Sleepwalking

Introduction
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By Michael J Howell MD

Sleepwalking is also known as or subsumes Nocturnal automatism and Somnambulism. -ed.

In this article, the author provides a review of sleepwalking disorder. Sleepwalking is a disorder of arousal with ambulation, and it usually originates from deep (N3) NREM sleep. Sleepwalking, like other disorders of arousal, is primed by conditions that increase the homeostatic sleep drive, such as sleep deprivation, and it is precipitated by conditions that lead to sudden arousal, such as obstructive sleep apnea. Patients with restless legs syndrome (RLS) have difficulty falling asleep and are predisposed to nocturnal ambulation. Sedative hypnotic medications, when prescribed for sleep initiation, then unleash complex sleepwalking behaviors, such as sleep related eating disorder among patients with RLS. Elimination of priming and precipitating conditions often results in elimination or moderation of sleepwalking behaviors.

Key Points

  • Under normal conditions, arousals from deep slow-wave sleep (N3) are transient and result in either a return to NREM sleep or conversely, to a full transition to consciousness within seconds. Disorders of arousal occur when the brain fails to fully transition to sleep or wakefulness, resulting in behaviors that are amnestic and inappropriate.
  • Sleepwalking is a disorder of arousal with ambulation. These episodes are typically short-lived, lasting only a few minutes. However, prolonged episodes occur, especially in the setting of sedative hypnotic medications.
  • Patients with sleep initiation difficulties related to motor restlessness (restless legs syndrome) are commonly misdiagnosed as insomniacs and treated with sedative hypnotic medications. These hypnotic agents then prime patients predisposed to ambulation.
  • Sleepwalking is effectively treated by reversing conditions that promote sleep drive, such as sleep restriction, and treating conditions that lead to sleep fragmentation, such as sleep-disordered breathing.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention and risk factors
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
References cited
Contributors