Sleep Soundly Every Night, Feel Fantastic Every Day (25 page)

  
Traumatic events or post-traumatic stress disorder

  
Lithium

  
Ambien

  
Benzodiazepine sleeping pills such as Halcion, diazepam, and somewhat with Lunesta.

  
Atypical antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel), and Risperdal.

As with children, sleep apnea, RLS, or periodic limb movements are causes in adults. By successfully treating
these issues, the sleepwalking will diminish and disappear. My patient Shannon was 52 years old and in menopause. She had sleepwalking episodes as a child, but they diminished as she reached adolescence. Three months prior to her appointment, she was getting up and sleepwalking around the house. Her concerned husband gently guided her back to bed. He was worried she'd fall down the stairs. The incident became more regular, occurring three times a week. Usually, she went back to bed on her own, and sometimes she would lie down on the living room couch and continue sleeping until morning. Once in a while, Shannon's husband found her in a closet. She had no recollection of these events when he spoke to her about them but she believed him. She knew she was sleepwalking because she found herself waking up some mornings in another room.

Shannon felt pins and needles in her legs as she fell asleep. Sometimes these prevented her from falling asleep and other times they would wake her up in the middle of the night. In addition, her husband noted that her legs “keep moving all night even when she is fast asleep.” After a sleep study, we determined that Shannon had a lot of periodic leg movements, about 50 to 60 an hour. About 20 of them were associated with mini-arousals that she was unaware of. She did not sleepwalk in our lab that night. However, her sleepwalking was becoming dangerous and more frequent. So I started her on a medication called pramipexole (Mirapex) that works for both restless legs syndrome and periodic limb movement disorder.

In the meantime I checked her ferritin, iron, and total iron capacity, and found that she did have low iron levels, causing her pins and needles symptoms of RLS. I placed her on iron in the form of ferrous sulfate tablets taken with vitamin C on an empty stomach three times a day. The latter improves the absorption of iron. Three months later, her iron levels were normal. When the deficiency was corrected,
the RLS went away, as did her periodic limb movement. Her husband reported that she was no longer sleepwalking or moving as much in the middle of the night.

 

Night terrors typically occur in children between the ages of three and twelve years, with a peak onset in children aged three and one-half years old. An estimated 1% to 6% of children experience night terrors. Night terrors are not to be confused with nightmares or bad dreams. During a night terror, children may bolt upright, look fearful or panicked, and cry inconsolably. They may also sweat or thrash their limbs. Although children may seem to be awake during a night terror, they will be unresponsive to attempts to communicate with them, and may not recognize others familiar to them. The disorder usually resolves during adolescence.

If the episodes are recurring with a frequency of every night or three times a week, visit your pediatrician. Most likely, you'll receive a referral to a sleep center. Be prepared to share information about your child's sleep habits including:

  
Does he or she snore?

  
Complain of the legs itching, cramping, or feeling like pins and needles?

  
Move restlessly in the night, especially moving his or her legs?

This information will help your doctor determine any precipitating factors that may be contributing to the night terrors, such as restless legs syndrome, and work with you to resolve them to eliminate the night terrors.

Night terrors are far less common for adults than sleepwalking, though patients frequently experience both night terrors and sleepwalking. Night terrors occur most often in people with post-traumatic stress disorder. As with children, night terrors in adults are characterized by sitting up, looking terrified, sweating, and perhaps screaming. The person may even run out of the house. They will not remember the event and usually it is the bed partner who is most terrified and prompts treatment.

Possible triggers include:

  
High stress or anxiety

  
Mental health issues