Sleepwalking is No Laughing Matter

Remember when you were a kid and you’d watch cartoons featuring characters walking in their sleep, arms outstretched in front of them and eyes closed as they would raid the refrigerator or narrowly avert falling off of cliffs? They all seemed pretty funny. They also did a serious disservice to our general understanding of what sleepwalking, or somnambulism, is.  According to Dr. Rafael Pelayo, a pediatric neurologist and sleep specialist at the Stanford Sleep Disorders Clinic, the person who suffers from somnambulism is not actually asleep – instead they are in a dissociated arousal state. Dr. Pelayo says that it’s estimated that one out of ten people in the United States has sleepwalked at some point in their life, with most of the experiences coming during the pre-teen and teenaged years. Though the phenomenon was once thought to be a sign of an underlying psychological disorder, recent studies have disproven that notion. Instead it is believed that sleepwalking is something that runs in families, but that there are environmental and other contributing factors that can make it more likely to happen. These include being sleep deprived and using alcohol before bed. What is most concerning about sleepwalking is the fact that people can truly get themselves into trouble when they’re doing it. Dr. Mark Mahawald is director of the Minnesota Regional Sleep Disorder Center at Hennepin County Medical Center and a professor of neurology at the University of Minnesota School of Medicine in Minneapolis. He acknowledges that a lot of people have sleepwalking episodes that are harmless, saying, “Sleepwalking is just part of the human condition. I think most people have awakened on a couch or on the floor with no memory of how they got there, but it is not something that people are going to talk about at a cocktail party.” But things can quickly become problematic because the sleepwalker has tremendous capabilities. “We tend to think that wakefulness and sleep are mutually exclusive, but this is not true, and sleep walking is a good example of this since people in this half-awake state are able to perform complex functions.” He explains that those functions can include driving, operating electronics, cooking, and even picking up weaponry and using it. “Anything that is ‘automatic’ you can do in your sleep, which is why it is important to find out if there are any weapons in the home of sleepwalkers.” Both physicians say that the focus of treating sleepwalking is always the safety of the individual and those with whom they live.  In addition to securing weapons, they advise equipping doors throughout the home with alarm buzzers that will sound when they are opened. These are not to awaken the patient as much as to notify others in the home that the sleepwalker needs to be directed back to bed. Stories of sleepwalkers can range from the amusing to the truly terrifying. Harry F. Rosenthal was a well-known journalist with the Associated Press who would frequently sleepwalk while on assignment. A classical music buff, his wife and children would often find him leading an unseen group of musicians. “There was Harry, sitting up in bed, conducting an orchestra – and he was also vocalizing all the instruments. I brought our kids in to see too, and I even made a tape recording of it.” Not quite as charming was the case of the 15-year old London girl who was discovered atop a construction crane, fast asleep and as astonished as the firefighters who rescued her by her circumstances. In some cases, Dr. Mahawald says, there are situations where there are questions about whether a person was sleepwalking or committed suicide. He recounts the tale of a sleepwalking college student who walked off of the roof of a dormitory building. “He suffered massive injuries, but he did survive. If he hadn’t survived it would have been considered a suicide, so I often wonder about the possibility of ‘pseudo suicide’ among sleep walkers – life threatening accidents that occur while they are sleepwalking.” Common sense precautions for children who show sleepwalking tendencies are to ensure that they are not sleeping on top bunks of bunk beds, and if the tendency continues into their adolescent years then special arrangements should be made to ensure that their college dorm rooms are on first floors or basement floors. Windows should also have heavy draperies or blinds that prevent them from easy access and potential harm.  By the same token, sleepwalkers should not be restrained in locked rooms or tied to beds. In some extremely serious cases it has been recommended that they sleep in cocoon type sleeping bags to restrict their movement, but that is as far as it goes. Sleepwalkers who show signs of violence, either to themselves or others, may be treated with medications such as antidepressants and then weaned off of the drug once the sleepwalking stops. One of the big concerns about sleepwalkers is that they seem to have a much higher threshold for pain, and can do themselves harm without waking up and reacting to it. One treatment protocol that has been showing promise has been teaching patients some self-hypnosis techniques that they can use before going to bed each night. Another strategy is called anticipatory wakening, which relies on the fact that sleepwalking occurs during slow wave sleep – the patients are awakened fifteen minutes after they fall asleep, which interrupts that sleep cycle. Dr. Mahawalk is dubious about the effectiveness of this treatment, as he says that interrupting the slow wave cycle doesn’t prevent the patient from reentering it when they go back to sleep. Still, he says that the old wives’ tale about not waking sleepwalkers is exactly that – a myth. Though sleepwalkers may be difficult to awaken, it is not harmful to do so.