Sleepwalking: The Night walk

Did you know that sleepwalking is a very common phenomenon? Yet, there are more questions surrounding it than there are answers

Girl sleeping soundlyTalking of sleepwalking, what immediately comes to mind is a scene from Shakespeare's Macbeth. Here, Lady Macbeth enters the stage, walking in her sleep, carrying a candle. Burdened with guilt, she recollects the terrible images of her past and the murders she executed. Besides giving a vivid [though dramatic] description of what a sleepwalking experience is like, the scene has preliminary pointers to one of the causes of sleepwalking—deep anxiety.

Sleepwalking is a sleep disorder also known as somnambulism or noctambulism. Those suffering from the disorder perform all the activities in their sleep, which they would otherwise perform when awake. They may walk around, clean things, shift them and perform several other actions without being aware of what they are doing. They may not remember doing any of it on waking up. Sleepwalkers usually also open their eyes in a wide stare while they are sleepwalking.

Sleepwalkers have reported to doing strange things. In an article published in the Sleep Medicine journal, Seton Hall University researchers documented a case of a 44-year-old woman who e-mailed people in her sleep. She must have had to perform complex actions to do so, including remembering her password and the procedure for e-mailing. According to Dr Fouzia Siddiqui, a neurologist at the University of Toronto, this is the first and only published case of 'sleep e-mailing'. However, the symptoms stopped on reducing her medication dose of insomnia. The point is that bizarre things are possible when a person sleepwalks!

Sometimes, sleepwalkers could be of danger to others and themselves. If they perform activities like using stairs, stoves, driving cars or crossing roads while they are sleepwalking, they could be at risk of accidents.

Why we sleepwalk

Dr Vishesh Kapur, director of the University of Washington Sleep Disorders Center at Harborview Medical Center, USA, explains that there are three states of being—wakefulness, non-REM [rapid eye movement] sleep and REM sleep [most associated with dreams]. Sleepwalking is a mixture of wakefulness and non-REM sleep. Thus, as commonly believed, sleepwalkers do not act out their dreams, because dreams occur in the REM stage of sleep. Disruption to sleep may create a state between non-REM sleep and wakefulness that causes sleepwalking.

Anxiety is also one of the underlying causes. Sue Wilson, a research fellow in Psychopharmacology at the University of Bristol, UK, who runs a sleep clinic, has found a link between stress hormones and sleepwalking. She concludes that sleepwalkers feel more stressed after a night's sleep than people who sleep normally. When they become concerned about their sleepwalking, their stress levels go higher. This leads to more sleep deprivation, and deeper sleep because of which they are more likely to sleepwalk again. And it becomes a vicious cycle.

Antonio Zadra of the Universite de Montreal and his team found that sleep deprivation could precipitate sleepwalking.

Genetics also play a role in sleepwalking. In addition, fever, drug and alcohol consumption may cause the disorder. Sleepwalking is also a symptom of mental and psychological disorders such as Post-Traumatic Stress Disorder and Multiple Personality Disorder. Sometimes, intense emotional problems underlie this condition.

How to deal with it

Child psychiatrist Dr Raeesh Maniar states that sleepwalking is a common condition, which is why people may not generally come to see specialists for sleepwalking alone, unless problems that are more serious accompany it.

In most cases, no treatment is necessary because sleepwalking rarely indicates any serious underlying medical or psychiatric problem. However, if the person is having frequent episodes and if there is a risk of injury to oneself or others, a specialist must be consulted.

"Since subconscious anxiety is one of the underlying factors, the patient is prescribed anti-anxiety medication for 3-6 months," says Dr Maniar.

Several therapeutic measures help get the situation under control. One such way is anticipatory awakenings. It involves waking the person approximately 15-20 minutes before the usual 'sleepwalking time' and keeping her awake throughout the time of the occurrence. Usually, this is a long-term treatment method used when episodes are frequent. Behavioral therapists advocate relaxation and mental imagery. Hypnosis is also an option.

One can also work at improving one's sleep hygiene. Following regular sleep times, sleeping in a soothing and comfortable environment and adopting a balanced lifestyle help.

If the problem is persistent, making certain changes in the immediate environment will help prevent major accidents. You may have to install grills and safety locks on doors, block staircases and keep sharp objects out of reach, particularly if the sleepwalker is a child. What needs to be done will depending entirely on the peculiarity of the sleepwalker.

Sleepwalking is indeed a strange phenomenon. On one hand, people do not consider it serious enough and on the other, there have even been cases where sleepwalking has been used as a defense against murder charges! What is really the mystery behind sleepwalking? One of the people I interviewed for this article, a general practitioner, very confidently told me, "there is no known cause of sleepwalking and no known treatment". While a lot still needs to be unraveled, we can definitely start by adopting a holistic approach in addressing the problem.

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