Somnambulism
Somnambulism (sleepwalking) is a pathological condition in which a person can perform actions unusual for a sleeping person in a state of sleep. If you do not delve into it and do not pay close attention to it, then by the nature of its movements, its activity may seem adequate and purposeful. However, such an impression is deceptive, since a person’s consciousness is clouded at this moment, since he is in a state of half-sleep and does not give an account of his own actions.
The content of the article:
Causes of somnambulism
Symptoms of somnambulism
Diagnosis of somnambulism
Treatment of somnambulism
Prognosis and prevention of somnambulism
Somnambulism
The danger of somnambulism lies in the fact that a half-asleep patient can perform actions that the dream pushes him to and this cannot be controlled. A person can harm himself, which often manifests itself in falls and physical injuries. In an extremely rare form of the disease, the patient may show aggression towards other people. Most often this happens to those who are trying to help, stop, return a person to bed or just get in the way.
In the usual uncritical form, somnambulism manifests itself in the fact that a person can walk in his sleep or just sit on the bed. The period of half-sleep-half-wakefulness lasts in most cases no more than one hour, after which the patient falls asleep normally, returning to his bed. Waking up in the morning, people do not remember their nocturnal adventures at all.
Sleepwalking is most common in children of preschool and primary school age. In adolescence, manifestations of somnambulism are associated with hormonal restructuring of the body. In most cases, sleepwalking takes place without any pathological consequences in the process of growing up a child.
In adults, somnambulism indicates disorders of a mental, psychological, neurological and physiological nature. If it is easy enough to observe the manifestations of sleepwalking in children and correct them in a timely manner, if necessary, then the reasons for such a condition in an adult should be carefully clarified. If timely diagnosis and treatment are not carried out, the patient’s condition may worsen, seizures become more frequent and eventually result in serious deviations.
In the past, this pathology was called “sleepwalking”, but in modern medicine it is considered incorrect. It originated from a combination of the Latin words “moon” and “madness”. However, in fact, somnambulism is not associated with the cycles of the moon, as it was believed in ancient times, the term sleepwalker is sometimes used out of habit.
Causes of somnambulism
Sleep is divided into two phases: slow and fast. The slow phase is the longest, it accounts for 80% of the entire night’s rest. It is divided into several states — drowsiness, medium and deep sleep. The REM sleep phase takes much less time, on average about 20%.
A full night’s sleep includes from 3 to 5 cycles, each of which lasts from one and a half to two hours. First, a person falls into a short nap, then falls deeply asleep. Slow sleep is 2-3 of the first cycles, fast sleep is short-term and is characteristic of the pre-morning and morning hours.
Slow deep sleep is the main part of our rest. Fast bears this name not only because of its brevity, but also because at this time a person’s eyes move quickly in a dream. This happens before waking up, when a person has dreams.
Somnambulism manifests itself in the phase of deep sleep, when a person’s consciousness is most detached. The cause of this condition is considered to be sudden flashes of electrical nervous activity in some neurons of the brain. In this state, part of the brain sleeps, and the other part continues to be active. To put it more simply, we can say that the part of the brain responsible for conscious meaningful activity is in a state of sleep, and the centers that control motor coordination are active.
In children, sleepwalking in most cases is associated with immaturity and insufficient development of the central nervous system. Children, due to their emotionality and impressionability, perceive the information received during the day very sensitively. Due to the functional immaturity of the nervous system and excessive loads, they have a state of partial sleep. Active games, strong emotional experiences, overexcitation due to computer games, cartoons, video programs in the evening or an excess of information can contribute to its manifestation. In fact, the child’s brain simply does not have time to calm down and this is manifested by night walks.
Other causes of somnambulism in children include the following factors:
heredity — manifestations of somnambulism occur in almost half of children, one of whose parents suffered from sleepwalking at some point in their life;
disease with high fever;
stress that the child’s psyche could not cope with;
epilepsy — sleepwalking may be one of the signs, and may also be one of the early manifestations of the disease.
In adults, sleepwalking is a rather rare phenomenon, diseases can provoke it:
neuroses of various etiologies, most often hysterical and obsessive-compulsive neurosis;
vegetative-vascular dystonia with panic attacks;
diabetes mellitus with nocturnal hypoglycemia;
migraine;
intoxication with brain damage;
the state of chronic stress;
obstructive sleep disorders;
chronic fatigue syndrome;
magnesium deficiency in the body (with improper nutrition or illness);
consequences of traumatic brain injury;
vascular diseases of the brain;
epilepsy;
neoplasms of the brain;
senile dementia;
drug addiction, alcoholism;
cardiac arrhythmia;
taking certain medications.
A sharp loud sound or a sudden flash of light that disturbed the sleeping person’s peace can cause sleepiness. It was this factor that led to the fact that sleepwalking in the past was directly associated with the impact of the full moon. In fact, there is nothing mystical about somnambulism, it is caused by brain disorders.
Symptoms of somnambulism
Not all people subject to somnambulism walk in their sleep. Signs of the disease may be other manifestations of partial sleep. Passive symptoms of somnambulism include a condition in which the patient sits on the bed in a dream with his eyes open and his gaze fixed. As a rule, after sitting like this for a short time, he goes to bed and continues to sleep peacefully until morning.
In difficult cases, the patient can move around the house and even go outside. At the same time, all movements from the outside look calm and purposeful. The eyes are open, but the eyeballs do not move, the gaze is absent and unconscious. Some patients perform a whole range of actions — take certain things, change clothes, leave the house, walk on the roof, balance at a dangerous height and unstable surface.
A number of generalizing factors have been identified for all manifestations of somnambulism:
Lack of awareness. Performing any actions, a person does not react in any way to the speech addressed to him, does not perceive dangerous conditions in his movements. This, as mentioned above, is a sign that part of the brain is in a state of sleep.
An absent look. The somnambulist’s eyes are always open, his gaze is focused on something far away. Even if someone comes close to the patient and tries to draw attention to himself, he looks through him. Consciousness is asleep.
Detachment. A person in a state of semi-sleep cannot show any emotions, his face does not express them at all, facial expressions in most cases are completely absent, as it happens during deep sleep.
Lack of memories. The sleeping consciousness is not able to fix in memory the nocturnal adventures of a person. In the morning, he remembers absolutely nothing about what happened to him during the night attack.
The same ending. For all somnambulists, the end of the attack is the same — he falls asleep in a normal sleep. If he managed to return to his own bed, he spends the night there until he wakes up. But the end of REM sleep can catch him far from his bed, then he goes to bed where he has to. In the morning, such people experience a real shock, because after falling asleep in their bed, it is unclear how they ended up in another place.
Diagnosis of somnambulism
To prescribe the correct effective treatment for sleepwalking, you must first find out the reason that provoked it. To do this, you need to contact a specialist neurologist or psychiatrist.
The first stage of diagnosis is a survey of the patient with careful identification of details. You can help the doctor if someone close to you will mark the time of going to bed, the beginning and end of an attack of somnambulism, the time of morning awakening. Also important factors for the specialist will be the list of medications taken and the main foods from the daily diet.
Depending on the results of the examination and interview of the patient, the doctor may prescribe instrumental, laboratory tests and consultations of narrow specialists — an endocrinologist, a pulmonologist, a cardiologist. The instrumental studies used in such cases include:
electroencephalography;
polysomnography;
Ultrasound of the cerebral vessels;
fundus examination;
MRI of the brain.
Laboratory tests are carried out according to indications. You may need an analysis for hormones, infection and the content of vitamins and minerals in the blood. According to the collected data, the reason for sleepwalking is revealed, based on which therapy is prescribed.
Treatment of somnambulism
In children, the disease passes independently in the process of growing up and developing the brain. Treatment of a child suffering from somnambulism is most often reduced to correcting the daily routine, nutrition and psychological stress.
In the case of an adult’s disease, the treatment process is not so simple and unambiguous, since the causes of its origin are much deeper and more serious. Sleepwalking therapy is carried out with the help of psychotherapy and medications. If attacks of nocturnal movements appear after stress, emotional or mental stress, then first of all the help of a psychologist or a psychotherapist is needed.
Medical treatment
According to individual indications, sedatives or sleeping pills may be prescribed to the patient, in some cases tranquilizers are used. The choice of drug therapy is a very important moment, the specialist takes into account many factors before prescribing a particular drug.
If a patient has vascular, neurological, endocrine or cardiac diseases, the main emphasis in therapy is on the treatment of the underlying disease. For example, if the reason for sleepwalking is attacks of severe arrhythmia, then it is heart disease that should be treated. In the case when the problem is caused by brain tumors, surgical intervention is likely to be required.
Mainly during treatment, it is important to create conditions under which a person will feel calm and confident. It is possible to relieve the state of fatigue and anxiety with the help of physiotherapeutic methods and relaxation practices.
Prognosis and prevention of somnambulism
In general, experts give a favorable forecast for getting rid of sleepwalking. With the help of medicines, physiotherapy, psychotherapy and preventive measures, manifestations of somnambulism in adults can be eliminated. Problems can arise only in the case of paroxysmal (epileptic) sleepwalking. In such situations, treatment can be prolonged and give only a temporary result. However, with the help of complex methods, even in this case, it is possible to achieve a stable and long-term remission.
Prevention of somnambulism is primarily based on the elimination of psychologically traumatic factors from the patient’s life, the correction of sleep and wakefulness, and the selection of a diet. Experts say that the most common cause of somnambulism are psychological factors, mental and physical overstrain. Prevention of relapse concerns simple rules — a person should fully rest, sleep at least 8 hours a day, eat a balanced diet, minimize stress and eliminate chronic fatigue syndrome.
Speaking about preventive measures, it is impossible not to mention the creation of safe conditions for somnambulists before, during and after treatment. It is necessary to make sure that the windows and doors are always closed in the patient’s bedroom, there are no sharp objects and corners. This is necessary to reduce the risk of injury during night attacks.
