greater chance of sleepwalking. The study found children with chronic parasomnias may often also present SDB or, to a lesser extent, RLS. Furthermore, the disappearance of the parasomnias after the treatment of the SDB or RLS periodic limb movement syndrome suggests that the latter may trigger the former.

The high frequency of SDB in family members of children with parasomnia provided additional evidence that SDB may manifest as parasomnias in children. Children with parasomnias are not systematically monitored during sleep, although past studies have suggested that patients with sleep terrors or sleepwalking have an elevated level of brief EEG arousals. When children receive polysomnographies, discrete patterns (e.g., nasal flow limitation, abnormal respiratory effort, bursts of high or slow EEG frequencies) should be sought; apneas are rarely found in children.

Children's respiration during sleep should be monitored with nasal cannula/pressure transducer system and/or esophageal manometry, which are more sensitive than the thermistors or thermocouples currently used in many laboratories.

The clear, prompt improvement of severe parasomnia in children who are treated for SDB, as defined here, provides important evidence that subtle SDB can have substantial health-related significance. Also noteworthy is the report of familial presence of parasomnia. Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias. RLS and SDB have been shown to have familial recurrence. RLS has been shown to have genetic involvement.


Adults

The persistence or onset of sleepwalking in adulthood is far less common than in children. It is a misconception that adult sleepwalking always indicates a psychological disorder. Sleepwalking can, however, be a symptom of people with psychological disorders. In one study, adult test subjects were given the Minnesota Multiphasic Personality Inventory, a psychiatric test. According to the study, patients showed "outwardly directed behavior patterns ... suggesting that these adults had difficulty handling aggression. They did not support an interpretation of sleepwalking as 'hysterical dissociation'."


Psychological Disorders and Drug Use

In some cases, sleepwalking in adults may be a symptom of a psychological disorder or of drug use. One study done by A.H. Crisp et al. of St. George's Hospital Medical School in London supports the possibility of dissociation in adult sleepwalkers because the test subjects scored unusually high on the hysteria portion of the Crown-Crisp experiential index.

According to J.E. Orme, an expert in psychology, "A higher incidence of sleepwalking events has been reported in patients with schizophrenia, hysteria and anxiety neuroses." Also, patients with migraine headaches or Tourette Syndrome are 4-6 times more likely to sleepwalk. Some medications that may increase sleepwalking include: Chlorpromazine (Thorazine), perphenazine (Trilafon), lithium, benzodiazepine (Triazolam), amitriptylin (Elavel, Endep), Zolpidem (Ambien) and beta blockers.




History

Sleepwalking has attracted a sense of mystery, but it had not been seriously investigated and diagnosed until the last century. Sleepwalking was initially thought to be a dreamer acting out a dream. For example, in one study published by the Society for Science & the Public in 1954, this was the conclusion: "Repression of hostile feelings against the father caused the patients to react by acting out in a dream world with sleepwalking, the distorted fantasies they had about all authoritarian figures, such as fathers, officers and stern superiors."

This same group published an article twelve years later with a new conclusion: "Sleepwalking, contrary to most belief, apparently has little to do with dreaming. In fact, it occurs when the sleeper is enjoying his most oblivious, deepest sleep - a stage in which dreams are not usually reported."

More recent research has discovered that sleepwalking is actually a disorder of NREM (non-rapid eye movement) arousal. Acting out a dream is the basis for a REM (rapid eye movement) sleep disorder called REM Behavior Disorder (or REM Sleep Behavior Disorder, RSBD). More accurate data about sleep is due to the invention of technologies such as the electroencephalogram (EEG) by Hans Berger in 1924 and BEAM by Frank Duffy in the early 1980s.




Society and Culture

The 19th-century German chemist and parapsychologist Baron Karl Ludwig von Reichenbach made extensive studies of sleepwalkers and used his discoveries to formulate his theory of the Odic force.

Sleepwalking has been found as a theme in many dramatic works. It is a major plot element in the classic silent German Expressionist film Das Cabinet des Dr. Caligari (English title: The Cabinet of Dr. Caligari). In Shakespeare's Macbeth, Lady Macbeth sleepwalks because of her overwhelming guilt and insanity. Sleepwalking is also central for Charles Brockden Brown's 1799 novel Edgar Huntly, Or, Memoirs of a Sleepwalker and in Heinrich Von Kleist's play The Prince of Homburg.

In the film version of Harry Potter and the Half Blood Prince, Luna Lovegood claims that she sleepwalks at night and, as a result, wears her shoes to bed. Also, in the Harry Potter and the Prisoner of Azkaban film Harry Potter uses this as an excuse as to why he was out of bed after hours, when he was really looking for Peter Pettigrew on the Marauder's Map. A sleepwalking murder is the main subject of the 2009 movie In My Sleep.

Italian composer Vincenzo Bellini's opera La Sonnambula is named after its heroine, a sleepwalker. In Dario Argento's Phenomena (1985), the protagonist, Jennifer Corvino (Jennifer Connelly), witnesses a murder while sleepwalking. In the film adaptation of Silent Hill, the protagonist's daughter suffers from sleepwalking.

In the House episode "Role Model", a woman has sexsomnia (sexual intercourse with her ex-husband while sleepwalking) and becomes pregnant. In the movie Step Brothers, the main characters, Brennan and Dale, both sleepwalk. In the 1947 Disney animated short "Sleepy Time Donald", Donald Duck is a prolonged sleepwalker, and Daisy Duck steers him away from many hazards. In the film Donnie Darko, the character Donnie Darko sleep walks and in one scene awakens in a golf course; he believes that his sleep walking is caused by an outside party or supernatural force.

Dr. John William Polidori, a friend of Lord Byron's, earned his medical degree from the University of Edinburgh in 1815 with a treatise on sleepwalking. He was present at the famous gathering at the Villa Diodati on 16 June 1816 when Byron issued a challenge to him, Percy Bysshe Shelley, Mary Godwin and Claire Clairmont to write a ghost story. Polidori wrote "The Vampyre", the first vampire story in English.




Crime

Because sleepwalking can result in violent behavior, legal courts sometimes deal with cases involving sleepwalkers. These cases include homicide, assault, and sexual harassment. The level of responsibility and severity of punishment has been highly debated because sleepwalkers are almost always oblivious to their activity during an episode.

According to Culebras, a Professor of Neurology at the State University of New York College of Medicine, "It is conceivable that the sleepwalker has the potential to drift into a confusional arousal, a state in which violence and assault are likely when prolonged and if given the adequate circumstances. The differential diagnosis should also include other conditions in which violence related to sleep is a risk, such as REM Sleep Behavior Disorder (RSBD), fugue states, and episodic wandering."

In the 1963 case Bratty v. Attorney-General for Northern Ireland, Lord Morris of Borth-y-Gest stated, "Each set of facts must require a careful examination of its own circumstances, but if by way of taking an illustration it were considered possible for a person to walk in his sleep and to commit a violent crime while genuinely unconscious, then such a person would not be criminally liable for that act."

Examples of sleepwalking cases include:




In the News ...


More Than 8 Million Americans Sleepwalk, Surprising Scientists   Live Science - May14, 2012
Adult sleepwalkers are more common than previously realized, with upward of 8 million American adults prone to nighttime ambulation, a new study finds. In fact, about 3.6 percent of U.S. adults have walked in their sleep at least once in the previous year, researchers report Monday (May 14) in the journal Neurology. One percent experienced at least two episodes of sleepwalking per month.

The findings are higher than previous studies had suggested, the researchers wrote, including an estimate from a decade-old study of the general European population, which found that only about 2 percent of people had trouble with sleepwalking within the previous year. Results from the new study also showed certain mental illnesses, including depression, and some antidepressant medications were linked with a higher risk of experiencing sleepwalking. The study may provide some clues for treating the disorder, said study researcher Maurice Ohayon, a psychiatrist at the Stanford University School of Medicine. "Now we know the biggest associations with sleepwalking, and the first thing to do is remove these pathological associations - sleep apnea, insomnia, alcohol consumption," Ohayon told LiveScience. "The key thing we must say to people is, don't be ashamed to be a sleepwalker."

Sleepwalking: a chronic problem

Sleepwalking, also known as somnambulism, usually occurs during non-rapid eye movement (REM) sleep (dreams, on the other hand, are most linked with the REM phases of sleep). Sleepwalkers should take episodes seriously, Ohayon said, as unconscious amblings can result in major injuries. Sleepwalkers may fall, run into things or even attempt complex tasks like driving a vehicle or initiating sex.

Children are more likely than adults to sleepwalk, a fact borne out by Ohayon and his colleagues' study: Slightly more than a quarter of people said they'd sleepwalked as a child or teen but had not done so recently. All told, 29.2 percent of people had experienced a sleepwalking episode at some point in their lives.

The study was one of the first large-scale, nationally representative looks at sleepwalking in the United States. The only previous study of sleepwalking prevalence in the U.S. was published 30 years ago and focused on Los Angeles-area adults alone.

In the new study, the researchers conducted hour-long phone interviews with 15,929 Americans over the age of 18, chosen to represent the population as a whole. The youngest person in the study was 18; the oldest, 102. The participants reported on their own sleeping problems and were not given official medical diagnoses.

The interviews revealed that sleepwalking is usually a chronic problem, with 80 percent of sleepwalkers reporting that they'd had episodes for more than five years. While only 1 percent of Americans sleepwalked more than twice a month, 2.6 percent had between one and 12 episodes of sleepwalking a year.

Why people sleepwalk

Sleepwalking appears to have a genetic component, as 30 percent of sleepwalkers reported having a relative who walked in their sleep, compared with only 17.2 percent of non-sleepwalkers. But other factors played a role as well. People with other sleep disorders, such as insomnia or sleep apnea, were at risk for sleepwalking, too. People with depression were 3.5 times more likely than mentally healthy people to sleepwalk more than twice a month.

Obsessive-compulsive disorder and alcohol abuse were also associated with sleepwalking. A person with obsessive-compulsive disorder was seven times more likely to sleepwalk more than twice a month than someone without. Other research has suggested that mental illness and sleep difficulties are tied together in the brain. An April 2012 study, for example, found that people with schizophrenia had disrupted circadian rhythms, the "body clock" that regulates sleep and waking.

Some medications were linked with sleepwalking, Ohayon and his colleagues found. People who took sleeping medications were 2.5 times more likely to sleepwalk more than twice a month than people who didn't. Individuals taking selective serotonin reuptake inhibitors, or SSRIs, which are used to treat depression, were at higher risk of sleepwalking as well. But when comparing depressed people taking SSRIs and depressed people not taking SSRIs, the researchers found that SSRIs did not increase sleepwalking risk. That means that it's most likely the depression, not the treatment, at the root of the nighttime ambling, Ohayon said.

The researchers are exploring the link between mental illness and sleepwalking in a study in which they follow participants over time so as to better work out the causal relationship between the two, Ohayon said. They also plan to investigate the genetic component of sleepwalking as well as the links with sleep apnea and insomnia.




Sleepwalking 'linked to chromosome fault'   BBC - February 8, 2011
Scientists believe they have discovered the genetic code that makes some people sleepwalk. By studying four generations of a family of sleepwalkers they traced the fault to a section of chromosome 20. Carrying even one copy of the defective DNA is enough to cause sleepwalking, the experts told the journal Neurology.

They hope to target the genes involved and find new treatments for the condition that affects up to 10% of children and one in 50 adults. Most often, sleepwalking is a fairly benign problem and something that will be outgrown.

Many children will have episodes where they will arise from their sleep in a trance-like state and wander. But more extreme cases of sleepwalking can be deeply disruptive and downright dangerous, particularly when the condition persists into adulthood.

Occurrences

Many children will have episodes where they will arise from their sleep in a trance-like state and wander.

But more extreme cases of sleepwalking can be deeply disruptive and downright dangerous, particularly when the condition persists into adulthood. Stress trigger

Sleepwalkers may perform complex feats such as locating the car keys, unlocking the doors and then driving.

There have even been high-profile cases where sleepwalkers have killed during an episode.

Despite this relatively little is known about the phenomenon, called somnambulism by medics.

Stress Trigger

Sleepwalkers may perform complex feats such as locating the car keys, unlocking the doors and then driving. There have even been high-profile cases where sleepwalkers have killed during an episode. Despite this relatively little is known about the phenomenon, called somnambulism by medics.

Experts do know that sleepwalking tends to run in families and that some people are particularly susceptible to it. And factors like being over-tired or stressed can be the trigger.

Typically, episodes happen early in the night, soon after the individual has fallen asleep and is in the deep, dreamless "slow wave" or non-rapid eye movement (NREM) stage of sleep. By morning, the person will usually have no recollection of the episode.

For the latest study, Dr Christina Gurnett and colleagues at the Washington University School of Medicine sought the help of a large family of sleepwalkers. The family had been referred to them because one of the youngest members, a 12-year-old girl called Hannah, had been experiencing particularly troublesome sleepwalking, which regularly caused her to leave the house and roam during the night.

Among the four generations of the family, spanning from the great-grandparents downwards, nine members out of the 22 were sleepwalkers. One family member - an uncle of Hannah's - frequently wakes to find he has put on eight pairs of socks during the night. Some of her other sleepwalking relatives have suffered injuries such as broken toes during their nocturnal wanderings.

Using saliva samples the researchers analyzed the family's DNA to unpick the genetics of the condition. A genome-wide search revealed the problem stemmed from genetic code housed on chromosome 20, and that this code had been passed down from generation to generation. Someone with the gene has a 50% chance of passing it on to their children. And any individual who inherited a copy of the faulty DNA would be a sleepwalker, they found.

Although they have yet to identify the precise gene or genes involved - there are a potential 28 - their hunch is that it will be the adenosine deaminase gene that is the culprit. This gene, which sits in the minute segment of chromosome 20 that the researchers identified, is already known to be linked to the slow wave sleep that sleepwalking occurs within.





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