Somnambulism (Sleep Walking) Treatment & Management

  • Author: Gregory Ackroyd, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Mar 25, 2010
 

Medical Care

  • General guidelines
    • Reassurance is the mainstay of treatment. The benign nature of the events and subsequent disappearance in most cases should be emphasized.
    • If environmental or predisposing factors are discovered, an attempt should be made to eliminate them. Assure adequate sleep, regulation of sleep cycle, and treatment of underlying medical conditions (eg, gastroesophageal reflux, obstructive sleep apnea, periodic leg movements, seizures).
    • Avoid auditory, tactile, or visual stimuli early in the sleep cycle. These have been shown to induce events in some patients with parasomnias.
    • Instruct parents to lock windows and doors, remove obstacles and sharp objects from the room, and add alarms (if necessary) to decrease the likelihood of injury during an episode.
    • Depending on the situation, comforting the child and gently redirecting him or her to bed may be appropriate. Attempts to confront or wake up patients during the events frequently lengthens the parasomnia episode and may induce resistance or violence from the patient.
  • Pharmacological measures may be necessary in the following situations:
    • The possibility of injury is real.
    • Continued behaviors are causing significant family disruption or excessive daytime sleepiness.
    • Unusual symptoms are present.
    • Nonpharmacological interventions have proven to be inadequate.
    • Benzodiazepines, tricyclic antidepressants, and serotonin reuptake inhibitors have been shown to be useful. Clonazepam in low doses before bedtime and continued for 3-6 weeks is usually effective.
    • Medication often can be discontinued after 3-5 weeks without recurrence of symptoms. Occasionally, frequency of episodes increases briefly after discontinuing the medication because of rebound sleep.
  • Nonpharmacological measures
    • Relaxation techniques, mental imagery, and anticipatory awakenings are preferred for long-term management. The first 2 techniques should be undertaken only with the help of an experienced behavioral therapist or hypnotist.
    • Anticipatory awakenings consist of waking the child approximately 15-20 minutes before the usual time of an event and then keeping him awake through the time during which the episodes usually occur.
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Surgical Care

Sleepwalking associated with sleep-disordered breathing may improve or resolve with surgical treatment of the respiratory disorder.

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Contributor Information and Disclosures
Author

Gregory Ackroyd, MD  Consulting Staff, North Bay Sleep Medicine Institute

Gregory Ackroyd, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

O'Neill F D'Cruz, MD  Professor, Departments of Neurology and Pediatrics, Director, Pediatric Sleep Program, University of North Carolina

O'Neill F D'Cruz, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Medical Association, Child Neurology Society, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Stephen J Sharp, MD  Assistant Professor of Neurology and Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Stephen J Sharp, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Anthony M Murro, MD  Laboratory Director, Professor, Department of Neurology, Medical College of Georgia

Anthony M Murro, MD is a member of the following medical societies: American Academy of Neurology and American Epilepsy Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Kenneth J Mack, MD, PhD  Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Ortho McNeil Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Speaking, consulting

References

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  15. Rosen GM, Mahowald MW, Ferber R. Sleepwalking, confusional arousals, and sleep terrors in the child. In: Principles and Practice of Sleep Medicine in the Child. 1995:99-106.

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