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Sleepwalking: Its manifestations, cases

and treatments

I. Introduction

Sleepwalking has been described in medical literature dating before


Hippocrates (460 BC-370 BC). In Shakespeare's tragic play, Macbeth,
Lady Macbeth's famous sleepwalking scene ("out, damned spot") is
ascribed to her guilt and resulting insanity as a consequence of her
involvement in the murder of her father-in-law.
Sleepwalking is characterized by complex behavior (walking)
accomplished while asleep. Occasionally nonsensical talking may occur
while sleepwalking. The person's eyes are commonly open but have a
characteristic glassy "look right through you" character. This activity
most commonly occurs during middle childhood and young adolescence.
Approximately 15% of children between 4-12 years of age will experience
sleepwalking. Generally sleepwalking behaviors are resolved by late
adolescence; however, approximately 10% of all sleepwalkers begin their
behavior as teens. A genetic tendency has been noted.
There are five stages of sleep. Stages 1, 2, 3, and 4 are characterized
as non-rapid eye movement (NREM) sleep. REM (rapid eye movement)
sleep is the sleep cycle associated with dreaming as well as surges of
important hormones essential for proper growth and metabolism. Each
sleep cycle (stages 1,2,3,4, and REM) lasts about 90-100 minutes and
repeats throughout the night. Thus the average person experiences 4-5
complete sleep cycles per night. Sleepwalking characteristically occurs
during the first or second sleep cycle during stages 3 and 4. Due to the
short time frame involved, sleepwalking tends not to occur during naps.
Upon waking, the sleepwalker has no memory of his behaviors.

II. Statement of the Problem

Sleepwalking: Its manifestations, cases and treatments

What causes sleepwalking?


What are the symptoms of sleepwalking?
What are the extents of sleepwalkers?
What are the criminal cases of sleepwalkers?
How can this be treated and prevented?
III. Review of Related Literature and Study

LOCAL LITERATURE AND STUDIES

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Monday October 27, 2008

Sleepwalking

BY DEFINITION this happens in a child...


* who is usually 4 to 15 years old
* who walks while asleep
* whose eyes are open but blank
* who is not as well coordinated as when awake
* who may perform semi-purposeful acts such as dressing and
undressing, opening and closing doors or turning lights on and off
* experiences the episode 1 to 2 hours after going to sleep. And the
episode may last 5 to 20 minutes.
* who cannot be awakened no matter what the parent does
Sleepwalking is an inherited tendency to wander during deep sleep.
About 15 percent of normal children sleepwalk. Sleepwalking usually
occurs within two hours of bedtime. Children stop sleepwalking during
adolescence.

Dealing with Sleepwalking

* Gently lead your child back to bed. First, steer your child into the
bathroom because she may be looking for a place to urinate. Then guide
her to her bedroom. The episode may end once she's in bed. Don't
expect to awaken her, however, before she returns to normal sleep.
* Protect your child from accidents. Although accidents are rare, they do
happen, especially if the child wanders outside. Sleepwalkers can be hit
by a car or bitten by a dog, or they may become lost. Put gates on your
stairways and special locks on your outside doors (above your child's
reach). Do not let your child sleep in a bunk bed.
* Help your child avoid exhaustion. Fatigue and a lack of sleep can lead
to more frequent sleepwalking. So be sure your child goes to bed at a
reasonable hour, especially when ill or exhausted. If your child needs to
be awakened in the morning, that means she needs an earlier bedtime.
Move lights-out time to 15 minutes earlier each night until your child can
self-awaken in the morning.
* Try prompted awakenings to prevent sleepwalking. If your child has
frequent sleepwalking try to eliminate this distressing sleep pattern. For
several nights, note how many minutes elapse from falling asleep to the
onset of the sleepwalking. Then awaken your child 15 minutes before the
expected time of onset. Remind your child at bedtime that when you do
this, her job is "to wake up fast."
Keep your child fully awake for five minutes. Carry out these prompted
awakenings for seven consecutive nights. IF the sleepwalking returns,
repeat this seven-night training program.

Early morning riser


Some children awaken before their parents do, usually between 5 and
6 a.m. These 1 to 3-year-olds are well rested and raring to go. They come
out of their room or call out from the crib and want everyone to wake up.
They are excited about the new day and want to share it with your. If
people don't respond, they make a racket. Such a child is a morning
person.
Most of these children have received plenty of sleep. They are no
longer tired. They are not awakening early on purpose. Most of them
were put to bed too early the night before, had too many naps, or had
naps that were too long. (Note: Early morning naps that begin within two
hours after breakfast also contribute to early morning awakening). Some
of them have a reduced sleep requirement- one that is below the average
of 10 to 12 hours per night that most children 1 to 10 years old need.
This is a genetic trait. Such children often have a parent who only
needs six hours or so of sleep at night. Other children may begin
awakening early in the springtime because of sunlight streaming through
their window. (This scenario is easily remedied with dark shades or
curtains). Finally, those children who are given a bottle in their crib, fed
an early breakfast, or allowed to come into their parents' bed early in the
morning may develop a bad habit that persists after the original cause
(e.g., too much nap time) is removed.

Helping Your Child Sleep Later


* Reduce naps. Assume your child is getting too much sleep during the
day. Many children over 1 year of age and most over 18 months of age
need only one nap (unless they are sick). If your child needs two naps, be
sure the first nap doesn't begin before 9 a.m.
If cutting back to one 2-hour nap after lunch doesn't help, shorten the
nap to 11/2 hours maximum. Also make sure your child gets plenty of
exercise after his nap, so he'll be tired at night.
* Delay bedtime until 8 or 9 p.m. These two steps should cure your child
unless he has a below-average sleep requirement. In that case, proceed
with the following limit-setting suggestions.
* Establish a rule. "You can't leave your bedroom until your parents are
up. You can play quietly in your bedroom until breakfast." Also tell your
child, "It's not polite to wake up someone who is sleeping. Your parents
need their sleep."
* If your child is in a crib, leave him there until 6 am. Put some toys in a
bag in his crib the night before (but not ones he can stand on).
If you put them in before he goes to sleep, he may play with them for a
while, fall asleep later, and sleep longer. If he cries, go in once to
reassure him and remind him of the toys. Don't include any surprises or
treats in his toy bag or he'll awaken early as children do on holiday
mornings. If he makes loud noises with the toys, remove those particular
toys.
If he cries, ignore it. If crying continues, visit him briefly every 15
minutes to reassure him that all is well and most people are sleeping.
Don't turn on the lights, talk much, give him a bottle, remove him from
the crib, or stay more than one minute.
* If your child is in a floor-level bed, keep him in his bedroom until 6
a.m. Get him a clock radio and set it for 6 a.m. Tell him he can't leave
his bedroom until the music comes on. Tell him he can play quietly
until then. Help him put out special toys or books the night before.
If he comes out of this room, put up a gate or close the door. Tell him
that you'll be happy to open the door as soon as he is back in his bed. If
this is a chronic problem, put up the gate the night before.
* If you meet strong resistance from your child, change his wake up
time gradually. Some children protest a great deal about the new rule,
especially if they have been coming into your bed in the morning. In that
case, move ahead a little more gradually. If he's been awakening at 5
a.m., help him to wait until 5:15 for 3 days. Set the clock radio for that
time. After your child has adjusted to 5:15 change the clock radio for
5:30. Move the wake-up time forward every 3 or 4 days.
* Praise your child for not waking other people in the morning. A star
chart or special treat at breakfast may help your child wait more
cooperatively.
* Change your tactics for weekends. Many parents want their child to
sleep in on Saturday and Sunday mornings. If this is your preference,
keep your early morning riser up an hour later the night before.
If you are using a clock radio with your program, turn it off or reset the
times for an hour later. As a last resort, put a breakfast together for your
child the night before and allow him to watch pre-selected videotape.

Toddler sleep concerns: Sleepwalking


Written for BabyCenter Philippines

Why it happens
Experts don't know exactly what causes sleepwalking, although it does
appear to run in families. Sleepwalking can start any time after your child
begins walking or crawling, and at least 15 per cent of all young children
will have an episode at some point. It usually occurs within an hour or
two of falling asleep, when your child is most deeply asleep. Sleeping in
strange places, a lack of sleep or a high fever can trigger a sleepwalking
episode.

A sleepwalking child appears to be wide awake, though he's actually not.


His eyes will be open, and he may even carry on a conversation, although
it probably won't make much sense. He may wander aimlessly around
the house or get up and mistake a cupboard for the bathroom!

What you can do

Don't try to wake your child. If he'll let you, gently guide him back to
bed. Your child will have no memory of the event the next morning, so
don't bring it up. Talking about it may make your toddler scared of
bedtime. Before tucking him in for the night, be sure to pick up any toys
or other objects that he could fall over during a middle-of-the-night
walkabout, and put a stairgate at the top of the stairs. Most injuries to
sleepwalking children happen when they fall out of a window or manage
to get outside, so keep windows and doors locked, too.

FOREIGN LITERATURE AND STUDIES

The Genetics of Sleepwalking

Sleepwalking is common in children and less common in adults, but


what role do genetics and environmental factors play in the origin of
sleepwalking? This large Finnish questionnaire study of 11,220 twins
(including 1,045 monozygotic and 1,899 dizygotic twin pairs) examined
the prevalence and genetics of sleepwalking in children and adults.
Overall, about 25% reported sleepwalking as children and less than 5%
reported sleepwalking as adults. Women reported significantly more
sleepwalking than men as children, but men reported more than women
as adults. The concordance rate was 0.55 among monozygotic twin pairs
and 0.35 among dizygotic twins. The authors calculated that the
tendency to sleepwalk is more than 50% genetically based in children
and over one third in adults. Only 0.06% of adult sleepwalkers reported
that they never sleepwalked as children.

Comment: Only through large-scale studies such as this can we begin to


sort out the genetic basis of behaviors often attributed to psychological
causes. These data should help reassure both physicians and their
patients of the genetic basis of sleepwalking, although environmental
precipitants remain uncertain.

Why Do Some People Sleepwalk?


—Carlos Navarro, via e-mail

Neurologist Antonio Oliviero of the National Hospital for Paraplegics in


Toledo, Spain, explains:
Sleep disorders such as sleepwalking arise when normal physiological
systems are active at inappropriate times. We do not yet understand why
the brain issues commands to the muscles during certain phases of
sleep, but we do know that these commands are usually suppressed by
other neurological mechanisms. At times this suppression can be
incomplete—because of genetic or environmental factors or physical
immaturity—and actions that normally occur during wakefulness emerge
in sleep.
People can perform a variety of activities while asleep, from simply
sitting up in bed to more complex behavior such as housecleaning or
driving a car. Individuals in this trancelike state are difficult to rouse, and
if awoken they are often confused and unaware of the events that have
taken place. Sleepwalking most often occurs during childhood, perhaps
because children spend more time in the “deep sleep” phase of slumber.
Physical activity only happens during the non–rapid eye movement
(NREM) cycle of deep sleep, which precedes the dreaming state of REM
sleep.
Recently my team proposed a possible physiological mechanism
underlying sleepwalking. During normal sleep the chemical messenger
gamma-aminobutyric acid (GABA) acts as an inhibitor that stifles the
activity of the brain’s motor system. In children the neurons that release
this neurotransmitter are still developing and have not yet fully
established a network of connections to keep motor activity under
control. As a result, many kids have insufficient amounts of GABA,
leaving their motor neurons capable of commanding the body to move
even during sleep. In some, this inhibitory system may remain
underdeveloped—or be rendered less effective by environmental factors
—and sleepwalking can persist into adulthood.
Sleepwalking runs in families, indicating that there is a genetic
component. The identical twin of a person who sleepwalks often, for
example, typically shares this nocturnal habit. Studies have also shown
that frequent sleepwalking is associated with sleep deprivation, fever,
stress and intake of drugs, especially sedatives, hypnotics,
antipsychotics, stimulants and antihistamines.
To clarify the many mysteries of sleepwalking, we need to find out
more about the brain mechanisms that control sleep and arousal states.
Future research will have to focus not only on what is happening while
sleepwalkers are sleeping but also on the characteristics of their waking
brains.

IV.Discussions

What causes sleepwalking?

Genetic factors
Sleepwalking occurs more frequently in identical twins, and is 10 times
more likely to occur if a first-degree relative has a history of
sleepwalking.

Environmental factors

• Sleep deprivation
• Fatigue
• Stress
• Anxiety
• Fever
• Sleeping in unfamiliar surroundings
• Some medications, such as zolpidem (Ambien)

Drugs, for example, sedative/hypnotics (drugs that promote sleep),


neuroleptics (drugs used to treat psychosis), minor tranquilizers (drugs
that produce a calming effect), stimulants (drugs that increase activity),
and antihistamines (drugs used to treat symptoms of allergy) can cause
sleepwalking.

Physiologic factors
• The length and depth of slow wave sleep, which is greater in young
children, may be a factor in the increased frequency of sleepwalking in
children.
• Conditions, such as pregnancy and menstruation, are known to
increase the frequency of sleepwalking.
Sleepwalking is sometimes associated with underlying conditions that
affect sleep, such as:
• Seizure disorders
• Sleep-disordered breathing — a group of disorders characterized by
abnormal breathing patterns during sleep, the most common of which is
obstructive sleep apnea
• Restless leg syndrome (RLS)
• Migraine headaches
• Stroke
• Head injuries or brain swelling
• Premenstrual period

Medical Conditions
Medical conditions that have been linked to sleepwalking include:
• Arrhythmias (abnormal heart rhythms)
• Fever
• Gastroesophageal reflux (food or liquid regurgitating from the stomach
into the food pipe)
• Nighttime asthma
• Nighttime seizures (convulsions)
• Obstructive sleep apnea (condition in which breathing stops
temporarily while sleeping)
• Psychiatric disorders, for example, posttraumatic stress disorder, panic
attack, or dissociative states, such as multiple personality disorder

What are the symptoms of sleepwalking?

Sleepwalking Symptoms
• Episodes range from quiet walking about the room to agitated running
or attempts to "escape." Patients may appear clumsy and dazed in their
behaviors.
• Typically, the eyes are open with a glassy, staring appearance as the
person quietly roams the house. They do not, however, walk with their
arms extended in front of them as is inaccurately depicted in movies.
• On questioning, responses are slow with simple thoughts, contain non-
sense phraseology, or are absent. If the person is returned to bed without
awakening, the person usually does not remember the event.
• Older children, who may awaken more easily at the end of an episode,
often are embarrassed by the behavior (especially if it was
inappropriate). In lieu of walking, some children perform repeated
behaviors (for example, straightening their pajamas). Bedwetting may
also occur.
• Sleepwalking is not associated with previous sleep problems, sleeping
alone in a room or with others, achluophobia (fear of the dark), or anger
outbursts.
• Some studies suggest that children who sleepwalk may have been
more restless sleepers when aged 4-5 years, and more restless with
more frequent awakenings during the first year of life.
Ambulation (walking or moving about) that occurs during sleep. The
onset typically occurs in prepubertal children.
Associated features include:
• difficulty in arousing the patient during an episode
• amnesia following an episode
• episodes typically occur in the first third of the sleep episode
• polysomnographic monitoring demonstrates the onset of an episode
during stage 3 or 4 sleep
• other medical and psychiatric disorders can be present but do not
account for the symptom
• the ambulation is not due to other sleep disorders such as REM sleep
behavior disorder or sleep terrors

What are the extents of sleepwalkers?

For some, the episodes of sleepwalking occur less than once per month
and do not result in harm to the patient or others. Others experince
episodes more than once per month, but not nightly, and do not result in
harm to the patient or others. In its most severe form, the episodes occur
almost nightly or are associated with physical injury. The sleepwalker
may feel embarrassment, shame, guilt, anxiety and confusion when they
are told about their sleepwalking behavior.
It is very important that if the sleepwalker exits the house, or is having
frequent episodes and injuries are occurring -- DO NOT delay, it is time
to seek professional help from a sleep disorder center in your area. There
have been some tragedies with sleepwalkers, don't let it happen to your
loved one!
In a few instances, sleepwalking can result in violent behavior. It is
very important that a chronic sleepwalker seek professional help and
follow the suggestions listed below to prevent having any violent
episodes.
Sleepwalkers have been known to get out of bed, open doors, make
sandwiches, and perform many other tasks. It is difficult to awake the
person while they are in this state and after their sleepwalking activity,
they usually do not remember what they did. One example is that a
sleepwalker might find a saucer and glass in their room the next morning
and not remember they had made a sandwich and a had a glass of milk
during the previous night hours.
Sleepwalking can be very serious. Some individuals may walk out of
the home and into the lake nearby, fall down stairs, or even get in their
car and drive. Sleepwalking is something that should not be ignored.
If you have a sleepwalker in your home, there are a few things you can
do before seeking medical help. However, once these efforts have not
shown an improvement it is recommended that you contact a physician
or other professional who might be able to help.

A few things you will need to change in your home and in the
sleepwalker's routine include:
• Making sure that the sleepwalker's bedroom is on the ground floor
• Creating a bedtime routine when preparing to go to sleep
• Creating a sleep environment by providing the sleepwalker with a
sound conditioner or white noise machine.
In many cases, developing a bedtime routine and a sleep environment
will help sleepwalkers. The main goal is to ensure they are receiving
enough rest. To create a bedtime routine all you have to do is pick a
specific bedtime and stick to it, have a calm or quiet time prior to bed
such as taking a relaxing bath. Do not watch television prior to going to
bed especially shows that might excite the sleepwalker such as violent or
scary movies.
Now, on the sleep environment. The room should be dark and free
from distractions such as televisions, computers, game systems and so
on and so forth. You can purchase a white noise machine to absorb all
the annoying sounds that might be causing difficulty in their sleeping
pattern. Outside noises could be disrupting sleep. Along with a white
noise machine, a calming tabletop water fountain could help in relieving
stress, which could be the root of the sleepwalking episodes.

What are the criminal cases of sleepwalkers?


Sleepwalkers and other people who have parasomnias, or involuntary
behaviors they act out while sleeping, are usually harmless. But
parasomnias occasionally lead to reckless actions, self-injury, and even
violence against others. Enter the "sleepwalking defense," a legal
argument that a criminal defendant isn't culpable because he or she
acted while in a sleeplike state, without consciousness or intent to
commit a crime. Here are seven historic criminal cases in which the
sleepwalking defense was invoked, sometimes successfully, sometimes
not.
1. Massachusetts v. Tirrell. In 1846, Albert Tirrell was acquitted in the
murder of a prostitute in Boston. Tirrell slit the woman's throat, almost
decapitating her. He also set fire to the brothel, then fled to New Orleans,
where he was arrested. His lawyer stated that Tirrell was a chronic
sleepwalker and perhaps committed the crime while asleep. The jury
agreed and found him not guilty, although many contemporaries didn't
buy the defendant's version of events. The Tirrell case is thought to be
the first U.S. legal case in which the sleepwalking defense was mounted
with success.
2. Fain v. Commonwealth. This classic case in the 1870s involved a
man who fell asleep in the lobby of a Kentucky hotel. When a porter
shook him to try to rouse him, the man drew a gun and shot the porter
three times. While the porter held him on the floor, the man repeatedly
yelled, "Hoo-wee!" He reportedly rose, left the room, and told a witness
that he'd shot someone; when told who it was, the man conveyed
sadness. The shooter was found guilty of manslaughter, but the
conviction was reversed on appeal. Evidence that he had a lifelong
history of sleepwalking and that he'd been sleep-deprived before the
attack was excluded from the first trial.
3. State v. Bradley. A Texas man, Isom Bradley, testified in the 1920s
that he and his mistress were preparing for bed when he became
alarmed about an enemy who had made a threat against him. Fearing a
secret attack, he went to bed with a pistol under his pillow. Later roused
by a noise, he jumped up and fired shots. When he "found himself and
got reconciled," he lit a lamp. His girlfriend was dead at the foot of the
bed. Bradley was convicted of murder, but the conviction was reversed
on appeal; the jury hadn't been informed of the possibility that he could
have been asleep and have fired the shots without volition while in a
somnambulistic state.
4. Regina v. Parks. Kenneth Parks, a young Canadian man, was
acquitted in the 1987 murder of his mother-in-law after using the
sleepwalking defense. On the night of the death, he arose from bed,
drove 14 miles to the house of his in-laws—with whom he was said to be
close—and strangled his father-in-law until the man passed out. He
bludgeoned his mother-in-law with a tire iron and stabbed them both with
a kitchen knife. The woman died; the man barely survived. Parks then
arrived at a police station. Police said he seemed confused about what
had transpired, and they noted something odd: Parks appeared oblivious
to the fact that he'd severed tendons in both his hands during the attack.
That obliviousness to pain, along with other factors, including a strong
family history of parasomnias, led experts to testify that Parks had been
sleepwalking during the attack. Not conscious, not responsible, not guilty.
5. Pennsylvania v. Ricksgers. In 1994, Michael Ricksgers was
convicted of the murder of his wife. He claimed he'd accidentally killed
her during a sleepwalking episode, which defense lawyers argued was
provoked by a medical condition, sleep apnea. Prosecutors presented an
alternative explanation: that Ricksgers was upset that his wife was
planning to leave him. Ricksgers told police that he awoke to find a gun
in his hand and his wife bleeding in bed beside him. He said that he
might have dreamed about an intruder breaking in. That didn't sway the
jury. Ricksgers was sentenced to life in prison without parole, according
to the Associated Press.
6. Arizona v. Falater. In 1997, Scott Falater, a devout Mormon, stabbed
his wife 44 times with a hunting knife. He then dragged her into a
backyard pool and held her head under water. A neighbor who witnessed
the drowning called police. Falater, who had no apparent motive, tried to
mount a sleepwalking defense. He said he had a history of sleepwalking,
was sleep-deprived, and was unconscious at the time of the attack. Yet
Falater had tried to conceal evidence: Police found the knife, bloody
clothes, boots, gloves, and undergarments stuffed in a Tupperware
container hidden in his car. Also, between the stabbing and the drowning,
the neighbor witnessed Falater motion for his dog to lie down, a possible
sign of consciousness. A jury found Falater guilty of first-degree murder
in 1999.
7. California v. Reitz. Stephen Reitz killed his lover, Eva Weinfurtner, a
married woman in her 40s, during what was supposed to be a romantic
Catalina Island getaway in 2001. He smashed her head with a flowerpot,
leaving shards in her scalp, dislocated her arm, punctured her with a
plastic fork, fractured her wrist, ribs, jaw, facial bones, and skull, and,
wielding a pocketknife, left three gaping stab wounds on the back of her
neck. Reitz told police that he had no recollection of the attack, though
through "flashbacks" he recalled believing that he was in a scuffle with a
male intruder.
Reitz, who had worked as a commercial fisherman, told police that the
knife wounds on Weinfurtner's neck were nearly identical to those that
fishermen use to kill sharks. At trial, his parents testified that he had
been a sleepwalker since childhood. The jurors didn't buy it. They
convicted Reitz of first-degree murder in 2004. Their decision was
presumably influenced by the defendant's history of violence towards
Weinfurtner, including an incident in which he had broken into her
apartment with a knife and told her that he would gut someone like a
fish.
How can this be treated and prevented?

Medical treatment for sleepwalking is necessary when sleepwalking is


caused by an underlying medical problem. In some instances,
medications may be prescribed to control sleepwalking. There are a
number of steps a person can take to lessen the impact of sleepwalking.

Tips to Prevent Sleepwalking

There is no known way to absolutely prevent sleepwalking; however,


certain steps can be taken to minimize one's risk. These include:
• Get adequate sleep
• Limit stress. Meditate or do relaxation exercises.
• Avoid any kind of stimuli (auditory or visual) prior to bedtime

Medical Treatment

If sleepwalking is caused by underlying medical conditions, for


example, gastroesophageal reflux, obstructive sleep apnea, seizures,
periodic leg movements or restless leg syndrome, sleepwalking episodes
should stop once the underlying medical condition is treated.
Medications may be necessary if the sleepwalker is at risk of injury, if
sleepwalking causes significant family disruption or excessive daytime
sleepiness, and when other treatment options have not worked.

What Medications Are Used to Treat Sleepwalking?

Medications that may be useful include:


• ProSom
• Klonopin
• Trazodone (Desyrel)
Medication can often be discontinued after several weeks without
recurrence of sleepwalking. Occasionally, sleepwalking increases briefly
after discontinuing the medication.
Treatment for sleepwalking is often unnecessary, especially if episodes
are infrequent and uncomplicated. Safety issues are of prime importance
to someone who sleepwalks and to others who are involved with
managing the condition. The following measures are usually
recommended:
• Locate the bedroom on the main floor, if possible.
• Place an alarm or a bell on the door of the bedroom.
• Lock the windows and cover them with large, heavy drapes.
• Keep the floor clear of harmful objects.
• Remove any hazardous materials and sharp objects from the room and
secure them in the house.
• Stay on the first floor when visiting others and when sleeping at a
hotel.
Medication may be used in cases where episodes are violent, injurious,
frequent, or disruptive. Therapy usually consists of either a
benzodiazepine, such as Diazepam® or Alprazolam®, or a tricyclic
antidepressant. Among other things, these drugs inhibit chemical
processes associated with sleep regulation, which, depending on the
patient, may or may not result in fewer episodes of sleepwalking.
Biofeedback and hypnosis have also been used effectively with individual
sleepwalking patients.
Many sleepwalkers claim the first step in management is to recognize
that sleepwalking is not evidence of insanity. Because sleepwalking is an
involuntary behavior, it separates people from most of the general public
and is often wrongly associated with madness. As mysterious as its
occurrence is, it does not indicate mental dysfunction and should not be
treated as such.

Other Treatment Options

Relaxation techniques, mental imagery, and anticipatory awakenings


are the preferred treatment options for long-term treatment of persons
with a sleepwalking disorder. Anticipatory awakenings consist of waking
the child or person approximately 15-20 minutes before the usual time of
an event, and then keeping him or her awake through the time during
which the episodes usually occur.
Relaxation and mental imagery techniques are most effective when
done with the help of an experienced behavioral therapist or hypnotist.

V.Conclusions

After reading the foreign and local literature and studies I have noticed
that they usually write about sleepwalking in children:

Usually this happens in a child:

* who is usually 4 to 15 years old


* who walks while asleep
* whose eyes are open but blank
* who is not as well coordinated as when awake
* who may perform semi-purposeful acts such as dressing and
undressing, opening and closing doors or turning lights on and off
* experiences the episode 1 to 2 hours after going to sleep. And the
episode may last 5 to 20 minutes.
* who cannot be awakened no matter what the parent does
A sleepwalking child appears to be wide awake, though he's actually
not. His eyes will be open, and he may even carry on a conversation,
although it probably won't make much sense.
Overall, about 25% reported sleepwalking as children and less than
5% reported sleepwalking as adults. Women reported significantly more
sleepwalking than men as children, but men reported more than women
as adults. The concordance rate was 0.55 among monozygotic twin pairs
and 0.35 among dizygotic twins. The authors calculated that the
tendency to sleepwalk is more than 50% genetically based in children
and over one third in adults. Only 0.06% of adult sleepwalkers reported
that they never sleepwalked as children.

VI. Recommendations

Just like any other condition, sleep walking research continues and will
no doubt do so, unless a miracle cure is established. Currently, the sleep
walking research suggests that the actions of sleep walkers in certain
cases may not be autonomous and need to be re-evaluated. For example,
a man actually killed someone while sleepwalking. The issue is whether
or not to acquit the defendant on the basis of autonomic actions or to
find him insane and, therefore, release him to treatment for mental
illness.
Subsequently, there is controversy surrounding an individual’s right to
plead insanity in cases like this, which complicates the perspective of
sleep walking behaviour.

Sleep walking research has concluded that there is a need to keep a


regular schedule for sleeping. Maintain a comfortable, restful bedroom is
also highly recommended. Using the bed for anything other than sex or
sleep should also be avoided, so the sleep walking research infers. This
means no television in your bedroom. Not popular with the non-sleep
walking partner though! People should get at least half an hour of
physical exercise a day, preferably outdoors. Sleep walking research also
suggest the individual should slow down their physical and mental
activities as bedtime approaches. The sleep walking research also
advocates cultivating a relaxed, calm state of mind at all times, but
particularly before bedtime. If possible, shift work should be avoided; also
stimulants or alcohol in the hours before retiring. The sleep walking
research urges those that follow the recommendations, but still struggle
with sleep walking, to consult a medical expert.
VII. Bibliography

• SLEEPWALKING CAUSES
Author: John Mersch, MD, FAAP
Editor: Melissa Conrad Stöppler, MD
January 17, 2009
http://www.emedicinehealth.com/sleepwalking/

• SLEEPWALKING CAUSES
Author: Mayo Clinic Staff
http://www.mayoclinic.com/health/sleepwalking/DS01009/DSECTI
ON=causes

• SLEEP DISORDERS: SLEEP WALKING BASICS


Reviewed by Leonard J. Sonne, MD on January 01, 2007
http://www.webmd.com/sleep-disorders/guide/sleepwalking-
causes

• SLEEPWALKING DISORDER SYMPTOMS - MENTAL HEALTH NET


The Sleep Disorders of Sleepwalking and Sleep Talking by
Jennifer Mueller

• http://www.sleepwellbaby.com/treatment-for-sleepwalking-s/356.htm

• 7 CRIMINAL CASES THAT INVOKED THE 'SLEEPWALKING DEFENSE'


By Lindsay Lyon
Posted: May 8, 2009

• SLEEP DISORDERS: HOW IS SLEEPWALKING TREATED?


http://www.webmd.com/sleep-disorders/guide/how-is-
sleepwalking-treated

• SLEEPWALKING
Original Date of Publication: 01 Dec 2000
Reviewed by: Stanley J. Swierzewski, III, M.D.
Last Reviewed: 04 Dec 2007
http://www.sleepdisorderchannel.com/sleepwalking/diagnosis.sht
ml

• http://www.babycenter.com.ph/toddler/sleep/sleepwalking/

• http://67.225.139.201/davao/sleepwalking

• THE GENETICS OF SLEEPWALKING


G Tucker
Published in Journal Watch Psychiatry April 1, 1997
http://psychiatry.jwatch.org/cgi/content/full/1997/401/1

• http://www.sleep-walking-why.com/Sleep-walking-research.html

Polytechnic University of the Philippines


College of Arts
Department of Psychology
Sta. Mesa, Manila

Sleepwalking: Its manifestations, cases


and treatments

BY:

CHARMEINE P. ROSALES
BSEM

PROF. ARTEMUS CRUZ

March 20, 2010