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  • Cited by 1
  • Print publication year: 2010
  • Online publication date: November 2010

Chapter 12 - Sleepwalking

from Section 2 - Disorders of arousal


Many of the parasomnias are manifestations of central nervous system activation and autonomic nervous system changes with skeletal muscle activity. Parasomnias can contribute to impaired academic or occupational performance, disturbances of mood and social adjustment. Identification of the presence of any psychological trauma or history of such trauma is important when trying to understand the possible sources of parasomnia. There is a predisposition to sleep-related dissociative disorder in victims of physical or sexual abuse or post-traumatic stress disorder (PTSD). Secondary sleep enuresis is also noted in these patients. This chapter begins with a thorough history-taking, keeping in mind the Parasomnia Classification in the International Classification of Sleep Disorders, 2nd edition (ICSD-2) and the differential diagnosis of abnormal behaviors and events during sleep. Seizures should always be considered in the differential of parasomnias, and formal EEG studies should be performed with appropriateness.


1. BroughtonRJ. Sleep disorders: disorders of arousal?Science 1968; 159: 1070–8.
2. KalesA, JacobsonA, PaulsonMJ, et al. Somnambulism: Psychophysiological correlates. I. All-night EEG studies. Arch Gen Psychiat 1966; 14: 586–94.
3. PressmanM. Factors that predispose, prime and precipitate NREM parasomnias in adults: Clinical and forensic implications. Sleep Med Rev 2007; 11: 5–30.
4. PressmanMR, MahowaldMW, SchenckCH, et al. Alcohol-induced sleepwalking or confusional arousal as a defense to criminal behavior: A review of scientific evidence, methods and forensic considerations. J Sleep Res 2007; 16: 198–212.
5. ZadraA, PilonM, MontplaisirJ. Phenomenology of somnambulism. Sleep 2006; 29: A269.
6. KaveyNB, WhyteJ, ResorSR, et al. Somnambulism in adults. Neurology 1990; 40: 749–52.
7. SchenckCH, MilnerDM, HurwitzTD, et al. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry 1989; 146: 1166–73.
8. MoldofskyH, GilbertR, LueFA, et al. Forensic sleep medicine: Violence, sleep, nocturnal wandering: Sleep-related violence. Sleep 1995; 18: 731–9.
9. GuilleminaultC, KirisogluC, BaoG, et al. Adult chronic sleepwalking and its treatment based on polysomnography. Brain 2005; 128: 1062–9.
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington, DC: APA, 1994.
11. American Academy of Sleep Medicine. ICSD-2: International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine, 2005.
12. HublinC, KaprioJ, PartinenM, et al. Parasomnias: Co-occurrence and genetics. Psychiatr Genet 2001; 11: 65–70.
13. SchenckCH, ParejaJA, PattersonAL, et al. 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.
14. BlattI, PeledR, GadothN, et al. The value of sleep recording in evaluating somnambulism in young adults. Electroencephalogr Clin Neurophysiol 1991; 78: 407–12.
15. JoncasS, ZadraA, PaquetJ, et al. The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology 2002; 58: 936–40.
16. PilonM, ZadraA, JoncasS, et al. Hypersynchronous delta waves and somnambulism: Brain topography and effect of sleep deprivation. Sleep 2006; 29: 77–84.
17. 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.
18. EspaF, DauvilliersY, OndzeB, et al. Arousal reactions in sleepwalking and night terrors in adults: The role of respiratory events. Sleep 2002; 25: 871–5.
19. GuilleminaultC, PalombiniL, PelayoR, et al. Sleepwalking and sleep terrors in prepubertal children: What triggers them?Pediatrics 2003; 111: e17–25.
20. GoodwinJ, KaeminghK, FregosiR, et al. Parasomnias and sleep disordered breathing in Caucasian and Hispanic children – the Tucson children's assessment of sleep apnea study. BMC Med 2004; 2. Available at–7015/2/14. Accessed January 15, 2005.
21. ZadraA, PilonM, MontplaisirJ. Polysomnographic diagnosis of sleepwalking: Effects of sleep deprivation. Ann Neurol 2008; 63: 513–9.
22. PilonM, MontplaisirJ, ZadraA. Precipitating factors of somnambulism: Impact of sleep deprivation and forced arousals. Neurology 2008; 70: 2284–90.
23. KlackenbergG. Somnambulism in childhood: Prevalence, course and behavioral correlations. Acta Paed Scand 1982; 71: 495–9.
24. HublinC, KaprioJ, PartinenM, et al. Prevalence and genetics of sleepwalking: A population-based twin study. Neurology 1997; 48: 177–81.
25. GoldinPR. Epidemiology of nine parasomnias in young adults. Sleep Res Online 1997; 26: 367.
26. BroughtonR. NREM arousal parasomnias. In KrygerMH, RothT, DementWC (Eds), Principles and Practice of Sleep Medicine. 3rd ed. Philadelphia, WB Saunders, 2000; 693–706.
27. SchenckCH, MahowaldMW. Two cases of premenstrual sleep terrors and injurious sleep-walking. J Psychosom Obst Gyn 1995; 16: 79–84.
28. HedmanC, PohjasvaaraT, TolonenU, et al. Parasomnias decline during pregnancy. Acta Neurol Scand 2002; 105: 209–14.
29. ZucconiM, OldaniA, Ferini-StrambiL, et al. Arousal fluctuations in non-rapid eye movement parasomnias: The role of cyclic alternating pattern as a measure of sleep instability. J Clin Neurophysiol 1995; 12: 147–54.
30. EspaF, OndzeB, DegliseP, et al. Sleep architecture, slow wave activity, and sleep spindles in adult patients with sleepwalking and sleep terrors. Clin Neurophysiol 2000; 111: 929–39.
31. PressmanMR. Hypersynchronous delta sleep EEG activity and sudden arousals from slow-wave sleep in adults without a history of parasomnias: Clinical and forensic implications. Sleep 2004; 27: 706–10.
32. GaudreauH, JoncasS, ZadraA, et al. Dynamics of slow-wave activity during the NREM sleep of sleepwalkers and control subjects. Sleep 2000; 23: 755–60.
33. GuilleminaultC, PoyaresD, AftabFA, et al. Sleep and wakefulness in somnambulism: A spectral analysis study. J Psychosom Res 2001; 51: 411–6.
34. ZadraA, PilonM, JoncasS, et al. Analysis of postarousal EEG activity during somnambulistic episodes. J Sleep Res 2004; 13: 279–84.
35. OlivieroA, DellaMarca G, TonaliPA, et al. Functional involvement of cerebral cortex in adult sleepwalking. J Neurol 2007; 254: 1066–72.
36. BassettiC, VellaS, DonatiF, et al. SPECT during sleepwalking. Lancet 2000; 356: 484–5.
37. LecendreuxM, BassettiC, DauvilliersY, et al. HLA and genetic susceptibility to sleepwalking. Mol Psychiatry 2003; 8: 114–7.
38. KalesA, SoldatosCR, BixlerEO, et al. Hereditary factors in sleepwalking and night terrors. Br J Psychiatr 1980; 137: 111–8.
39. PaiMN. Sleep-walking and sleep activities. J Ment Sci 1946; 92: 756–65.
40. KalesA, SoldatosCR, CaldwellAB, et al. Somnambulism. Clinical characteristics and personality patterns. Arch Gen Psychiat 1980; 37: 1406–10.
41. GauS-F, SoongW-T. Psychiatric comorbidity of adolescents with sleep terrors or sleepwalking: A case-control study. Aust NZ J Psychiat 1999; 33: 734–9.
42. MahowaldMW, SchenckCH. Dissociated states of wakefulness and sleep. In LydicR, BaghdoyanHA (Eds), Handbook of Behavioural State Control: Cellular and Molecular Mechanisms. New York: CRC Press, 1999; 143–58.
43. SchenckCH, BoydJL, MahowaldMW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997; 20: 972–81.
44. JuszczakGR, SwiergielAH. Serotonergic hypothesis of sleepwalking. Med Hypotheses 2005; 64: 28–32.
45. HarrisM, GrunsteinRR. Treatments for somnambulism in adults: Assessing the evidence. Sleep Med Rev 2009; 13: 295–7.
46. ReidWH, AhmedI, LevieCA. Treatment of sleepwalking: A controlled study. Am J Psychother 1981; 35: 27–37.
47. HauriPJ, SilberMH, BoeveBF. The treatment of parasomnias with hypnosis: A 5-year follow-up study. J Clin Sleep Med 2007; 3: 369–73.
48. HurwitzT, MahowaldM, SchenckC, et al. A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror. J Nerv Ment Dis 1991; 179: 228–33.
49. TobinJD, Jr. Treatment of somnambulism with anticipatory awakening. J Pediatr 1993; 122: 426–7.
50. RemullaA, GuilleminaultC. Somnambulism (sleepwalking). Expert Opin Pharmacother 2004; 5: 2069–74.