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Sleepwalking (cont.)

What Are the Symptoms of Sleepwalking?

  • Episodes range from quiet walking about the room to agitated running or attempts to "escape." Patients may appear clumsy and dazed in their behaviors.
  • Typically, the eyes are open with a glassy, staring appearance as the person quietly roams the house. They do not, however, walk with their arms extended in front of them as is inaccurately depicted in movies.
  • On questioning, responses are slow with simple thoughts, contain non-sense phraseology, or are absent. If the person is returned to bed without awakening, the person usually does not remember the event.
  • Older children, who may awaken more easily at the end of an episode, often are embarrassed by the behavior (especially if it was inappropriate). In lieu of walking, some children perform repeated behaviors (for example, straightening their pajamas). Bedwetting may also occur.
  • Sleepwalking is not associated with previous sleep problems, sleeping alone in a room or with others, achluophobia (fear of the dark), or anger outbursts.
  • Some studies suggest that children who sleepwalk may have been more restless sleepers when aged 4-5 years, and more restless with more frequent awakenings during the first year of life.

When Should I Call the Doctor about Sleepwalking?

For children and adults, sleepwalking is usually a sign of lack of sleep, intense emotional problems, stress, or fever. As these conditions resolve, sleepwalking incidences disappear.

In most cases, no treatment is necessary because sleepwalking rarely indicates any serious underlying medical or psychiatric problem.

In most children, sleepwalking disappears at puberty. However, it can occasionally persist into adulthood or may even begin in adulthood.

Consult a sleep specialist if the person is having frequent episodes, injuring himself or herself, or showing violent behavior.

What Are the Exams and Tests to Diagnose Sleepwalking?

Usually, no exams and tests are necessary. However, a medical evaluation may be completed to rule out medical causes of sleepwalking. Additionally, one may get a psychologic evaluation done to determine whether excessive stress or anxiety is the cause of sleepwalking.

Sleep study tests may be done in persons in whom the diagnosis is still unclear.

Differential Diagnosis

Sleepwalking, night terrors, and confusional arousals are all common non-REM sleep disorders that tend to overlap in some of their symptoms. A percentage of young children through mid adolescence will experience some or all of these behaviors.

  • Sleepwalking: see above
  • Night terrors: Like sleepwalking, night terrors tend to occur during the first half of a night's sleep, often within 30-90 minutes from falling asleep. Also, like sleepwalking, night terrors occur during stage 3 sleep. However, unlike sleepwalking, an individual with night terrors will portray a sudden and often agitated arousal that may appear to parents as violent and terrified behaviors. Night terrors often start during the toddler years with a peak incidence between 5–7 years of age. During these times, evidence of a surge in autonomic nervous system activity is evident. Accelerated heart and respiratory rates, dilated pupils, and sweating are characteristic. Triggers for night terrors may include sleep deprivation, stress, or medications (stimulants, sedatives, antihistamines, etc.). Unlike sleepwalking, episodes of night terrors may recur for several weeks in a row, abate completely, and later return.
  • Confusional arousals: Similar to night terrors, confusional arousals are characterized by a sudden and violent arousal from sleep with behaviors described as agitated and semi-purposeful in pattern. Speech is generally coherent (unlike in sleepwalking). A distinguishing point between night terrors and confusional arousals is the lack of autonomic nervous system phenomena in the latter. Confusional arousals tend to occur during the first half of a night's sleep (during stage 3). They are characteristically short-lived, lasting only 5 - 30 minutes in duration. Affected individuals typically have no memory of the event.
  • Nocturnal seizures: Several important differential points help delineate the above three sleep behaviors from seizure activity that occurs at night. Seizures by their nature are very brief, lasting often only a few minutes. In addition, seizure events likely to be confused with the above are characterized by a series of repeated, stereotypical, and frequent behaviors occurring in clusters. Importantly, seizures more commonly occur in the second half of the night's sleep. Patients often with have post-ictal (post-seizure) issues including headache, extreme grogginess, being hard to arouse, as well as incontinence of urine and stool. To assist in establishing a correct diagnosis a neurologist may perform a video-EEG study to help clarify the issue.
Medically Reviewed by a Doctor on 11/29/2016

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