A walk on the wild side - sleepwalking

Nation's Business, Oct, 1993 by Marcia J. Pear

You're standing in front of the refrigerator at 3 a.m., gobbling fistfuls of raspberry jam. Another time you awaken in bed, wearing your overcoat.

No, you aren't going crazy. You're sleepwalking.

This unusual sleep condition, known as somnambulism, is the result of being caught between two states of consciousness. Each night, we pass through a series of sleep stages. Dreaming occurs during the lighter, REM (rapid eye movement) stage. The mind roams freely over vivid nocturnal landscapes, yet the body is essentially paralyzed. Gradually, we sink into dreamless slow-wave sleep. Most people proceed smoothly from one stage to another many times a night.

In sleepwalkers, however, the mechanism that governs the transition from slow-wave sleep to waking tends to malfunction, says Dr. Ernest Hartmann, professor of psychiatry at Tufts University, Medford, Mass., and director of the Sleep Disorders Center at Newton-Wellesley Hospital, Newton, Mass. "It's a disorder of arousal," he says. "Sleepwalkers are usually not self-aware, yet there is a lot of muscular activity."

Sleepwalking is more common in children than in adults. An estimated 15 to 30 percent of children sleepwalk at least once. By comparison, only about 1 percent of adults sleepwalk.

Episodes can occur a few times a week or less than once a year. The events are short-lived, usually under five minutes, and most people either come to full alertness or put themselves back to bed.

Adults who sleepwalk have a genetic predisposition to do so. "Something in a sleepwalker's brain stem didn't merge perfectly in childhood," Hartmann says. "But the brain is very adaptable; it eventually accommodates and finds other pathways [to traverse the sleep span]." That is why sleepwalking declines significantly as we age.

That also explains why stress, sleep deprivation, fever, or excessive alcohol and drug use can trigger a sleepwalking episode in someone who is susceptible.

Dr. Michael Silber, assistant professor of neurology at Mayo Medical School, Rochester, Minn., and a consultant neurologist with the Mayo Sleep Disorders Center, says, "If you're predisposed to sleepwalking, a loud noise can set off an episode, as can an unusual sleep-wake schedule." And, while sleepwalking may be inconvenient or even disturbing to the somnambulist, it's rarely dangerous. "Most sleepwalking is pretty benign, although people can injure themselves by falling down stairs, for example," he says.

There are a few well-publicized cases of violence linked to sleepwalking, such as the Canadian man who purportedly got into his car while fast asleep, drove to his wife's parents' home, and killed his mother-in-law. (He was acquitted.)

But "it's very unusual for someone who's sleepwalking to act in a specific, goal-directed way," Silber says.

The condition is likewise rarely indicative of an underlying psychological problem. And while there appears to be a tendency among some sleepwalkers to ingest bizarre foods or even nonfoods like cigarettes, there aren't common sleepwalking "themes," Sliber says.

It is important to distinguish sleepwalking from another dramatic nighttime disturbance known as REM sleep behavior disorder. "In REM behavior disorder, people actually act out their dreams," Silber says. "They lose the muscle paralysis that is common in normal REM-stage sleep." One man dreamed he was a star quarterback, tackled his bedroom dresser, and gashed his forehead.

What is the surest way to quell a midnight rambler's wanderlust? The conventional wisdom about guiding a sleepwalker gently back to bed is sound. Says Silber: "Don't try to wake them because you might not succeed, and the person could become confused and lash out in reaction to being touched."

For occasional sleepwalkers, common-sense precautions work best. First, Hartmann says, make the sleep environment as safe as possible. Lock your door, and avoid sleeping next to a large plate-glass window. Second, skip late-night caffeine, alcohol, and heavy meals, and don't exercise right before bed.

If sleepwalking is turning you into a daytime zombie or endangering anyone, more serious steps may be in order. The American Sleep Disorders Association can provide referrals to accredited sleep clinics throughout the United States. Call (507) 287-6006.

Hartmann suggests that for some people, "psychotherapy can be helpful in freeing repressed anger and other emotions that can aggravate sleepwalking tendencies." Silber has successfully used hypnosis to help nonviolent sleepwalkers curtail their meanderings. Finally, in the most severe cases, medication may be appropriate.

Often, Silber says, "just reassuring a sleepwalker that this is not something sinister or psychiatric" can go a long way toward calming jangled nerves.

Marcia J. Pear is a free-lance health writer in San Francisco