Sleep Soundly Every Night, Feel Fantastic Every Day (24 page)

Answer each question YES or NO

Count the items you marked as YES and enter here _________

OSA—High Risk—Score is 5 to 8

OSA—Intermediate Risk—Score is 3 or 4

OSA—Low Risk—Score is 0 to 2

 

 

Para,
of Greek origin, refers to something amiss or irregular;
somia
refers to conditions of sleep. Parasomnias are sleep disorders that are intrusive to sleep and involve abnormal movements, behaviors, emotions, perceptions, or dreams. Parasomnias may occur during each sleep stage:

1.
 
Non-rapid eye movement (non-REM) parasomnias tend to develop during the first half of the night. They are frequently associated with slow-wave sleep and are referred to as arousal parasomnias. These include confusional arousals, night terrors, and sleepwalking. The individual frequently shows an abrupt arousal from deep sleep when they occur, but the waking is not complete. The higher brain centers, such as the frontal lobes and prefrontal cortex, remain in a sleep state. The result is an absence of higher brain functions that control impulsivity, reasoning, judgment, and memory for past actions.

2.
 
Rapid eye movement (REM) parasomnias, such as REM sleep behavior disorder, occur during REM sleep. REM sleep makes up about 20% of our sleep and tends to
increase during the second half of the night. People with REM parasomnias may have dreams of a violent nature and may punch, kick, tackle, or dive out of bed, causing injury to themselves or to a bed partner. Most of the time—but not always—the person can recall a dream if awakened.

 

 

Sleep isn't a break from our lives. It's the missing third of the puzzle of what it means to be living.

—DAVID K. RANDALL

Sleepwalking, also known as somnambulism, is common in children. However, sleepwalking may persist into or begin in adulthood. Sleepwalkers arise from slow wave sleep (non-REM) and walk, sit up in bed, or do other activities that are usually performed during a state of full consciousness. Sleepwalking usually happens during the first third of the night when most slow wave sleep occurs.

Night terrors, a state of intense fear with a piercing scream or cry, sweating, and agitation, also typically occur in the early stages of sleep and may coexist with sleepwalking.

A sleepwalker may sit up or bolt from bed. He or she is unresponsive to conversation or commands, and may be quiet or agitated. The sleepwalker's eyes can be open, but
glazed over and not seeing as an awake person. Though appearing to be awake, the sleepwalker remains asleep. In rare instances, a sleepwalker may be violent if startled awake. Episodes of sleepwalking can last from 10 to 30 minutes. Some patients can retain images after waking, but most have total amnesia of the event.

The sleepwalker's behavior can be benign like a young child wandering through the house and going back to bed, or involve more complex behaviors. One sleepwalking 11-year-old always went to the back door and tried to go outside. One night, he was successful in unlocking the door and walked into the yard. His mother wondered how he'd managed to unlock the door.

Sleepwalking is more prevalent in children, especially in preschoolers and children between the ages of 3 and 12. Most kids who sleepwalk occasionally do not have an underlying sleep disorder. Children simply have more slow-wave sleep. In other words, a six-year-old might have 40% slow-wave sleep, and a young adult might have 15% to 20%. The more slow-wave sleep, the more likely a child is to sleepwalk. In these cases, children usually have spontaneous resolution after puberty because slow-wave sleep decreases.

An effective treatment to curb sleepwalking is scheduled awakenings. First, the parent should observe approximately what time the sleepwalking usually occurs. Then, they are instructed to gently and briefly awaken the child 30 minutes earlier than when they sleepwalk. This interrupts their sleep in a loving way. Doing this for 25 to 30 days can eliminate sleepwalking for up to six months. I don't use medications with kids unless the sleepwalking is very frequent because the scheduled awakenings tend to work with persistent parents.

If the sleepwalking is frequent and doesn't resolve after scheduled awakenings, we would consider a sleep study to rule out sleep apnea, periodic limb movement, or even nocturnal seizures, which can be misinterpreted as sleepwalking. Insufficient sleep may also be a possibility. Children have more deep, slow-wave sleep when they are sleep-deprived and thus there is more potential for sleepwalking. This was the case with a recent patient. Carmelita, seven years old and thin, came to the sleep clinic because she was a sleepwalker. Her parents reported that she watched television until eleven o'clock at night and then got up for school at six o'clock in the morning. This seven-year-old should be getting at least eleven hours of sleep, not seven hours. She was sleep-deprived, which was causing her sleepwalking. Once Carmelita started going to bed by 8:00 p.m., her frequent sleepwalking ended.

If another disorder is the cause, such as sleep apnea, treatment for these disorders is generally effective at eliminating the sleepwalking. In one study of prepubescent children with repetitive sleepwalking and night terrors, the parasomnias disappeared after the children were treated for sleep breathing disorders (SBD), restless legs syndrome (RLS), and periodic leg movements. Treatment effects were maintained at three months and at six months.

Adults who sleepwalk most often exhibited it as children. The persistence or onset of sleepwalking in adulthood is less common than in children but it is more common than previously thought. According to a 2012 study conducted by the Stanford University School of Medicine, about 3.6% of U.S. adults—or upward of 8.4 million—are prone to sleepwalking. Adult sleepwalkers are more likely than children to turn violent. One cohort research project (2007–2011) involved 140 adult
sleepwalkers who were evaluated and followed over time at the Sleep Disorders Clinic in Montpellier, France. Violent behavior in sleep was investigated in 95 of those adults. Psychological stress, strong positive emotions, and sleep deprivation triggered the onset and frequency of violence in almost 60% of the participants. Among the adults whose pattern continued from childhood, 58% experienced violent sleepwalking episodes.

Genetics may play a role. Thirty-eight percent of sleepwalkers have a first-generation relative who is also a sleepwalker. The pattern of inheritance was the least understood aspect until recently. Researchers assessed sleepwalking in four generations of one family. Thirteen members were not affected and nine were sleepwalkers. They determined that sleepwalking passes through generations via one chromosome. You can inherit it from only one parent but not every person who carries that chromosome will pass it forward. More research needs to be done in order to determine who is most at risk for experiencing sleepwalking.

Possible triggers include:

  
Lack of sleep, sleep-deprivation

  
Sleep apnea

  
Restless legs syndrome

  
Stress or anxiety