Sleep Terror Disorder and Sleepwalking Disorder

Sleep terrors are characterized by a sudden awakening from Stage 3/4 sleep that is accompanied by a piercing scream, intense anxiety, and excessive autonomic arousal. These signs are significantly more intense than in nightmares. The individual may sit up in bed but is usually unresponsive to the environment. Disorientation and confusion are predominant. There is no recall of any specific imagery or dreams, and there may be a total amnesia for the sleep terror episode on arising in the morning. Sleep terrors occur mostly in the first third of the night, when deep NREM sleep predominates. Their incidence is more common between ages 4 and 12 years, and they tend to resolve spontaneously during adolescence. Their persistence in adulthood has been associated with a greater likelihood of concomitant psychopathology (J. D. Kales et al. 1980). Although less frequent, sleep terrors with an onset during adulthood can be associated with other conditions such as PTSD and sleep apnea.

Sleepwalking disorder, or somnambulism, is a disorder in which the patient sits up in bed or gets out of bed during sleep and walks about in a poorly coordinated and automatic manner.

Sleep talking also may occur. Sleepwalking occurs early in the night, when deep NREM sleep predominates. It is associated with impaired arousal, and the patient does not respond to the efforts of others to communicate with or to awaken him or her. Full awakening is achieved only through persistent efforts, and confusion, disorientation, and amnesia of sleepwalking usually occur on awakening at night or the next morning. There is a genetic predisposition to sleepwalking, as indicated by increased rates among first-degree relatives. Sleepwalking not only may cause social embarrassment but also carries a significant potential for injuries (A. Kales et al. 1980). Other behaviors, such as eating or violent punching or kicking, can occur in conjunction with sleepwalking episodes. Sleep-related eating appears to be more common among women, and sleep-related violence is more common among men (Guilleminault et al. 1995b; Moldofsky et al. 1995; Schenck et al. 1993b).

Sleep terror and sleepwalking have several common features, and their co-occurrence is also quite frequent. Because they may well be part of the same phenomenon, treatment recommendations are similar and are discussed together.

Behavioral/psychotherapeutic treatment Sleepwalking can be life threatening; therefore, the first-line treatment should consist of safety measures, including sleeping on the ground floor; locking bedroom windows and doors; removing all potentially dangerous objects, including weapons; and rearranging furniture to minimize risk of injury. The second-line intervention modality involves preventive measures. Because both sleepwalking and sleep terror originate from deep NREM sleep, and because this type of sleep increases as a function of wakefulness, it is important to avoid sleep deprivation. When sleepwalking is drug induced, the schedule of medication intake should be altered, if possible (Berlin and Qayyum 1986).