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Dr. Michael J. Breus

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Are You a Sleepwalker? Know Your Risk

Posted: 08/04/2012 8:50 am

Sleepwalking is a disorder that's easily -- and often -- misunderstood. When you think of sleepwalking, what comes to mind? A groggy, wandering toddler, or a movie-style sleepwalker with arms outstretched? Sleepwalking is a very real sleep disorder that affects adults as well as children, with consequences that can range from the embarrassing to the downright dangerous.

In recent years we've heard about sleepwalking most often in connection with hypnotic sleep medications, such as Ambien and Lunesta, with news stories of people on these medications doing all sorts of activities while asleep, including sleep eating and sleep driving.

A new study sheds some revealing light on sleepwalking: How common it is, who is at greater risk for experiencing it, and what medications are most strongly associated with it? The findings indicate that sleepwalking may be more common among adults than previously thought, and that this is a sleep disorder that runs in families.

Researchers at Stanford University investigated nocturnal wandering among 19,136 adults ages 18 and older. They collected information using a survey that addressed sleep habits, sleep disorders, mental and physical health, and medication use.

Since an official sleepwalking diagnosis is best conducted with an overnight sleep monitoring test, and this study used self-reported information in a survey, researchers used the phrase "nocturnal wandering" to describe the sleepwalking-like behavior. Participants answered questions about how often nocturnal wandering occurred, about behavior during the nocturnal wandering episodes, as well as about family history of the sleep disorder, medication use and other medical conditions. They found that nearly one-third of adults had some experience with nocturnal wandering:

• 29.2 percent reported an episode of nocturnal wandering at some point in their lives.
• 3.6 percent reported experiencing nocturnal wandering within the past year.
• 2.6 percent said they'd had between 1-12 episodes of nocturnal wandering in the past year.
• 1 percent reported experiencing episodes at least two or more times in the past month.

As the researchers themselves point out, the actual numbers of people having episodes of nocturnal wandering is likely to be higher, since this sleep disorder is typically accompanied by mental confusion and some amount of amnesia upon wakening. Some people who wander at night simply don't remember that it happened and therefore can't report it.

Researchers found that the presence of other sleep disorders was associated with a higher likelihood of nocturnal wandering. Sleep apnea, circadian rhythm disorder, and insomnia all were reported more frequently among people who also reported frequent episodes of nocturnal wandering. Their results showed:

• People with obstructive sleep apnea were 3.9 times as likely to experience nocturnal wandering two or more times a month than those without sleep apnea.
• Those who suffer from circadian rhythm disorder were 3.4 times as likely to have episodes of nocturnal wandering at least twice a month.
• Insomnia was associated with 2.1 times the risk of frequent nocturnal wandering.

Addiction and mental health issues were also associated with a higher risk of nocturnal wandering, according to the study's findings. Researchers found that people with alcohol dependence or addiction were more likely to have frequent sleepwalking episodes. So were those who reported serious depression and obsessive-compulsive disorder.

• People who reported alcohol addiction or alcohol dependence were 3.5 times as likely to report frequent episodes of nocturnal wandering, two or more per month.
• Those with major depressive disorder were at 3.5 times greater risk for frequent episodes of nocturnal wandering.
• Obsessive-compulsive disorder was associated with 3.9 times the risk of experiencing two or more episodes of nocturnal wandering per month.

These are all conditions that are also associated with other sleep disorders and with fragmented sleep. Sleep deprivation itself is a risk factor for sleepwalking.

In recent years, hypnotic sleep medications have been linked to sleepwalking in news reports. These types of medications include the drugs Ambien, Lunesta, and Sonata, and they've been the subject of much attention for possibly causing all sorts of nocturnal sleep activity, including sleepwalking, sleep eating and even sleep driving. The current study noted that some over-the-counter sleep medications were associated with an increased risk of nocturnal wandering.

A common type of antidepressant known as SSRI, or selective serotonin reuptake inhibitor, was associated with an increased risk of nocturnal wandering. SSRI medications are some of the most often prescribed antidepressants on the market today, including Prozac, Zoloft, Paxil, and Celexa, among many others.

Researchers also discovered what appears to be a strong family connection among sleepwalkers. Among those who reported a history of sleepwalking, 30.5 percent also reported having at least one family member who also experienced episodes of sleepwalking.

There's a great deal more for us to learn about what causes sleepwalking, particularly when it comes to the effects of sleep medications. It's important to know your risk factors and to use sleep medications -- even those over-the-counter types -- only in consultation with your doctor. Sleepwalking may look funny in a cartoon, but it's actually no laughing matter.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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