Signs and symptoms
Sleepwalking is characterized by:
partial arousal during non-rapid eye movement (NREM) sleep, typically during the first third of the night
dream content that may or may not be recalled when awake
dream-congruent motor behavior that may be simple or complex
impaired perception of the environment
impaired judgement, planning and problem-solving.Despite how it is portrayed in many cultures (eyes closed and walking with arms outstretched), the sleepwalkers eyes are open but may appear as a glassy-eyed stare or blank expression and pupils are dilated. They are often disoriented, consequent to awakening: the sleepwalker may be confused and perplexed, and might not know why or how they got out of bed; however, the disorientation will fade within minutes. They may talk while sleepwalking, but the talk typically does not make sense to the observer. There are varying degrees of amnesia associated with sleepwalking, ranging from no memory at all, vague memories or a narrative. Associated disorders
In the study "Sleepwalking and Sleep Terrors in Prepubertal Children" it was found that, if a child had another sleep disorder – such as restless leg syndrome (RLS) or sleep-disorder breathing (SDB) – there was a greater chance of sleepwalking. The study found that children with chronic parasomnias may often also present SDB or, to a lesser extent, RLS. Furthermore, the disappearance of the parasomnias after the treatment of the SDB or RLS periodic limb movement syndrome suggests that the latter may trigger the former.
A systematic review of the literature found that approximately 50% of drinkers have experienced memory loss during a drinking episode and have had associated negative consequences similar to sleepwalkers, including injury and death.Other differential diagnoses include Rapid eye movement sleep behavior disorder, confusional arousals, and night terrors. Assessment
An assessment of sleepwalking via polysomnography poses the problem that sleepwalking is less likely to occur in the sleep laboratory, and if an episode occurs, it is usually less complex than what the patient experiences at home. Therefore, the diagnosis can often be made by assessment of sleep history, time-course and content of the sleep related behaviors. Sometimes, home videos can provide additional information and should be considered in the diagnostic process.Some features that should always be assessed include:
Age of onset
When the episode occurs during the sleep period
How often these episodes occur (frequency) and how long they last (duration)
Description of the episode, including behavior, emotions, and thoughts during and after the event
How responsive the patient is to external stimuli during the episode
How conscious or aware the patient is, when awakened from an episode
If the episode is remembered afterwards
The triggers or precipitating factors
Sleep–wake pattern and sleep environment
Daytime sleepiness
Other sleep disorders that might be present
Family history for NREM parasomnias and other sleep disorders
Medical, psychiatric, and neurological history
Medication and substance use historyThe assessment should rule out differential diagnoses. Treatment
There have been no clinical trials to show that any psychological or pharmacological intervention is effective in preventing sleepwalking episodes. Despite this, a wide range of treatments have been used with sleepwalkers.