Causes of Fatigue Slideshow Pictures Take the Sleep Quiz! Foods That Help or Harm Your Sleep Slideshow Pictures

Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

View Full Profile

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View Full Profile

Exams and Tests

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. Approximately 15%-20% 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 and 4 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 stages 3 and 4). 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.