Definition

Somnambulism is a condition that can cause a person to get out of bed and walk while asleep. This condition is a disorder that occurs during sleep (parasomnia), in the same group as night terrors. In both conditions, patients cannot respond to anything and usually do not remember this incident. Somnambulism most often occurs in children, although adults can also experience it.

Causes

Sleep consists of waking, the NREM (non-rapid eye movement) phase, and the REM (rapid eye movement) phase. This cycle usually lasts 50 minutes in babies born at term and reaches its peak in adolescence, which is 90 minutes long.

During all parts of the sleep cycle, the brain remains active with slight changes in the nervous system, nerve wave rhythms, and chemical compounds that send signal messages (neurotransmitters) in the brain. The deepest sleep phase is slow-wave sleep (SWS), which occurs immediately after falling asleep and just before waking up. Children usually enter this phase in the first 15 minutes, lasting 45-75 minutes.

Somnambulism occurs because a person is trapped when changing between one sleep phase and another (for example, from the NREM phase to waking). This substitution causes confusion and unclear perception. In children with somnambulism, the first SWS sleep phase is often disrupted. This condition occurs more often in children aged 4-8 years, which is considered a sign of an immature brain.

Risk Factor

Somnambulism can run in families. If your parents or siblings have a history of somnambulism, you have a 10 times greater risk of experiencing the same condition. In addition, identical twins have a higher risk of experiencing somnambulism.

A person's risk of somnambulism will be higher if:

• Lack of sleep
• Having a messy sleep schedule
• Stress
• Drunk
• Taking medications such as:
  • Sedative medication to help sleep or calm down
  • Neuroleptic drugs to treat symptoms of psychosis such as delusions and hallucinations
  • Stimulant drugs to increase stamina or;
  • Antihistamines, usually used to treat allergy symptoms
• Certain medical conditions, such as:
  
  • Heart rhythm problems
  • Fever
  • Gastroesophageal reflux disease (GERD)
  • Asthma
  • Seizures
  • Obstructive sleep apnea (stops breathing briefly during sleep)
  • Restless legs syndrome
  • Other mental disorders such as post-traumatic stress disorder (PTSD), panic disorder, or dissociative states such as multiple personality disorder

Symptoms

Usually, the symptoms of somnambulism are noticed by other people around the patient. These symptoms usually occur without realizing it. People with somnambulism can walk quietly around their room, run or try to "escape", open their eyes with a blank stare, and respond to questions slowly or not at all. The person can also babble and be delirious while sleeping. Sometimes, they can also do activities such as moving things or eating while asleep. If the person wakes up in the middle of an episode of somnambulism, the person may feel embarrassed.

Because most patients do not remember when they walked in their sleep, this incident was usually noticed by their partners or family members. These symptoms generally occur temporarily and rarely, so most people do not seek medical help.

Diagnosis

Somnambulism is usually fairly easy to diagnose. You usually only need to answer questions regarding your child's sleeping habits in detail and the history of illness for both the child and the family. Direct physical examination usually does not show any abnormalities. You or your child can undergo several examinations as follows:

Polysomnography

Polysomnography is a sleep examination. You or your child will be asked to sleep in a special sleep lab, and the examiner will record your pulse, brain waves, and body movements while you or your child sleeps. Unfortunately, this examination is quite expensive and difficult to carry out.

Electroencephalography (EEG)

EEG is performed to check electrical waves in the brain. Usually, this examination will only be carried out if the doctor suspects a serious condition that causes a person to experience somnambulism.

Management

Management of somnambulism does not aim to cure this condition, but rather to reduce the risk of somnambulism and the complications that can follow it. Somnambulism is a mild condition and will disappear over time if it is not followed by other medical problems. This condition does not require drug therapy.

If somnambulism is related to sleep breathing problems, surgery to repair the airway can usually prevent subsequent somnambulism.

The doctor may advise you to wake the patient on a scheduled basis. Before doing this, you can note the time interval between the patient starting to sleep and experiencing sleepwalking, because usually they tend to be similar. You can also record the length of one (single) episode of sleepwalking. Next, you can wake the patient 15-30 minutes before the predicted time. Patients need to stay awake until the predicted sleepwalking time is over. This needs to be done every day for 2-3 weeks.

The doctor can also refer you or your child to an experienced therapist to teach relaxation techniques and visual imagery. Usually, these two things need to be done regularly to help prevent episodes of somnambulism.

If there is someone with somnambulism in your house, you can do the following things:

• Make sure the room is completely dark and quiet at night. Sound, touch and light stimuli can trigger sleepwalking episodes in people with somnambulism
• Lock doors and windows, remove objects that may cause tripping and sharp objects, and set alarms to reduce the risk of injuries that can occur when sleepwalking
• If the patient sleeps upstairs, you can install a fence on the stairs upstairs which will be closed at night
• Calm your child before bed
• Don't wake up or disturb people who are sleeping, because it can prolong the sleepwalking time and can even end in resistance and even violence

If you as an adult experience somnambulism, you can make lifestyle changes, such as:

• Sleep at the same time every day
• Get into the habit of relaxing before bed
• If you have a habit of drinking alcohol or taking other illegal drugs, you need to stop these habits
• If the medicines above are prescribed by a doctor, you can consult with the doctor who is treating you

In most children, somnambulism will disappear at puberty. However, in some cases, somnambulism can continue into adulthood or even begin to occur in adulthood.

Complications

Somnambulism is a mild condition if it is not accompanied by other medical conditions. Complications that can occur and are quite dangerous are injuries, for example due to falling from a height or walking through window glass.

Prevention

Somnambulism in children is difficult to prevent, because it cannot be known whether someone will experience somnambulism or not. However, the risk of somnambulism can be reduced by ensuring a regular sleep schedule, getting enough sleep, avoiding excessive physical and psychological stress, and taking medication as prescribed by your doctor. As an adult, prevention can also be done by avoiding the consumption of alcohol and other illegal drugs.

When to See a Doctor?

Somnambulism can usually be treated on its own. However, you can consult a doctor if the patient sleepwalks too often, injures themselves, or commits violence while sleepwalking. Apart from that, you can also consult if your child's school performance or work performance is disrupted due to this problem.

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