Tuesday, September 22, 2020

Sleepwalkers don’t know they strolled around last night

There is a story in my family about our nephew, Jacob, a notorious sleepwalker.
Jacob is said to have one day woken up and, in his sleep, went to the tool shade and obtained himself an axe. He then proceeded to the fields where he dutifully cut down the big tree that stood in the middle of the field.

It is said Jacob did all this heavy duty piece of work while he was fast asleep. I never got a chance to prove it but some people swear it happened. Jacob himself is said not to have remembered anything in the morning when family elders tried to thank him.

It is, however, very unlikely that Jacob was asleep when he brought down the tree.
But he was a sleep-walker who was intercepted outside his hut many times.

“One of the main concerns with sleep walking, known as somnambulism, is injury to oneself or others,” says Dr. Vishesh Kapur, director of the University of Washington Sleep Disorders Center at Harborview Medical Center. “When there is any issue of complex behavior that has someone leaving the home or potentially doing activities that could hurt them, they should be evaluated and treated.”

Our Jacob never accessed any evaluation expert but the family always keeps a nocturnal eye on him and we were all warned against waking him up while he sleepwalked but, instead, to lead him back to his place of sleep and wake him up there. This, I suppose, is meant to minimize the confusion to the sleepwalker when he comes awake.

But why do people sleep-walk and how common is it?

Experts say that sleepwalking is, surprisingly, simply caused by the lack of sleep and, according to the Internet Encyclopedia Project, it affects more than 18% of the world’s population. It is also believed that men are more likely to sleepwalk than females.
“It can cause mental confusion, bouts of amnesia and even physical injuries in those affected as they wander,” wrote Robin Lloyd in LiveScience of May 10, 2008.

Kapur says that sleepwalking is “a disorder of arousal, a kind of mixed state of being”.

“There are three states of being in the world of sleep researchers: wakefulness, non-REM (rapid eye movement) sleep and REM sleep (most associated with dreams).” Sleepwalking is a mixture of wakefulness and non-REM sleep, he said.

“Some sort of arousal or disruption to sleep can also trigger sleepwalking, Kapur said. So people with sleep apnea (an interruption of breathing – snoring is commonly caused by apnea) sometimes sleepwalk, because apnea can create a state where someone is in between non-REM sleep and wakefulness.”

Family genetics can also predispose one to sleepwalking, Kapur said, but a lot is still unknown about why some people sleepwalk and others do not. He said that sleepwalking is common in kids “but usually they outgrow it”.

Rachel Nowak (“Sleepwalking woman had sex with strangers”, New Scientist, Oct 15) wrote that activities such as eating, bathing, urinating, dressing, or even driving cars, whistling, and committing murder had been reported or claimed to have occurred during sleepwalking.

“Contrary to popular belief, most cases of sleepwalking do not consist of walking around (without the conscious knowledge of the subject). Most cases of somnambulism occur when the person is awakened (something or someone disturbs their SWS), the person may sit up, look around and immediately go back to sleep. But these kinds of incidences are rarely noticed or reported unless recorded in a sleep clinic.”

Wikipedia says that sleepwalkers engage in their activities with their eyes open so they can navigate their surroundings, not with their eyes closed and their arms outstretched, as often parodied in cartoons and films.

In the February 2008 issue of the journal Annals of Neurology, Zadra, Mathieu Pilon and Jacques Montplaisir explain how they evaluated 40 suspected sleepwalkers.

Each was referred to the Sleep Research Centre at Sacre-Coeur Hospital at the Universite de Montreal teaching hospital, between August 2003 and March 2007.

“Our study found that sleep deprivation can precipitate sleepwalking in predisposed individuals,” Zadra, of the University of Montreal and who led a team that recently investigated the link between sleep loss and sleepwalking, said.

Sleepwalkers, he says, should keep a regular bedtime to avoid unwanted evening strolls.

The Medical Encyclopedia puts sleepwalking simply as “a disorder that occurs when a person walks or does another activity while they are still asleep”.

It goes on to say that the normal sleep cycle has distinct stages, from light drowsiness to deep sleep.

“During rapid eye movement (REM) sleep, the eyes move quickly and vivid dreaming is most common,” it says. “Each night people go through several cycles of non-REM and REM sleep. Sleep walking (somnambulism) most often occurs during deep, non-REM sleep (stage 3 or stage 4 sleep) early in the night. If it occurs during REM sleep, it is part of REM behavior disorder and tends to happen near morning.”

However, the Encyclopedia concedes that the cause of sleep walking in children is usually unknown “but may have to do with fatigue, lack of sleep, or anxiety.”

Sleep walking in adults, it goes on to say, can have to do with mental disorders, reactions to drugs and alcohol, or medical conditions such as partial complex seizures. In the elderly, sleep walking may be a symptom of an organic brain syndrome or REM behavior disorders.

“When someone sleep walks, they may sit up and look as though they are awake while they are actually asleep. They may get up and walk around, or do complex activities such as moving furniture, going to the bathroom, and dressing and undressing. Some people even drive a car while they are asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer.”

Allen J. Blaivas, D.O., Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, Virginia says that symptoms of sleep walking include: eyes open during sleep; may have blank look on face; may sit up and appear awake during sleep; walking during sleep; other detailed activity of any type during sleep; not remembering the sleep walking episode upon awakening; confused; disoriented upon awakening and sleep talking that does not make sense.

Experts say that some people mistakenly believe that a sleep walker should not be awakened.

“It is not dangerous to awaken a sleep walker, although it is common for the person to be confused or disoriented for a short time when they wake up,” says Blaivas. “Another misconception is that a person cannot be injured when sleep walking. Actually, sleep walkers are commonly injured by tripping and losing balance.”

Kapur says treatments for sleep walking include better sleep hygiene, keeping a regular sleep schedule (to avoid sleep deprivation) and avoiding an excess of alcohol and caffeine or maybe any at all, particularly in the evening.
For extreme cases, medication may be prescribed.

Blaivas also advises sleepwalkers to avoid the use of alcohol or central nervous system depressants.
“Avoid getting too tired and try to prevent insomnia, because this can trigger a sleep walking episode. Also avoid or minimize stress, anxiety, and conflict, which can worsen the condition.”

In addition, he says, safety measures may be needed to prevent injury. This may include changing the area by moving objects such as electrical cords or furniture to reduce the chances of tripping and falling. And you may need to lock the doors and/or the gate.

“Often the best way to deal with a sleepwalker safely is to direct the person back to the bed,” advises Wikipedia. “However, the person may continue getting up until he or she has accomplished the task that prompted the sleepwalking in the first place.”

For instance, if a sleepwalker is cleaning – a common sleepwalking activity – assisting in the cleaning may help to end the episode.

“As sleepwalkers do not tend to remember anything said or done while sleepwalking, there is no need to worry about embarrassment to you or the individual afterward.”

SOURCES: Robin Lloyd (LiveScience), Ask Yahoo,Wikipedia.

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The Telegraph September 23

Digital edition of The Telegraph, September 23, 2020.