Sleepwalking or walking in a dream

In the International Classification of Diseases (ICD-10), there is no pathology of sleepwalking, but there is a dream (medical name somnambulism) - V class (mental and behavior disorders), code - F51.3.

From time immemorial this unusual state in a dream, accompanied by unconscious movement, some actions and even speech, was attributed to the negative influence of moonlight (especially when the moon was full). In fact, the moon has nothing to do with it: sleepwalking is a kind of sleep disturbance - parasomnia.

[1], [2]

Epidemiology

Sleepwalking is more common in boys than in girls. The peak of manifestation of this parasomnia occurs at the age of 8 to 12 years, although the manifestation is noted at an earlier age. According to the latest data (2015), the total prevalence of sleepwalking in childhood - from 2.5 to 13 years - is 29.1%.

It is believed that sleepwalking in adults affects up to 2.5-3% of the population. According to the results of a survey conducted in 2010-2012. A team of scientists from the American Academy of Neurology (AAN) under the auspices of the National Institute of Health, sleepwalking occurs in adults much more often than previously thought.

As writes Neurology journal (2012, May), the dream is provoked by the presence of depression, anxiety, obsessive-compulsive disorders. Of the 15,929 Americans over the age of 18 (involved in the study), almost a third had a history of sleepwalking. In 3,6% such a case was noted only once a year; in 2,6% - attacks of sleepwalking happened monthly. And 17% of participants had lunatics among blood relatives.

People suffering from depression "travel" in a dream 3.5 times more often than those who do not have protracted depressive conditions. And in obsessive-compulsive disorders somnambulism is noted in 7.3% of patients.

[3], [4], [5], [6], [7], [8],

Causes of the sleepwalking

Most experts identify the key causes of sleepwalking in neurosis, which arises from traumatic life circumstances and internal contradictions of the personality and can lead to certain disorders of the nervous system, in particular, the processes of excitation and inhibition in the cerebral cortex. That is, sleepwalking arises as a psychogenic neurotic reaction.

[9], [10]

Risk factors

Risk factors for the manifestation of such a CNS reaction include:

• severe fatigue, insufficiency of sleep (prolonged disturbance of its schedule), anxiety, stress, depression;
• obsessive-compulsive disorder (adults are not excluded sleepwalking and obsessive thoughts, that is, the neurosis of obsessive thoughts );
• strokes;
• craniocerebral trauma;
• fever;
• migraine with aura;
• encephalitis and other infections of the brain;
• hyperthyroidism;
• with the sleep apnea indus;
• Essential narcolepsy (Jelino disease);
• neurodegenerative changes in the brain (with Alzheimer's or Parkinson's disease);
• reception of tricyclic antidepressants, neuroleptics, hypnotics;
• drug addiction;
• alcohol abuse (causes alcohol sleepwalking).

Sleepwalking in children, as well as sleepwalking in adolescents - is not so rare: according to a survey conducted by the National Sleep Foundation (USA), 1% of children from 3 to 7 years old and 2% of schoolchildren regularly go to sleep. Mentally, these children are healthy, and in most cases parasomnia passes as they grow older.

According to psychoneurologists, more attention should be paid to sleepwalking in adults - when all structures of the brain have been formed long ago, and this sleep disorder may indicate the onset of irreversible neurodegenerative processes.

Is sleepwalking associated with epilepsy? Since a phase similar to a paradoxical dream is detected during epileptic seizures and epileptics are unable to recall the events that occurred before the attack, sleepiness is seen as part of a complex of epileptic symptoms in patients with this disease.

And one more question: is it inherited by sleepwalking? Family propensity to this type of parasomnia was traced by specialists back in the 1980s. And in 2011 it was reported that scientists from the University of Washington examined four generations of one family, where 9 members out of 22 suffered from sleepwalking, and all of them had a DNA defect on the 20th chromosome. So the first genetic locus for sleepwalking has already been discovered. According to the journal of the American Medical Association JAMA Pediatrics, 48-61% of children with sleepwalking have one or both parents-lunatics.

[11], [12], [13], [14],

Pathogenesis

The pathogenesis of sleepwalking is associated with changes in the normal neurophysiological mechanism of sleep or with individual features of the bioelectric activity of the cerebral cortex and subcortex during night sleep.

By the way, those who sleep for a long time during the day, despite the fact that the weakening of alpha-waves of the brain occurs at night, sleepwalking may occur in the afternoon.

From the moment of falling asleep to awakening, there are five repetitive cycles of sleep, during which alternate intervals of orthodox slow sleep (NREM - without eyeballs under closed eyelids) and fast - paradoxical sleep (REM - with motion of closed eyes). Their average ratio in the structure of night sleep is 80% and 20%, respectively.

Immediately after the person is plunged into sleep, the alpha waves of the brain weaken and are replaced by theta-waves, which leads to a decrease in muscle activity, body temperature, heart rate and respiration, and metabolism slows down. It is a slow sleep (NREM), and as it deepens, bioelectric signals generated by the brain become predominantly delta waves. In this case, some subcortical and cortical neurons are really inactive during sleep, and other groups of neurons can be alternately active. Thus, the reticular formation of the brain and the structure of the hippocampus, even during sleep, will react to any external stimuli, initiating movement to preserve the integrity of the organism. Very active during sleep subcortical thinking (subconscious).

In periods of rapid (REM) sleep, which temporarily replace a slow sleep, on the contrary: pulse and breathing increase, cerebral blood flow increases, the adrenal glands synthesize hormones faster, and the activity of the neurons of the brain is very similar to their state during wakefulness.

The attacks of sleepwalking occur in the first two hours after falling asleep - during the third stage of the deepest NREM sleep, when the parasympathetic nervous system that supports the homeostasis dominates. Sleepwalking occurs in people with sleep disorders, when the brain "gets stuck" at the stage of slow sleep, desynchronization of the brain's bioelectric signals occurs, and part of its cortex and individual zones of the subcortex are brought into a state of partial physiological activity.

The pathogenesis of sleepwalking in children and adolescents also depends on the degree of maturity of the brain structures that ensure the functional activity of the central nervous system. In childhood and adolescence, the hypothalamic-pituitary system works intensively (producing growth hormone growth hormone), and the bioelectric activity of the cerebral cortex has its own characteristics. Thus, the synchronization of its biopotentials increases in 6-10 years, it decreases in 11-14 years, and after 15-16 years it increases again. With a decrease in the level of synchronization, the processes of excitation of the central nervous system prevail, multiple violations of autonomic functions are observed.

But sleepwalking according to Freud is a sign of an unresolved emotional conflict and is an attempt to satisfy unconscious instinctual needs.

[15], [16], [17], [18], [19], [20], [21],

Symptoms of the sleepwalking

The first signs of sleepwalking: a sleeping person sits in bed, opens his eyes, gets up and goes ...

Mandatory symptoms of sleepwalking: empty, like glazed eyes and absent facial expression; awkward movements; lack of response to the environment and confusion.

A sleepwalker can wander around the apartment, start dressing, pick up items, rearrange things in the room, climb into the closet, climb up the sill; can leave the house and go in an unknown direction (including, on the roadway). Children-somnambulists can safely go to the parents' bedroom or simply to the side of the world; a frequent symptom is enuresis and grinding of teeth in a dream (bruxism).

The attack of sleepwalking can last less than a minute, and can last for half an hour. To wake a person in this state is very difficult, since the brain is resistant to excitation during deep sleep.

Take a recumbent position and calm down the patient can anywhere. And waking up, he does not remember anything and comes into confusion. Admittedly, adults sometimes recall individual moments from what happened.

In the list of symptoms, sleepwalking and somnolocia are called sleep and sleep, that is, talking aloud during sleep. Doubt is also related to parasomnia and manifests itself in different ways: mumbling, loud enough sounds, cries and even a long, often vague speech. Most often, a sleeping person begins to talk during a less deep delta-wave of the orthodox stage of sleep. Sleepwalking and doubtfulness in the form of screams are more common in children and adolescents, especially when combined with nightmares.

Sleepwalking in adults can include elements of aggressiveness, as well as inadequate actions. Perhaps obscene exposure and even sexual activity in a state of somnambulism. Until 2003, physicians defined this as sexual behavior in a dream; but there was a tendency to allocate sexual sleepwalking, which - with the filing of a group of Canadian neurologists (Shapiro S., Trajanovic N., Fedoroff J.) - is now called sexmessemia.

Complications and consequences

According to doctors, sleepwalking itself in children and adolescents does not harm them emotionally, since memory does not record these "night walks", and sleep is not considered a sign of mental ill health. But then, what is the danger of sleepwalking?

Sufferers of sleepwalking can easily get injured, for example, going down the stairs, falling or trying to jump from a height. Prolonged sleep disturbance can lead to excessive sleepiness during the day and, possibly, to problems with academic achievement and behavior in the school.

It does not exclude undesirable consequences for others - when the actions in the parasomnemic state are aggressive and violent in nature (especially in men).

The fact that the sleepwalker can not be awakened is a common misconception; in fact, it is necessary to wake up, otherwise the "walk" may end in an accident. However, children are advised not to disturb, but gently return back to bed.

[22], [23], [24]

Diagnostics of the sleepwalking

Diagnosis of sleepwalking should be carried out by a neuropathologist, psychiatrist or somnologist.

To determine the degree of brain activity and the study of sleep characteristics, specialists use instrumental diagnostics:

• an electroencephalogram (EEG);
• electromyogram (EMG);
• electrooculogram (EOG);
• polysomnography.

[25], [26]

Differential diagnosis

The task performed by differential diagnosis is to identify neurodegenerative changes in the brain (MRI is used), obsessive-compulsive disorders and other conditions in which parasomnias can be observed. And differentiate them from delusions and hallucinations.

[27], [28], [29], [30], [31], [32]

Treatment of the sleepwalking

In the majority of cases, the treatment of sleepwalking is not carried out: complex therapeutic help should be provided for the disease, which led to the development of parasomnia.

Most often, the problem can be eliminated or at least the symptoms of sleepwalking in a child can be mitigated by improving sleep hygiene. For example, experts advise to conduct regular relaxing procedures before bed. If sleepwalking in children manifests itself frequently, doctors can recommend the use of a planned awakening - 45-50 minutes after the child has fallen asleep. This breaks the sleep cycle and prevents an attack.

For the treatment of sleepwalking, hypnosis can be used in adults. In addition, some may prescribe pharmacological agents, such as hypnotics and sedatives or antidepressant drugs. So, as a first line of treatment for sex somnias (sexual sleepwalking), use clonazepam tablets (other names - Klonopin, Ictoril, Rivotril) - 0.5 mg per hour before bedtime. This psychotropic drug is contraindicated in cases of kidney disease, liver problems, muscle weakness and pregnancy. Among the side effects noted nausea, ataxia, depressive state and increased irritability. Continuous reception is addictive.

The main reason for sleepwalking is the prevention of injuries during seizures. A child can not sleep on top of a bunk bed; windows and the door to the balcony for the night are tightly closed, excess pieces of furniture are removed (so that the lunatic does not stumble), the lock on the front doors should be blocked (to prevent the exit to the street).

Sleepwalking and the army

Many people are wondering whether they are taking to the army with sleepwalking?

The suitability for military service of military men of the National Guard of Ukraine who undergo medical examination in accordance with the Regulations on Military Medical Examination in the Armed Forces of Ukraine was approved by Order No. 402 of the Minister of Defense of Ukraine on August 14,

Annex to Order No. 402, Article 18: Behavioral syndromes, personality and emotion disorders F50-F69; F80-F99 (associated with eating disorders, with substance abuse that does not cause dependence); disorders of behavior and emotions in adolescence (hyperkinetic, social, emotional, unspecified mental), etc. In sleepwalking, the ICD code is F51.3.

If the listed behavioral syndromes and personality disorders: 1) are pronounced, with a tendency to repeated long decompensations or pathological reactions - a person is unsuitable for military service with removal from military records; 2) Moderately expressed with unsustainable compensation or compensated - a person is not suitable for military service in peacetime, is limited in wartime.