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  • Print publication year: 2010
  • Online publication date: November 2010

Case 17 - Frequent night-time wanderings

from Part IV - Parasomnias

Summary

This chapter presents the clinical history, examination, and the results of the procedures performed on a 30-year-old male shift worker who was admitted for the evaluation of uncontrolled daytime sleepiness and generalized muscle hypotonic attacks. The patient was also falling to the ground without loss of consciousness. The chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The results of polysomnography (PSG) showed that the patient had a total sleep time of 400 minutes and a total wake time of 40 minutes, with a sleep efficiency of 91%. The diagnosis was narcolepsy with cataplexy. Sodium oxybate was administered in increasing doses, and the progression after a year and a half was satisfactory; no episodes of cataplexy occurred during regular work hours. After 4 months of treatment with sodium oxybate, the patient did not complain of daytime sleepiness.

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Suggested reading

Historical
BroughtonRJ.Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in “dreaming sleep.” Science 1968; 159: 1070–8.
Review
PressmanMR.Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev 2007; 11: 5–30.
General
AASM (American Academy of Sleep Medicine). International Classification of Sleep Disorders, 2nd edn.: Diagnostic and Coding Manual. Westchester, Illinois: American Academy of Sleep Medicine, 2005.
OhayonMM, GuilleminaultC, PriestRG.Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry 1999; 60: 268–76.
PlazziG, TinuperP, MontagnaP, ProviniF, LugaresiE.Epileptic nocturnal wanderings. Sleep 1995; 18: 749–56.
SansoneRA, SansoneLA.Zolpidem, somnambulism, and nocturnal eating. Gen Hosp Psychiatry 2008; 30: 90–1.
SchenckCH, ParejaJA, PattersonAL, MahowaldMW.Analysis of polysomnographic events surrounding 252 slow-wave sleep arousals in thirty-eight adults with injurious sleepwalking and sleep terrors. J Clin Neurophysiol 1998; 15: 159–66.

Historical

BroughtonRJ.Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in “dreaming sleep.” Science 1968; 159: 1070–8.

Review

PressmanMR.Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev 2007; 11: 5–30.

General

AASM (American Academy of Sleep Medicine). International Classification of Sleep Disorders, 2nd edn.: Diagnostic and Coding Manual. Westchester, Illinois: American Academy of Sleep Medicine, 2005.
OhayonMM, GuilleminaultC, PriestRG.Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry 1999; 60: 268–76.
PlazziG, TinuperP, MontagnaP, ProviniF, LugaresiE.Epileptic nocturnal wanderings. Sleep 1995; 18: 749–56.
SansoneRA, SansoneLA.Zolpidem, somnambulism, and nocturnal eating. Gen Hosp Psychiatry 2008; 30: 90–1.
SchenckCH, ParejaJA, PattersonAL, MahowaldMW.Analysis of polysomnographic events surrounding 252 slow-wave sleep arousals in thirty-eight adults with injurious sleepwalking and sleep terrors. J Clin Neurophysiol 1998; 15: 159–66.