Sleepwalking

Implies getting out of bed and walking around although the person is still asleep. This usually occurs in a non-REM state (non-dreaming) of sleep. The person in case can do several activities like moving furniture around, doing work related tasks, wandering outside, eating or talking without having any memory of these things after waking up.

 

Night terrors

Episodes in which a person will suddenly sit up in bed and start screaming. This usually happens in the first part of the night and no memory of the event is recorded.

 

Bedwetting (enuresis)

Usually occurs in children and is of two types: primary and secondary. Primary enuresis appears from the inability to wake up and urinate when the bladder is full. Secondary enuresis occurs either when a child or adult faces periods of high mental or social stress, or due to the emergence of a medical condition (diabetes, urinary tract infection). It shouldn’t be a concern until after the age of 6-7 years (children develop bladder control skills in time).

Causes

Sleepwalking:

sleep deprivation

fatigue

stress

depression, anxiety

high fever

medication/substances: hypnotics, sedatives, alcohol

Underlying conditions that can cause sleepwalking:

sleep apnea

narcolepsy (neurological disorder – inability to regulate sleep-wake cycles)

restless legs syndrome (uncontrollable urge to move the legs)

hyperthyroidism

head injury, stroke

gastroesophageal reflux disease

 

Night terrors:

sleep deprivation

stress

sleeping in unfamiliar surroundings

lights, noise

sleep apnea (abnormal breathing pattern)

migraines

head injuries

restless legs syndrome

 

Bedwetting

a small bladder or bladder nerves that have not yet matured

stressful events (starting school, becoming a big brother/sister)

lack of sufficient levels of vasopressin (anti-diuretic hormone produced by the pituitary gland) – levels normally increase during sleep and reduce the amount of urine produced by the kidneys

urinary tract infections

sleep apnea

diabetes

chronic constipation

psychiatric problems (Alzheimer’s disease, dementia)

a family history predisposition: if the parents had bedwetting problems, the child is likely to have them too

Symptoms and signs

Sleepwalking:

 

getting out of bed and walking around

glassy-eyed expression

doing routine activities

not responding/communicating with people they come across

disorientation, confusion after being awakened

falling asleep quickly after

not having any memory of the episode

sleep terrors (night terrors)

 

 

Night terrors:

 

during night terrors the person remains asleep

does not remember anything regarding the episode

screaming, shouting

kicking

sweating

heavy breathing

racing pulse

wide-eyed stare

aggressive behavior

 

Bedwetting:

 

in primary bedwetting, the child has not regularly stayed dry during sleep for six months

 

in secondary bedwetting, the child/adult experiences “accidental episodes” at least twice a week for at least three months after they have had dry periods (that have lasted six months)

 

in the case of urinary tract infections: day-time “accidents”, frequent urination, pink coloration of the urine, pain while urinating

Advice

Sleepwalking and Night terrors:

 

your doctor will perform a physical and psychological examination in order to rule out other conditions such as night-time seizures, panic attacks or other sleep disorders

 

you can undergo a sleep study: monitoring is done in a laboratory and sensors are attached to the patient (brain waves, heart rate, breathing, oxygen levels are monitored)

 

if there are underlying conditions, they should be treated to prevent sleepwalking and night terrors

 

anticipatory awakenings: awaken the person in case 15 minutes before he/she usually sleepwalks

 

improve sleep habits

 

medication: benzodiazepines or antidepressants

 

learning self-hypnosis

 

 

Bedwetting:

 

the matter should be treated with patience, as the event is recorded as being most embarrassing for the child

 

bedwetting is usually outgrown by children

 

a doctor will recommend urine tests to see if there are signs of infection or diabetes and also X-rays or imaging tests (to have a look at the bladder and kidneys) if he suspects a structural problem in the child’s urinary system

 

moisture alarms are available (devices that are connected to a moisture sensitive pad on the child’s pajamas or bedding) and help the child wake before he/she wets the bed

 

medication: desmopressin (increase the levels of anti-diuretic hormone), anticholinergics (reduce bladder contractions and increase bladder capacity)

 

limit liquid intake in the evening

 

avoid foods/drinks that contain caffeine

 

encourage double-voiding of the bladder before bedtime

 

constipation treatment

 

alternative therapies: acupuncture, hypnosis

 

punishing or teasing the child on this matter is of no help, instead parents should encourage and celebrate the child’s effort regarding the matter

MISCONCEPTIONS
  •  

    You should never wake up a sleepwalker.

     

    A sleepwalker is perfectly aware of what he/she is doing.

     

    Sleepwalking mainly occurs in adults.

     

    Bedwetting is just a sign of laziness.

     

    Bedwetting is a sign of antisocial tendencies.

     

    Night terrors are just bad dreams.

     

    Eating cheese can give you nightmares and night terrors.

Statistics

Recurrent sleepwalking affects 5% of children and 7% of adults

 

Prevalence is high in children between the ages of 3 and 8 years old

 

About 8.4 million Americans sleepwalk each year

 

In the USA, 1-6% of children experience night terrors

 

Less than 1% of adults experience frequent night terrors

 

Bedwetting is twice as common in boys than in girls

Did you know?

 

Somnambulistic sex behavior (or sexsomnia) is a variation of sleepwalking and can imply all types of sexual activity from sexual vocalizations and masturbating to complex sexual acts.

 

Sleep-related eating disorder is another variation of sleepwalking that implies binge-eating.

 

Awakening a sleepwalker is not dangerous but most likely he/she will be confused or agitated after awakening.

 

Natural sleep aids are not always risk-free. For example, large doses of valerian root can cause dizziness and a sluggish state in the morning.

 

Bedwetting is more common in children with ADHD.

 

A small number of the children with primary enuresis don’t produce the additional vasopressin needed during the night.