Sleepwalking
Encyclopedia
Sleepwalking, also known as somnambulism, is a sleep disorder
belonging to the parasomnia
family. Sleepwalkers arise from the slow wave
sleep stage in a state of low consciousness and perform activities that are usually performed during a state of full consciousness. These activities can be as benign as sitting up in bed, walking to the bathroom, and cleaning, or as hazardous as cooking, driving, having sex, violent gestures, grabbing at hallucinated objects, or even homicide.
Although generally sleepwalking cases consist of simple, repeated behaviours, there are occasionally reports of people performing complex behaviours while asleep, although their legitimacy is often disputed. In 2004, sleep medicine experts in Australia
claimed to have successfully treated a woman who claimed to have sex with strangers in her sleep. In December 2008, reports were published of a woman who sent semi-coherent emails while sleepwalking, including one inviting a friend around for dinner and drinks. Sleepwalkers often have little or no memory of the incident, as they are not truly conscious. Although their eyes are open, their expression is dim and glazed over. Sleepwalking may last as little as 30 seconds or as long as 30 minutes.
's Department of Neurology, sleepwalking may be inherited as an autosomal dominant disorder with reduced penetrance. Genome-wide multipoint parametric linkage analysis for sleepwalking revealed a maximum logarithm of the odds score of 3.44 at chromosome 20q12-q13.12 between 55.6 and 61.4 cM.
sleep periods). This is followed by stage 3, stage 2, stage 1, and a REM period. In normal adults, a cycle will last about 1.5 hours. According to Lavie, Malhotra, and Pillar, "The length and content of sleep cycles change throughout the night as well as with age." Sleepwalking generally occurs during the first third of the night (between 11 p.m. and 1 a.m.) during the slow wave NREM sleep stage. High delta activity
within the brain usually accompanies slow wave NREM sleep, and when 20–50% of all activity is delta activity, stage 3 is scored. When delta activity reaches 50% or higher, stage 4 is scored. Usually, if sleepwalking occurs at all, it will only occur once in a night.
. According to the popular source of MedicineNet, an automatism is "an unconscious movement that may resemble simple repetitive tics or may be a complex sequence of natural-looking movements." The individual often does not remember what he was doing or how he was doing it. These repetitive actions may include chewing, lip-smacking, pulling at clothing, or wandering around looking confused. Epileptic automatisms
are also associated "with the absence attacks of petit mal epilepsy."
Some actions that take place during sleepwalking could be classified as "automatisms". The distinction between "non-insane automatism" and "insane automatism" may be important in the legal context (see Crime below).
s in somnambulists up to 17 years of age. This presence might suggest an immaturity in the central nervous system, also a possible cause of sleepwalking. Sleepwalking is clustered in families, and the percentage of childhood sleepwalking increases to 45% if one parent was affected, and 60% if both parents were affected. However, there is no recorded preference to male or female individuals. Thus, heritable factors appear to predispose an individual to develop sleepwalking, but expression of the trait may be also influenced by environmental factors. Other precipitating factors to sleepwalking are those factors which increase the slow wave sleep stage. These most commonly include sleep deprivation, fever, and excessive tiredness. The use of some neuroleptics
or hypnotics can also cause sleepwalking to occur.
, and tricyclic antidepressants. However, for most sleepwalkers, many experts advise putting away dangerous items and locking doors and windows before sleep to reduce risks of harmful activity. Good sleep hygiene and avoiding sleep deprivation is also recommended.
There are conflicting viewpoints on whether it is harmful to wake a sleepwalker. Some experts say that sleepwalkers should be gently guided back to bed without waking them. Others counter that idea and state that waking a sleepwalker may result in their disorientation, but it is not harmful.
in the U.S., sleepwalking is prevalent in 1–15% of the general populace. Sleepwalking is most prevalent in children, and usually disappears by adolescence. Sleepwalking in adults is less common, but when it does occur, the events occur three times more often per year and last for more years than in children. Sleepwalking in old age is rare and usually indicates another disorder. Old age disorders may include delirium, drug toxicity or a seizure disorder.
In the study "sleepwalking and sleep terrors in prepubera children" they found that if a child had another sleepdisorder such as restless leg syndrome (RLS) or sleep-disorder breathing (SDB) that they had a greater chance of sleepwalking. The study found 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. The high frequency of SDB in family members of children with parasomnia provided additional evidence that SDB may manifest as parasomnias in children. Children with parasomnias are not systematically monitored during sleep, although past studies have suggested that patients with sleep terrors or sleepwalking have an elevated level of brief EEG arousals. When children receive polysomnographies, discrete patterns (e.g., nasal flow limitation, abnormal respiratory effort, bursts of high or slow EEG frequencies) should be sought; apneas are rarely found in children. Children's respiration during sleep should be monitored with nasal cannula/pressure transducer system and/or esophageal manometry, which are more sensitive than the thermistors or thermocouples currently used in many laboratories. The clear, prompt improvement of severe parasomnia in children who are treated for SDB, as defined here, provides important evidence that subtle SDB can have substantial health-related significance. Also noteworthy is the report of familial presence of parasomnia. Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias. RLS and SDB have been shown to have familial recurrence. RLS has been shown to have genetic involvement.
, a psychiatric test. According to the study, patients showed "outwardly directed behavior patterns...suggest[ing] that these adults had difficulty handling aggression. They did not support an interpretation of sleepwalking as 'hysterical dissociation
'."
, hysteria and anxiety neuroses
.". Also, patients with migraine
headaches or Tourette Syndrome
are 4–6 times more likely to sleepwalk. Some medications that may increase sleepwalking include: chlorpromazine
(Thorazine), perphenazine
(Trilafon), lithium
, benzodiazepine
(Triazolam), amitriptyline
(Elavel, Endep), zolpidem (Ambien) and beta blockers.
.
Sleepwalking was initially thought to be a dreamer acting out a dream. For example, in one study published by the Society for Science & the Public in 1954, this was the conclusion: "Repression of hostile feelings against the father caused the patients to react by acting out in a dream world with sleepwalking, the distorted fantasies they had about all authoritarian figures, such as fathers, officers and stern superiors." This same group published an article twelve years later with a new conclusion: "Sleepwalking, contrary to most belief, apparently has little to do with dreaming. In fact, it occurs when the sleeper is enjoying his most oblivious, deepest sleep—a stage in which dreams are not usually reported." More recent research has discovered that sleepwalking is actually a disorder of NREM
(non-rapid eye movement) arousal. Acting out a dream is the basis for a REM (rapid eye movement) sleep disorder called REM Behavior Disorder (or REM Sleep Behavior Disorder, RSBD). More accurate data about sleep is due to the invention of technologies such as the electroencephalogram (EEG
) by Hans Berger in 1924 and BEAM
by Frank Duffy in the early 1980s.
In 1907, Sigmund Freud spoke about sleepwalking to the Vienna Psychoanalytic Society (Nunberg and Federn). He believed that sleepwalking was connected to fulfilling sexual wishes and was surprised that a person could move without interrupting their dream. At that time, Freud suggested that the essence of this phenomenon was the desire to go to sleep in the same area as the individual had slept in childhood. Ten years later, he speculated about somnambulism in the article "A Metapsychological Supplement to the Theory of Dreams" (1916-17 [1915]). In this essay, he stated to clarify and expand his hypothetical ideas on dreams. The dreams is a fragile equilibrium that is only partially successful because the repressed unconscious impulses of the unconscious system. This does not obey the wishes of the ego and maintain their countercathexis. Another reason why dreams are partially successful is because certain preconscious daytime thoughts can be resistant and these can retain a part of their cathexis as well. It is probable how unconscious impulses and day residues can come together and result in a conflict. Freud then wondered about the outcome of this wishful impulse which represents an unconscious instinctual demand and then it becomes a dream wish in the preconscious. Furthermore, Freud stated that this unconscious impulse could be expressed as mobility during sleep. This would be what is observed in somnambulism, though what actually makes it possible remains unknown.
, a friend of Lord Byron's
, earned his medical degree from the University of Edinburgh
in 1815 with a treatise on sleepwalking. He was present at the famous gathering at the Villa Diodati
on 16 June 1816 when Byron issued a challenge to him, Percy Bysshe Shelley
, Mary Godwin
and Claire Clairmont
to write a ghost story. Polidori wrote "The Vampyre
", the first vampire story in English.
Sleepwalking features in Thomas Hardy's novel Tess of the d'Urbervilles
, where it is ascribed to Angel Clare's "deep distress and confusion". In the novel Heidi
, the main character of that name starts sleepwalking because of homesickness.
Sleepwalking is also central for Charles Brockden Brown
's 1799 novel Edgar Huntly, Or, Memoirs of a Sleepwalker
.
's opera La Sonnambula
is named after its heroine, a sleepwalker.
In Shakespeare's Macbeth
, Lady Macbeth
sleepwalks because of her overwhelming guilt and insanity
.
Sleepwalking is also a theme in Heinrich Von Kleist
's play The Prince of Homburg
.
Mike Birbiglia
's one-man play Sleepwalk With Me recounts his true experiences of sleepwalking.
The 1926 silent film of "The Cabinet Of Dr. Caligari
" story by "Carl Majer and Hans Janowitz" Berlin the movie portrays "Somnambulist
" like being a Zombie to do the will of another
German Expressionist film Das Kabinett des Doktor Caligari (English
title: The Cabinet of Dr. Caligari
).
In the 1947 Disney
animated short "Sleepy Time Donald", Donald Duck
is a prolonged sleepwalker, and Daisy Duck
steers him away from many hazards.
In the classic TV sitcom, The Dick Van Dyke Show
, a two-part episode was aired depicting Rob Petrie's brother Stacey (played by Jerry Van Dyke
) as a sleepwalker that displays a polar opposite personality of himself when asleep. When awake, he's very shy and quiet, when asleep, he's funny and very outgoing.
In the film version of Harry Potter and the Half Blood Prince, Luna Lovegood claims that she sleepwalks at night and, as a result, wears her shoes to bed. Also, in the Harry Potter and the Prisoner of Azkaban film
Harry Potter uses this as an excuse as to why he was out of bed after hours, when he was really looking for Peter Pettigrew on the Marauder's Map.
A sleepwalking murder is the main subject of the 2009 movie In My Sleep
.
In Dario Argento
's Phenomena
(1985
), the protagonist, Jennifer Corvino (Jennifer Connelly
), witnesses a murder while sleepwalking.
In the film adaptation of Silent Hill
, the protagonist's daughter suffers from sleepwalking.
In the House
episode "Role Model", a woman has sexsomnia (sexual intercourse with her ex-husband while sleepwalking) and becomes pregnant. In the movie Step Brothers
, the main characters, Brennan and Dale, both sleepwalk.
In the film Donnie Darko
, the character Donnie Darko sleep walks and in one scene awakens in a golf course; he believes that his sleep walking is caused by an outside party or supernatural force.
at the State University of New York
College of Medicine, "It is conceivable that the sleepwalker has the potential to drift into a confusional arousal, a state in which violence and assault are likely when prolonged and if given the adequate circumstances.
The differential diagnosis may also include other conditions in which violence related to sleep is a risk, such as REM Sleep Behavior Disorder (RSBD), fugue state
s, and episodic wandering." In the 1963 case Bratty v Attorney-General for Northern Ireland, Lord Morris
stated, "Each set of facts must require a careful examination of its own circumstances, but if by way of taking an illustration it were considered possible for a person to walk in his sleep and to commit a violent crime while genuinely unconscious, then such a person would not be criminally liable for that act."
In the case of the law, an individual can be accused of non-insane automatism
or insane automatism
. The first is used as a defense for temporary insanity or involuntary conduct, resulting in acquittal. The latter results in a "special verdict of not guilty by reason of insanity." This verdict of insanity can result in a court order to attend a mental institution.
Examples of legal cases involving sleepwalking in the defence include:
Sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...
belonging to the parasomnia
Parasomnia
For the 2008 horror film, see Parasomnia Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep...
family. Sleepwalkers arise from the slow wave
Slow-wave sleep
Slow-wave sleep , often referred to as deep sleep, consists of stages 3 and 4 of non-rapid eye movement sleep, according to the Rechtschaffen & Kales standard of 1968. As of 2008, the American Academy of Sleep Medicine has discontinued the use of stage 4, such that the previous stages 3 and 4 now...
sleep stage in a state of low consciousness and perform activities that are usually performed during a state of full consciousness. These activities can be as benign as sitting up in bed, walking to the bathroom, and cleaning, or as hazardous as cooking, driving, having sex, violent gestures, grabbing at hallucinated objects, or even homicide.
Although generally sleepwalking cases consist of simple, repeated behaviours, there are occasionally reports of people performing complex behaviours while asleep, although their legitimacy is often disputed. In 2004, sleep medicine experts in Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
claimed to have successfully treated a woman who claimed to have sex with strangers in her sleep. In December 2008, reports were published of a woman who sent semi-coherent emails while sleepwalking, including one inviting a friend around for dinner and drinks. Sleepwalkers often have little or no memory of the incident, as they are not truly conscious. Although their eyes are open, their expression is dim and glazed over. Sleepwalking may last as little as 30 seconds or as long as 30 minutes.
Nomenclature, classification, and codification
According to a study by Dr. Christina A. Gurnett, of the Washington University School of MedicineWashington University School of Medicine
Washington University School of Medicine , located in St. Louis, Missouri, is one of the graduate schools of Washington University in St. Louis. One of the top medical schools in the United States, it is currently ranked 4th for research according to U.S. News and World Report and has been listed...
's Department of Neurology, sleepwalking may be inherited as an autosomal dominant disorder with reduced penetrance. Genome-wide multipoint parametric linkage analysis for sleepwalking revealed a maximum logarithm of the odds score of 3.44 at chromosome 20q12-q13.12 between 55.6 and 61.4 cM.
Sleep stages
Sleep is categorized into stages of a cycle between REM sleep and NREM sleep. NREM sleep is further divided into four stages: stage 1 (a light sleep period), stage 2 (a consolidated sleep period), and stage 3 and 4 (slow waveSlow-wave sleep
Slow-wave sleep , often referred to as deep sleep, consists of stages 3 and 4 of non-rapid eye movement sleep, according to the Rechtschaffen & Kales standard of 1968. As of 2008, the American Academy of Sleep Medicine has discontinued the use of stage 4, such that the previous stages 3 and 4 now...
sleep periods). This is followed by stage 3, stage 2, stage 1, and a REM period. In normal adults, a cycle will last about 1.5 hours. According to Lavie, Malhotra, and Pillar, "The length and content of sleep cycles change throughout the night as well as with age." Sleepwalking generally occurs during the first third of the night (between 11 p.m. and 1 a.m.) during the slow wave NREM sleep stage. High delta activity
Delta wave
A delta wave is a high amplitude brain wave with a frequency of oscillation between 0–4 hertz. Delta waves, like other brain waves, are recorded with an electroencephalogram and are usually associated with the deepest stages of sleep , also known as slow-wave sleep , and aid in characterizing the...
within the brain usually accompanies slow wave NREM sleep, and when 20–50% of all activity is delta activity, stage 3 is scored. When delta activity reaches 50% or higher, stage 4 is scored. Usually, if sleepwalking occurs at all, it will only occur once in a night.
Automatism
Researchers sometimes disagree about the classification of sleepwalking as an automatismAutomatic behavior
Automatic behavior, from the Greek automatos or self-acting, is the spontaneous production of often purposeless verbal or motor behavior without conscious self-control or self-censorship...
. According to the popular source of MedicineNet, an automatism is "an unconscious movement that may resemble simple repetitive tics or may be a complex sequence of natural-looking movements." The individual often does not remember what he was doing or how he was doing it. These repetitive actions may include chewing, lip-smacking, pulling at clothing, or wandering around looking confused. Epileptic automatisms
Absence seizure
Absence seizures are one of several kinds of seizures. These seizures are sometimes referred to as petit mal seizures ....
are also associated "with the absence attacks of petit mal epilepsy."
Some actions that take place during sleepwalking could be classified as "automatisms". The distinction between "non-insane automatism" and "insane automatism" may be important in the legal context (see Crime below).
Causes
Several experts theorize that the development of sleepwalking in childhood is due to a delay in maturation. There are also high-voltage delta waveDelta wave
A delta wave is a high amplitude brain wave with a frequency of oscillation between 0–4 hertz. Delta waves, like other brain waves, are recorded with an electroencephalogram and are usually associated with the deepest stages of sleep , also known as slow-wave sleep , and aid in characterizing the...
s in somnambulists up to 17 years of age. This presence might suggest an immaturity in the central nervous system, also a possible cause of sleepwalking. Sleepwalking is clustered in families, and the percentage of childhood sleepwalking increases to 45% if one parent was affected, and 60% if both parents were affected. However, there is no recorded preference to male or female individuals. Thus, heritable factors appear to predispose an individual to develop sleepwalking, but expression of the trait may be also influenced by environmental factors. Other precipitating factors to sleepwalking are those factors which increase the slow wave sleep stage. These most commonly include sleep deprivation, fever, and excessive tiredness. The use of some neuroleptics
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
or hypnotics can also cause sleepwalking to occur.
Treatment
There are some drugs that can be prescribed for sleepwalkers, such as a low dose of benzodiazepines, such as clonazepamClonazepam
Clonazepamis a benzodiazepine drug having anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. It is marketed by Roche under the trade name Klonopin in the United States and Rivotril in Australia, Brazil, Canada and Europe...
, and tricyclic antidepressants. However, for most sleepwalkers, many experts advise putting away dangerous items and locking doors and windows before sleep to reduce risks of harmful activity. Good sleep hygiene and avoiding sleep deprivation is also recommended.
There are conflicting viewpoints on whether it is harmful to wake a sleepwalker. Some experts say that sleepwalkers should be gently guided back to bed without waking them. Others counter that idea and state that waking a sleepwalker may result in their disorientation, but it is not harmful.
Epidemiology
According to the National Sleep FoundationNational Sleep Foundation
The National Sleep Foundation is an independent nonprofit organization in the USA whose objectives are to improve public health and safety by achieving understanding of sleep and sleep disorders, and to support sleep-related education, research, and advocacy.Established in 1990, the NSF relies on...
in the U.S., sleepwalking is prevalent in 1–15% of the general populace. Sleepwalking is most prevalent in children, and usually disappears by adolescence. Sleepwalking in adults is less common, but when it does occur, the events occur three times more often per year and last for more years than in children. Sleepwalking in old age is rare and usually indicates another disorder. Old age disorders may include delirium, drug toxicity or a seizure disorder.
Children
Sleepwalking events are common in childhood and decrease with age. According to Lavie, Malhotra and Pillar, the peak age is 4–8 years, when prevalence is 20% frequency of events. It is also known that "between 25–33% of somnambulists have nocturnal enuresis" (bed-wetting). Like sleepwalking, enuresis is more common in children and fades away as the child ages. Some children who sleepwalk are also affected by night terrors. However, night terrors are much more common in adult sleepwalkers, up to 50% more common. Some parents worry about the psychological implications of sleepwalking on their child, but Larissa Hirsch, MD, editor of the website KidsHealth, says, "Sleepwalking is not usually a sign that something is emotionally or psychologically wrong with a child. And it doesn't cause any emotional harm."In the study "sleepwalking and sleep terrors in prepubera children" they found that if a child had another sleepdisorder such as restless leg syndrome (RLS) or sleep-disorder breathing (SDB) that they had a greater chance of sleepwalking. The study found 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. The high frequency of SDB in family members of children with parasomnia provided additional evidence that SDB may manifest as parasomnias in children. Children with parasomnias are not systematically monitored during sleep, although past studies have suggested that patients with sleep terrors or sleepwalking have an elevated level of brief EEG arousals. When children receive polysomnographies, discrete patterns (e.g., nasal flow limitation, abnormal respiratory effort, bursts of high or slow EEG frequencies) should be sought; apneas are rarely found in children. Children's respiration during sleep should be monitored with nasal cannula/pressure transducer system and/or esophageal manometry, which are more sensitive than the thermistors or thermocouples currently used in many laboratories. The clear, prompt improvement of severe parasomnia in children who are treated for SDB, as defined here, provides important evidence that subtle SDB can have substantial health-related significance. Also noteworthy is the report of familial presence of parasomnia. Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias. RLS and SDB have been shown to have familial recurrence. RLS has been shown to have genetic involvement.
Adults
The persistence or onset of sleepwalking in adulthood is far less common than in children. It is a misconception that adult sleepwalking always indicates a psychological disorder. Sleepwalking can, however, be a symptom of people with psychological disorders. In one study, adult test subjects were given the Minnesota Multiphasic Personality InventoryMinnesota Multiphasic Personality Inventory
The Minnesota Multiphasic Personality Inventory is one of the most frequently used personality tests in mental health. The test is used by trained professionals to assist in identifying personality structure and psychopathology....
, a psychiatric test. According to the study, patients showed "outwardly directed behavior patterns...suggest[ing] that these adults had difficulty handling aggression. They did not support an interpretation of sleepwalking as 'hysterical dissociation
Dissociative identity disorder
Dissociative identity disorder is a psychiatric diagnosis and describes a condition in which a person displays multiple distinct identities , each with its own pattern of perceiving and interacting with the environment....
'."
Psychological disorders and drug use
In some cases, sleepwalking in adults may be a symptom of a psychological disorder or of drug use. One study, A.H.Crisp and colleagues, of St. George's Hospital Medical School in London, suggests higher levels of dissociation in adult sleepwalkers, since test subjects scored unusually high on the hysteria portion of the "Crown-Crisp Experiential Index". J.E.Orme, of the Psychology Department at Middlewood Hospital, Sheffield has suggested that "A higher incidence [of sleepwalking events] has been reported in patients with schizophreniaSchizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, hysteria and anxiety neuroses
Neurosis
Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic...
.". Also, patients with migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
headaches or Tourette Syndrome
Tourette syndrome
Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical tics and at least one vocal tic; these tics characteristically wax and wane...
are 4–6 times more likely to sleepwalk. Some medications that may increase sleepwalking include: chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
(Thorazine), perphenazine
Perphenazine
Perphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. It has been in clinical use for decades....
(Trilafon), lithium
Lithium
Lithium is a soft, silver-white metal that belongs to the alkali metal group of chemical elements. It is represented by the symbol Li, and it has the atomic number 3. Under standard conditions it is the lightest metal and the least dense solid element. Like all alkali metals, lithium is highly...
, benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
(Triazolam), amitriptyline
Amitriptyline
Amitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
(Elavel, Endep), zolpidem (Ambien) and beta blockers.
History
Sleepwalking has attracted a sense of mystery, but it had not been seriously investigated and diagnosed until the last century. The 19th-century German chemist and parapsychologist Baron Karl Ludwig von Reichenbach made extensive studies of sleepwalkers and used his discoveries to formulate his theory of the Odic forceOdic force
The Odic force is the name given in the mid-19th century to a hypothetical vital energy or life force by Baron Carl von Reichenbach...
.
Sleepwalking was initially thought to be a dreamer acting out a dream. For example, in one study published by the Society for Science & the Public in 1954, this was the conclusion: "Repression of hostile feelings against the father caused the patients to react by acting out in a dream world with sleepwalking, the distorted fantasies they had about all authoritarian figures, such as fathers, officers and stern superiors." This same group published an article twelve years later with a new conclusion: "Sleepwalking, contrary to most belief, apparently has little to do with dreaming. In fact, it occurs when the sleeper is enjoying his most oblivious, deepest sleep—a stage in which dreams are not usually reported." More recent research has discovered that sleepwalking is actually a disorder of NREM
NREM
Non-rapid eye movement, or NREM is, collectively, sleep stages 1 – 3, previously known as stages 1 – 4. Rapid eye movement sleep is not included. There are distinct electroencephalographic and other characteristics seen in each stage. Unlike REM sleep, there is usually little or no eye movement...
(non-rapid eye movement) arousal. Acting out a dream is the basis for a REM (rapid eye movement) sleep disorder called REM Behavior Disorder (or REM Sleep Behavior Disorder, RSBD). More accurate data about sleep is due to the invention of technologies such as the electroencephalogram (EEG
EEG
EEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
) by Hans Berger in 1924 and BEAM
Neuroimaging
Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...
by Frank Duffy in the early 1980s.
In 1907, Sigmund Freud spoke about sleepwalking to the Vienna Psychoanalytic Society (Nunberg and Federn). He believed that sleepwalking was connected to fulfilling sexual wishes and was surprised that a person could move without interrupting their dream. At that time, Freud suggested that the essence of this phenomenon was the desire to go to sleep in the same area as the individual had slept in childhood. Ten years later, he speculated about somnambulism in the article "A Metapsychological Supplement to the Theory of Dreams" (1916-17 [1915]). In this essay, he stated to clarify and expand his hypothetical ideas on dreams. The dreams is a fragile equilibrium that is only partially successful because the repressed unconscious impulses of the unconscious system. This does not obey the wishes of the ego and maintain their countercathexis. Another reason why dreams are partially successful is because certain preconscious daytime thoughts can be resistant and these can retain a part of their cathexis as well. It is probable how unconscious impulses and day residues can come together and result in a conflict. Freud then wondered about the outcome of this wishful impulse which represents an unconscious instinctual demand and then it becomes a dream wish in the preconscious. Furthermore, Freud stated that this unconscious impulse could be expressed as mobility during sleep. This would be what is observed in somnambulism, though what actually makes it possible remains unknown.
In popular culture
Sleepwalking has been a theme, or at least a plot device, in many dramatic works.Literature
Dr. John William PolidoriJohn Polidori
John William Polidori was an English writer and physician of Italian descent. He is known for his associations with the Romantic movement and credited by some as the creator of the vampire genre of fantasy fiction. His most successful work was the 1819 short story, The Vampyre, the first vampire...
, a friend of Lord Byron's
George Gordon Byron, 6th Baron Byron
George Gordon Byron, 6th Baron Byron, later George Gordon Noel, 6th Baron Byron, FRS , commonly known simply as Lord Byron, was a British poet and a leading figure in the Romantic movement...
, earned his medical degree from the University of Edinburgh
University of Edinburgh
The University of Edinburgh, founded in 1583, is a public research university located in Edinburgh, the capital of Scotland, and a UNESCO World Heritage Site. The university is deeply embedded in the fabric of the city, with many of the buildings in the historic Old Town belonging to the university...
in 1815 with a treatise on sleepwalking. He was present at the famous gathering at the Villa Diodati
Villa Diodati
The Villa Diodati is a manor in Cologny close to Lake Geneva. It is most famous for having been the summer residence of Lord Byron, Mary Shelley, Percy Shelley, John Polidori and others in 1816, where the basis for the classical horror stories Frankenstein and The Vampyre was laid.Originally called...
on 16 June 1816 when Byron issued a challenge to him, Percy Bysshe Shelley
Percy Bysshe Shelley
Percy Bysshe Shelley was one of the major English Romantic poets and is critically regarded as among the finest lyric poets in the English language. Shelley was famous for his association with John Keats and Lord Byron...
, Mary Godwin
Mary Shelley
Mary Shelley was a British novelist, short story writer, dramatist, essayist, biographer, and travel writer, best known for her Gothic novel Frankenstein: or, The Modern Prometheus . She also edited and promoted the works of her husband, the Romantic poet and philosopher Percy Bysshe Shelley...
and Claire Clairmont
Claire Clairmont
Clara Mary Jane Clairmont , or Claire Clairmont as she was commonly known, was a stepsister of writer Mary Shelley and the mother of Lord Byron's daughter Allegra.-Early life:...
to write a ghost story. Polidori wrote "The Vampyre
The Vampyre
"The Vampyre" is a short story or novella written in 1819 by John William Polidori which is a progenitor of the romantic vampire genre of fantasy fiction...
", the first vampire story in English.
Sleepwalking features in Thomas Hardy's novel Tess of the d'Urbervilles
Tess of the d'Urbervilles
Tess of the d'Urbervilles: A Pure Woman Faithfully Presented, also known as Tess of the d'Urbervilles: A Pure Woman, Tess of the d'Urbervilles or just Tess, is a novel by Thomas Hardy, first published in 1891. It initially appeared in a censored and serialised version, published by the British...
, where it is ascribed to Angel Clare's "deep distress and confusion". In the novel Heidi
Heidi
Heidi is a Swiss work of fiction, published in two parts as Heidi's years of learning and travel and Heidi makes use of what she has learned.It is a novel about the events in the life of a young girl in her grandfather's care, in the Swiss Alps...
, the main character of that name starts sleepwalking because of homesickness.
Sleepwalking is also central for Charles Brockden Brown
Charles Brockden Brown
Charles Brockden Brown , an American novelist, historian, and editor of the Early National period, is generally regarded by scholars as the most ambitious and accomplished US novelist before James Fenimore Cooper...
's 1799 novel Edgar Huntly, Or, Memoirs of a Sleepwalker
Edgar Huntly
Edgar Huntly, Or, Memoirs of a Sleepwalker is a 1799 novel by the American author Charles Brockden Brown.-Plot summary:Edgar Huntly, a young man who lives with his uncle and sisters on a farm outside Philadelphia, begins the novel determined to learn who murdered his friend Waldegrave...
.
Theatre
Italian composer Vincenzo BelliniVincenzo Bellini
Vincenzo Salvatore Carmelo Francesco Bellini was an Italian opera composer. His greatest works are I Capuleti ed i Montecchi , La sonnambula , Norma , Beatrice di Tenda , and I puritani...
's opera La Sonnambula
La sonnambula
La sonnambula is an opera semiseria in two acts, with music in the bel canto tradition by Vincenzo Bellini to an Italian libretto by Felice Romani, based on a scenario for a ballet-pantomime by Eugène Scribe and Jean-Pierre Aumer called La somnambule, ou L'arrivée d'un nouveau seigneur.The first...
is named after its heroine, a sleepwalker.
In Shakespeare's Macbeth
Macbeth
The Tragedy of Macbeth is a play by William Shakespeare about a regicide and its aftermath. It is Shakespeare's shortest tragedy and is believed to have been written sometime between 1603 and 1607...
, Lady Macbeth
Lady Macbeth (Shakespeare)
Lady Macbeth is a fictional character in Shakespeare's Macbeth . She is the wife to the play's protagonist, Macbeth, a Scottish nobleman. After goading him into committing regicide, she becomes Queen of Scotland, but later suffers pangs of guilt for her part in the crime...
sleepwalks because of her overwhelming guilt and insanity
Insanity
Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity...
.
Sleepwalking is also a theme in Heinrich Von Kleist
Heinrich von Kleist
Bernd Heinrich Wilhelm von Kleist was a poet, dramatist, novelist and short story writer. The Kleist Prize, a prestigious prize for German literature, is named after him.- Life :...
's play The Prince of Homburg
The Prince of Homburg (play)
The Prince of Homburg is a play by Heinrich von Kleist written in 1809-10, but not performed until 1821, after the author's death. A performance during his lifetime was not possible because Princess Marianne of Prussia , by birth a member of the Hesse-Homburg family, to whom Kleist had given sight...
.
Mike Birbiglia
Mike Birbiglia
-Professional work:Birbiglia has released three albums, including My Secret Public Journal Live, which was named one of the best comedy albums of the decade by the Onion AV Club....
's one-man play Sleepwalk With Me recounts his true experiences of sleepwalking.
The 1926 silent film of "The Cabinet Of Dr. Caligari
The Cabinet of Dr. Caligari
The Cabinet of Dr. Caligari is a 1920 silent horror film directed by Robert Wiene from a screenplay by Hans Janowitz and Carl Mayer. It is one of the most influential of German Expressionist films and is often considered one of the greatest horror movies of the silent era. This movie is cited as...
" story by "Carl Majer and Hans Janowitz" Berlin the movie portrays "Somnambulist
Somnambulist
Somnambulist can refer to:* a person who engages in somnambulism * The title of a song "The Fleeting Somnambulist" by Deathrock/Gothic Band Christian Death, Written by by Rozz Williams November 6, 1963 - April 1, 1998...
" like being a Zombie to do the will of another
Film and Television
It is a major plot element in the classic silentSilent film
A silent film is a film with no synchronized recorded sound, especially with no spoken dialogue. In silent films for entertainment the dialogue is transmitted through muted gestures, pantomime and title cards...
German Expressionist film Das Kabinett des Doktor Caligari (English
English language
English is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...
title: The Cabinet of Dr. Caligari
The Cabinet of Dr. Caligari
The Cabinet of Dr. Caligari is a 1920 silent horror film directed by Robert Wiene from a screenplay by Hans Janowitz and Carl Mayer. It is one of the most influential of German Expressionist films and is often considered one of the greatest horror movies of the silent era. This movie is cited as...
).
In the 1947 Disney
The Walt Disney Company
The Walt Disney Company is the largest media conglomerate in the world in terms of revenue. Founded on October 16, 1923, by Walt and Roy Disney as the Disney Brothers Cartoon Studio, Walt Disney Productions established itself as a leader in the American animation industry before diversifying into...
animated short "Sleepy Time Donald", Donald Duck
Donald Duck
Donald Fauntleroy Duck is a cartoon character created in 1934 at Walt Disney Productions and licensed by The Walt Disney Company. Donald is an anthropomorphic white duck with a yellow-orange bill, legs, and feet. He typically wears a sailor suit with a cap and a black or red bow tie. Donald is most...
is a prolonged sleepwalker, and Daisy Duck
Daisy Duck
Daisy Duck is a cartoon character created in 1940 by Walt Disney Productions as the girlfriend of Donald Duck. Like Donald, Daisy is an anthropomorphic white duck, but has large eyelashes and ruffled tail feathers to suggest a skirt. She is often seen wearing a hair bow, blouse, and shoes...
steers him away from many hazards.
In the classic TV sitcom, The Dick Van Dyke Show
The Dick Van Dyke Show
The Dick Van Dyke Show is an American television sitcom that initially aired on the Columbia Broadcasting System from October 3, 1961, until June 1, 1966. The show was created by Carl Reiner and starred Dick Van Dyke and Mary Tyler Moore. It was produced by Reiner with Bill Persky and Sam Denoff....
, a two-part episode was aired depicting Rob Petrie's brother Stacey (played by Jerry Van Dyke
Jerry Van Dyke
Jerry Van Dyke is an American comedian and actor. He is the younger brother of comedian and actor Dick Van Dyke, and made his acting debut on The Dick Van Dyke Show with several guest appearances as Rob Petrie's brother, Stacey...
) as a sleepwalker that displays a polar opposite personality of himself when asleep. When awake, he's very shy and quiet, when asleep, he's funny and very outgoing.
In the film version of Harry Potter and the Half Blood Prince, Luna Lovegood claims that she sleepwalks at night and, as a result, wears her shoes to bed. Also, in the Harry Potter and the Prisoner of Azkaban film
Harry Potter and the Prisoner of Azkaban (film)
Harry Potter and the Prisoner of Azkaban is a 2004 fantasy film directed by Alfonso Cuarón and based on the novel of the same name by J. K. Rowling. It is the third instalment in the Harry Potter film series, written by Steve Kloves and produced by Chris Columbus, David Heyman and Mark Radcliffe...
Harry Potter uses this as an excuse as to why he was out of bed after hours, when he was really looking for Peter Pettigrew on the Marauder's Map.
A sleepwalking murder is the main subject of the 2009 movie In My Sleep
In My Sleep
In My Sleep is 2010 suspense thriller movie written, directed and produced by film director Allen Wolf. It stars Philip Winchester, Lacey Chabert, Tim Draxl, Abigail Spencer and Kelly Overton. The story is about a man who believes he may have murdered a good friend while...
.
In Dario Argento
Dario Argento
Dario Argento is an Italian film director, producer and screenwriter. He is best known for his work in the horror film genre, particularly in the subgenre known as giallo, and for his influence on modern horror and slasher movies....
's Phenomena
Phenomena (film)
Phenomena is a 1985 Italian horror film directed by Dario Argento. An edited version of the film was released in the United States under the title Creepers , the game called Clock_Tower_ that was released in 1995 for snes , was loosely based on Phenomena.Jennifer Connelly stars as a young girl who...
(1985
1985 in film
-Events:* 3 December - Roger Moore steps down from the role of James Bond after twelve years and seven films. He is replaced by Timothy Dalton.* The Academy Award for Best Picture was won by Out Of Africa, while the highest grossing film was Back to the Future.* Bliss wins AFI Award for best Movie...
), the protagonist, Jennifer Corvino (Jennifer Connelly
Jennifer Connelly
Jennifer Lynn Connelly is an American film actress, who began her career as a child model. She appeared in magazine, newspaper and television advertising, before making her motion picture debut in the 1984 crime film Once Upon a Time in America...
), witnesses a murder while sleepwalking.
In the film adaptation of Silent Hill
Silent Hill (film)
Silent Hill is a 2006 horror film directed by Christophe Gans and written by Roger Avary. The story is an adaptation of the Silent Hill series of survival horror video games created by Konami. The film, particularly its emotional, religious and aesthetic content as well as its creature design,...
, the protagonist's daughter suffers from sleepwalking.
In the House
House (TV series)
House is an American television medical drama that debuted on the Fox network on November 16, 2004. The show's central character is Dr. Gregory House , an unconventional and misanthropic medical genius who heads a team of diagnosticians at the fictional Princeton-Plainsboro Teaching Hospital in...
episode "Role Model", a woman has sexsomnia (sexual intercourse with her ex-husband while sleepwalking) and becomes pregnant. In the movie Step Brothers
Step Brothers (film)
Step Brothers is a 2008 American slapstick buddy-comedy film directed by Adam McKay, produced by Judd Apatow and Jimmy Miller, and stars Will Ferrell and John C. Reilly, who originally teamed up in Talladega Nights . The screenplay was written by Ferrell and McKay, from a story written by Ferrell,...
, the main characters, Brennan and Dale, both sleepwalk.
In the film Donnie Darko
Donnie Darko
Donnie Darko is a 2001 American psychological thriller film written and directed by Richard Kelly and starring Jake Gyllenhaal, Drew Barrymore, Patrick Swayze, Maggie Gyllenhaal, Noah Wyle, Jena Malone, and Mary McDonnell...
, the character Donnie Darko sleep walks and in one scene awakens in a golf course; he believes that his sleep walking is caused by an outside party or supernatural force.
Crime
Because sleepwalking can result in violent behavior, legal courts sometimes deal with cases involving sleepwalkers. These cases include homicide, assault, and sexual harassment. The level of responsibility and severity of punishment has been highly debated because sleepwalkers are almost always oblivious to their activity during an episode. According to Culebras, a Professor of NeurologyNeurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
at the State University of New York
State University of New York
The State University of New York, abbreviated SUNY , is a system of public institutions of higher education in New York, United States. It is the largest comprehensive system of universities, colleges, and community colleges in the United States, with a total enrollment of 465,000 students, plus...
College of Medicine, "It is conceivable that the sleepwalker has the potential to drift into a confusional arousal, a state in which violence and assault are likely when prolonged and if given the adequate circumstances.
The differential diagnosis may also include other conditions in which violence related to sleep is a risk, such as REM Sleep Behavior Disorder (RSBD), fugue state
Fugue state
A fugue state, formally dissociative fugue or psychogenic fugue , is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality...
s, and episodic wandering." In the 1963 case Bratty v Attorney-General for Northern Ireland, Lord Morris
John Morris, Baron Morris of Borth-y-Gest
John William Morris, Baron Morris of Borth-y-Gest CH, PC, MC was a British judge.In 1914, with the beginning of the First World War, Morris served in the Royal Welsh Fusiliers until its end...
stated, "Each set of facts must require a careful examination of its own circumstances, but if by way of taking an illustration it were considered possible for a person to walk in his sleep and to commit a violent crime while genuinely unconscious, then such a person would not be criminally liable for that act."
In the case of the law, an individual can be accused of non-insane automatism
Automatism (case law)
Automatism is a rarely used criminal defence which denies that the accused was criminally responsible for his or her actions. The term automatism was first used in the trial of Harrison-Owen in 1951, although accused persons had been exonerated on grounds of automatic behaviour before then e.g...
or insane automatism
Automatism (case law)
Automatism is a rarely used criminal defence which denies that the accused was criminally responsible for his or her actions. The term automatism was first used in the trial of Harrison-Owen in 1951, although accused persons had been exonerated on grounds of automatic behaviour before then e.g...
. The first is used as a defense for temporary insanity or involuntary conduct, resulting in acquittal. The latter results in a "special verdict of not guilty by reason of insanity." This verdict of insanity can result in a court order to attend a mental institution.
Examples of legal cases involving sleepwalking in the defence include:
- 1981, Steven Steinberg, of ScottsdaleScottsdale, ArizonaScottsdale is a city in the eastern part of Maricopa County, Arizona, United States, adjacent to Phoenix. According to the U.S. Census Bureau, as of 2010 the population of the city was 217,385...
, ArizonaArizonaArizona ; is a state located in the southwestern region of the United States. It is also part of the western United States and the mountain west. The capital and largest city is Phoenix...
, accused of killing his wife and acquitted on the grounds of temporary insanity.
- 1991, R v BurgessR v BurgessR v Burgess [1991] 2 QB 92 is a decision of the Court of Appeal of England and Wales that found sleepwalking as insane automatism. In a previous decision, Burgess was found not guilty by reason of insanity because his case fell under the M'Naghten Rules...
, accused of hitting his girlfriend on the head with a wine bottle and then a video tape recorder. Found not guilty, at BristolBristolBristol is a city, unitary authority area and ceremonial county in South West England, with an estimated population of 433,100 for the unitary authority in 2009, and a surrounding Larger Urban Zone with an estimated 1,070,000 residents in 2007...
Crown Court, by reason of insane automatism.
- 1992, R. v. ParksR. v. ParksR. v. Parks, [1992] 2 S.C.R. 871 is a leading Supreme Court of Canada decision on the criminal automatism defence.In an early morning in May 1987, Ken Parks drove to the house of his wife's parents. He attacked both of them with a kitchen knife, killing the mother and leaving the father seriously...
, accused of killing his mother-in-law and attempting to kill his father-in-law, was acquitted by the Supreme Court of CanadaSupreme Court of CanadaThe Supreme Court of Canada is the highest court of Canada and is the final court of appeals in the Canadian justice system. The court grants permission to between 40 and 75 litigants each year to appeal decisions rendered by provincial, territorial and federal appellate courts, and its decisions...
.
- 1994, Pennsylvania v. Ricksgers, accused of killing his wife and sentenced to life in prison without parole.
- 1999, Arizona v. Falater, Scott Falater of Phoenix, Arizona, accused of killing his wife. The court concluded that the murder was too complex to be committed while sleepwalking. Falater was charged with first-degree murder, a life sentence with no opportunity of parole.
- 2008, Brian Thomas, accused of killing his wife while he dreamt she was an intruder, whilst on holiday in West WalesWest WalesWest Wales is the western area of Wales.Some definitions of West Wales include only Pembrokeshire, Ceredigion and Carmarthenshire, an area which historically comprised the Welsh principality of Deheubarth., an area called "South West Wales" in the Nomenclature of Territorial Units for Statistics....
. Thomas was found not guilty.