Adult Sleepwalkers Research Articles

Two cases of young adults sleepwalking

We report two cases of young adults sleepwalking. The first was a 19-year-old man whose episode occurred at the end of the first sleep stage 4. The second patient, a 28-year-old man, had episodes after the first and/or second slow wave sleep. Neither patient had epileptic discharges on a polysomnogram. Sleepwalking is diagnosed in only one percent of patients who are seen in our sleep clinic; this rate is lower than that of narcolepsy. In Japan, there have been few case reports of adult sleepwalking. We report these cases to further the study of sleep medicine, in particular of sleepwalking, in Japan.

Functional involvement of cerebral cortex in adult sleepwalking

The pathophysiology of adult sleepwalking is still poorly understood. However, it is widely accepted that sleepwalking is a disorder of arousal. Arousal circuits widely project to the cortex, including motor cortex. We hypothesized that functional abnormality of these circuits could lead to changes in cortical excitability in sleepwalkers, even during wakefulness. We used transcranial magnetic stimulation (TMS) to examine the excitability of the human motor cortex during wakefulness in a group of adult sleepwalkers. When compared with the healthy control group, short interval intracortical inhibition (SICI), cortical silent period (CSP) duration, and short latency afferent inhibition (SAI) were reduced in adult sleepwalkers during wakefulness. Mean CSP duration was shorter in patients than in controls (80.9 +/- 41 ms vs. 139.4 +/- 37 ms; p = 0.0040). Mean SICI was significantly reduced in patients than in controls (73.5 +/- 38.4% vs. 36.7 +/- 13.1%; p = 0.0061). Mean SAI was also significantly reduced in patients than in controls (65.8 +/- 14.2% vs. 42.8 +/- 16.9%; p = 0.0053). This neurophysiological study suggests that there are alterations in sleepwalkers consistent with an impaired efficiency of inhibitory circuits during wakefulness. This inhibitory impairment could represent the neurophysiological correlate of brain "abnormalities" of sleepwalkers like "immaturity" of some neural circuits, synapses, or receptors.

Sleepwalking, a disorder of NREM sleep instability

Background and purpose Thirty-two chronic sleepwalkers who were part of a larger, previously reported sleepwalking group all achieved control of sleepwalking after undergoing treatment for an associated sleep disorder. In the current study, all records were blindly scored to perform a cyclic alternating pattern (CAP) analysis. Patients and methods Thirty-two young adult chronic sleepwalkers had polysomnography (PSG) on initial nights without sleepwalking events, as did age-matched normal controls and patients with mild sleep-disordered breathing (SDB). More than 90% of these patients with mild SDB had upper airway resistance syndrome (UARS). Ten randomly selected PSGs for sleepwalkers and matched controls also had quantitative electroencephalographic (EEG) analysis using Fast Fourier Transformation (FFT) with determination of delta power for each non-rapid eye movement (NREM)–REM sleep cycle. Results Compared to normal controls, an investigation of CAP in sleepwalkers demonstrated the presence of an abnormal CAP rate with a decrease in phase A1 and an increase in phases A2 and A3 on non-sleepwalking nights. The results of CAP analysis in sleepwalkers were similar to those obtained in age-matched UARS patients. Furthermore, the analysis of the first four NREM–REM sleep cycles reconfirmed the presence of an important decrease in delta power in sleep cycles 1 and 2 during a non-sleepwalking night in sleepwalkers compared to normal controls. Conclusions The presence of both ‘hypersynchronous slow delta’ and ‘burst of delta waves’ have been reported in sleepwalkers, but their significance is controversial. These EEG patterns are similar to phase A1 (and possibly A2) of the CAP. Proper analysis of the sleep EEG of sleepwalkers should integrate CAP analysis. Sleepwalkers on a non-sleepwalking night present instability of NREM sleep, as demonstrated by this analysis. This instability is similar to the one noted in UARS patients. Subtle sleep disorders associated with chronic sleepwalking constitute the unstable NREM sleep background on which sleepwalking events occur. A subtle associated sleep disorder should be systematically searched for and treated in the presence of sleepwalking with abnormal CAP.

Chronic adult sleepwalking: clinical features and diagnostic evaluation

Background Adult sleepwalking is considered to be a rare parasomnia in normal adults. When episodes occur almost nightly or are associated with physical injury to the patients or others and duration is 3 months or longer then sleepwalking becomes chronic. We present the clinical features and diagnostic evaluation of patients with chronic sleepwalking who attended our Outpatients' Clinic of Sleep Disorders.

Hypersynchronous Delta Waves and Somnambulism: Brain Topography and Effect of Sleep Deprivation

Hypersynchronous delta activity (HSD) is usually described as several continuous high-voltage delta waves (> or = 150 microV) in the sleep electroencephalogram of somnambulistic patients. However, studies have yielded varied and contradictory results. The goal of the present study was to evaluate HSD over different electroencephalographic derivations during the non-rapid eye movement (NREM) sleep of somnambulistic patients and controls during normal sleep and following 38 hours of sleep deprivation, as well as prior to sleepwalking episodes. N/A. Sleep disorders clinic. Ten adult sleepwalkers and 10 sex- and age-matched control subjects were investigated polysomnographically during a baseline night and following 38 hours of sleep deprivation. N/A. During normal sleep, sleepwalkers had a significantly higher ratio of HSD over the time spent in stage 2, 3 and 4 on frontal and central derivations when compared with controls. Sleep deprivation resulted in a significant increase in the ratio of the time in HSD over the time in stage 4 on the frontal lead in both groups and on the central lead in controls. There was no evidence for a temporal accumulation of HSD prior to the episodes. HSD shows a clear frontocentral gradient across all subjects during both baseline and recovery sleep and has relatively low specificity for the diagnosis of NREM parasomnias. Increases in HSD after sleep deprivation may reflect an enhancement of the homeostatic process underlying sleep regulation.

Adult Chronic Sleepwalking and Its Treatment Based on Polysomnography

Adult Chronic Sleepwalking and Its Treatment Based on Polysomnography

Adult chronic sleepwalking and its treatment based on polysomnography

Adult sleepwalking affects 2.5% of the general population and may lead to serious injuries. Fifty young adults with chronic sleepwalking were studied prospectively. Clinical evaluation, questionnaires from patients and bed partners, and polysomnography were obtained on all subjects in comparison with 50 age-matched controls. Subjects were examined for the presence of psychiatric anxiety, depression and any other associated sleep disorder. Isolated sleepwalking or sleepwalking with psychiatric disorders was treated with medication. All other patients with other sleep disorders were treated only for their associated problem. Prospective follow-up lasted 12 months after establishment of the most appropriate treatment. Patients with only sleepwalking, treated with benzodiazepines, dropped out of follow-up testing and reported persistence of sleepwalking, as did patients with psychiatric-related treatment. Chronic sleepwalkers frequently presented with sleep-disordered breathing (SDB). All these patients were treated only for their SDB, using nasal continuous positive airway pressure (CPAP). All nasal CPAP-compliant patients had control of sleepwalking at all stages of follow-up. Non-compliant nasal CPAP patients had persistence of sleepwalking. They were offered surgical treatment for SDB. Those successfully treated with surgery also had complete resolution of sleepwalking. Successful treatment of SDB, which is frequently associated with chronic sleepwalking, controlled the syndrome in young adults.

Initial demonstration of the accuracy and utility of an ambulatory, three-dimensional body position monitor with normals, sleepwalkers and restless legs patients

Objective: To evaluate the accuracy and provide a pilot demonstration of the clinical utility of the BodyTrac, a new, ambulatory device that identifies body position and records and stores this data for a period of over 2 weeks. Background: Diagnosis and treatment evaluation of behavioral sleep-related events (BSREs) that occur with the major parasomnias such as sleepwalking, night terrors and REM behavior disorder have been hampered by the problems inherent in recording relatively rare events which are mostly not recalled by the patients. The number, time of occurrence and pattern of motor behavior for these events has, therefore, never been adequately described. Even the amount of nocturnal walking associated with the restless legs syndrome (RLS) has been hard to specify given the usual problems of night to night variability and in obtaining accurate, subjective reports. The newly developed BodyTrac monitor, by recording body position once every 30 s during a sleep period, provides an enabling technology for evaluating BSREs and may also enhance evaluation of nocturnal waking activities of RLS patients. Design and methods: Three test protocols were completed: an analog-type laboratory test of the BodyTrac's accuracy, an evaluation of seniors with and without sleep disorders, and, finally, evaluation of adult sleepwalkers and RLS patients including a full-night sleep lab assessment. The last two procedures also included monitoring in the home environment. Results and conclusions: The BodyTrac reliably and accurately identified both the wearer's body position (93% agreement with observer) and BSREs (sensitivity=100%, specificity=94−100%.) Patients were able to wear the BodyTrac during sleep in their home environment with minimal discomfort. The pilot data here suggest that some sleep walkers may have many small BSREs in addition to the larger events that are usually the only ones known to occur.

Dynamics of Slow-Wave Activity During the NREM Sleep of Sleepwalkers and Control Subjects

To compare the number and distribution of awakenings from slow-wave sleep (SWS) and both the power and dynamics of EEG slow-wave activity (SWA) in sleepwalkers and controls. Somnambulism is considered to be a disorder of arousal from NREM sleep and related to anomalous SWS and SWA. Power spectral analyses have never been used to quantify patients' SWA across sleep cycles. N/A SETTING: N/A PATIENTS: A polysomnographic study was performed on 15 adult sleepwalkers and 15 age- and sex-matched controls. N/A MEASUREMENTS & RESULTS: Sleepwalkers had a significantly greater number of awakenings from SWS than did control subjects. Controls showed a greater decrease in SWA across NREM cycles. Sleepwalkers had a significantly lower level of SWA during the first NREM period, where most awakenings take place. Sleepwalkers appear to suffer from an abnormality in the neural mechanisms responsible for the regulation of SWS.

Prevalence and genetics of sleepwalking: a population-based twin study.

We investigated the prevalence of sleepwalking using a well defined population previously used for epidemiologic investigations: the Finnish Twin Cohort. The study population consisted of 11,220 subjects aged 33 to 60 years, and it included 1,045 monozygotic and 1,899 dizygotic twin pairs. Questions on the frequency of sleepwalking were asked separately for occurrence in childhood and adulthood. Childhood sleepwalking was significantly more frequent in women ("often" in 2.8% of women and 2.0% of men and "sometimes" in 6.9% of women and 5.7% of men). As adults, sleepwalking had occurred in 3.9% of men and in 3.1% of women, and it was reported "weekly" in 0.4% for both genders. There was no significant difference in frequency between monozygotic and dizygotic twin individuals, either in childhood or adulthood. For sleepwalking in childhood the probandwise concordance rate was 0.55 for monozygotic and 0.35 for dizygotic pairs, and for adults, 0.32 for monozygotic, and 0.06 for dizygotic pairs. Those who reported never having walked in their sleep in childhood did so as adults rarely (0.6%), both men and women. Those who reported walking in their sleep often or sometimes in childhood did so as adults for 24.6% of men and for 18.3% of women. Of adult men sleepwalkers 88.9% had a positive history of sleepwalking in childhood, and in women, 84.5%. The proportion of total phenotypic variance attributed to genetic influences was 66% in men and 57% in women in childhood sleepwalking, and 80% in men and 36% in women in adult sleepwalking. Our results show that there are substantial genetic effects in sleepwalking in both childhood and adulthood.

Night terrors. Clinical characteristics and personality patterns.

The development and clinical course of night terrors and the personality patterns of patients with this disorder were evaluated in 40 adults who had a current complaint of night terrors. Compared with a group of adult sleepwalkers, the patients with night terrors had a later age of onset for their disorder, a higher frequency of events, and an earlier time of night for the occurrence of episodes. Both groups had high levels of psychopathology, with higher values for the night terror group. This sleepwalkers showed active, outwardly directed behavioral patterns, whereas the night terror patients showed an inhibition of outward expressions of aggression and a predominance of anxiety, depression, tendencies obsessive-compulsive/, and phobicness. Although night terrors and sleepwalking in childhood seem to be related primarily to genetic and developmental factors, their persistence and especially their onset in adulthood are found to be related more to psychological factors.

Sleepwalking and night terrors in adulthood clinical EEG findings.

This is the first controlled study to show a lack of relation between a positive history of sleepwalking or night terrors in adults and daytime EEG abnormalities. We recorded a standard clinical EEG on 35 adult sleepwalkers (SW), 35 adult night terror patients (NT), and 35 control subjects (CS). Three subjects in the SW group showed abnormalities: one during both the resting record (RR) and hyperventilation (HV), and two only during HV. None in the NT group showed any EEG abnormality. Two control subjects showed abnormalities of both RR and HV, and a third only during HV. The number of abnormal EEGs within each group was limited, and the three groups did not significantly differ from one another. Our results suggest that the daytime clinical EEG is of limited value in evaluating adults with the primary complaint of sleepwalking or night terrors. However, further all-night sleep EEG studies utilizing clinical montage are needed to investigate the temporal relationship of sleepwalking and night terror events to possible EEG abnormalities.