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There are many sleep disorders. The following are covered.
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Bruxism, Fibromyalgia, Sleepwalking, Hypersomnia, Sleep Terrors

What is Sleepwalking (Somnambulism)?

Sleepwalking (Somnambulism) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.

What are the symptoms of Sleepwalking (Somnambulism)?

Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in prepubertal children.

Associated features include:

  • difficulty in arousing the patient during an episode
  • amnesia following an episode
  • episodes typically occur in the first third of the sleep episode
  • polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
  • other medical and psychiatric disorders can be present but do not account for the symptom
  • the ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors

How Common is Sleepwalking?

Medical reports show that about 18% of the population are prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age.  Sleepwalking can have a genetic tendency. If a child begins to sleepwalk at the age of 9, it often lasts into adulthood.

How serious is Sleepwalking?

For some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in harm to the patient or others. In its most severe form, the episodes occur almost nightly or are associated with physical injury.  The sleepwalker may feel embarrassment, shame, guilt, anxiety and confusion when they are told about their sleepwalking behavior.

If the sleepwalker exits the house, or is having frequent episodes and injuries are occurring -- DO NOT delay, it is time to seek professional help from a sleep disorder center in your area. There have been some tragedies with sleepwalkers, don't let it happen to your loved one!

What can be done about sleepwalking?

There are some things a sleepwalker can do:

  • Make sure you get plenty of rest; being overtired can trigger a sleepwalking episode.
  • Develop a calming bedtime ritual. Some people meditate or do relaxation exercises; stress can be another trigger for sleepwalking.
  • Remove anything from the bedroom that could be hazardous or harmful.
  • The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.
  • An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary.
  • Hypnosis has been found to be helpful for both children and adults.
  • An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.
  • Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or considerably reduces them.

What are Sleep Terrors?

Sleep Terrors are characterized by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic (Controlled by the part of the nervous system that regulates motor functions of the heart, lungs, etc.) and behavioral manifestations of intense fear. Also known as Pavor Nocturnus, incubus, severe autonomic discharge, night terror.

What are the symptoms of Sleep Terrors?

  • A sudden episode of intense terror during sleep
  • The episodes usually occur within the first third of the night
  • Partial or total amnesia occurs for the events during the episode.

Associated features include:

  • Polysomnographic monitoring demonstrates the onset of episodes during stage 3 or 4 sleep
  • Tachycardia usually occurs in association with the episodes.
  • Other medical disorders are not the cause of the episode, e.g., epilepsy
  • Other sleep disorders can be present, e.g., nightmares.

How serious are Sleep Terrors?

Some people have episodes of sleep terror that may occur less than once per month, and do not result in harm to the patient or others. While some people experience episodes less than once per week, and do not result in harm to the patient or others. In its severest form, the episodes occur almost nightly, or are associated with physical injury to the patient or others. Consult a sleep specialist if you are concerned.

What is Sleep Bruxism?

Sleep Bruxism is a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep.  The disorder has also been identified as nocturnal bruxism, nocturnal tooth-grinding and nocturnal tooth-clenching.

What are the Symptoms?

The symptoms of Sleep Bruxism are tooth-grinding or tooth-clenching during sleep that may cause:

  • abnormal wear of the teeth
  • sounds associated with bruxism (It's about as pleasant as fingernails on a chalkboard!)
  • jaw muscle discomfort

How serious is the disorder?

Some people have episodes that occur less than nightly with no evidence of dental injury or impairment of psychosocial functioning. And others experience nightly episodes with evidence of mild impairment of psychosocial functioning. Yet others have nightly episodes with evidence of dental injury, tempomandibular (jaw) disorders, other physical injury or moderate or severe impairment of psychosocial functioning.

When someone with suspected sleep bruxism has a polysomnographic test there is evidence of jaw muscle activity during the sleep period and the absence of abnormal movement during sleep.  Other sleep disorders may be present at the same time, e.g., obstructive sleep apnea, restless legs syndrome.

What is Fibromyalgia?

Fibromyalgia is a disorder involving chronic pain in your muscles, ligaments and tendons. Fibromyalgia is also known as Fibromyositsis, rheumatic pain modulation disorder or Fibrositis Syndrome.

What are the symptoms of Fibromyalgia?

  • Unrefreshing sleep
  • Muscular pain
  • Firm, tender zones are found within the muscles, particularly those of the neck and shoulders

Polysomnography shows alpha activity during non-REM sleep, particularly stage 3 and 4 sleep. A Multiple Sleep Latency Test (MSLT) shows a normal amount of time in falling asleep.

What is the treatment for Fibromyalgia?

A low dose of tri-cyclic antidepressants seem to help. Exercise and relaxation techniques are suggested. Sometimes an analgesic is prescribed.

What is Hypersomnia?

Hypersomnia is excessive sleepiness. It is an excessively deep or prolonged major sleep period. It may be associated with difficulty in awakening. It is believed to be caused by the central nervous system and can be associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (1-2 hours) sleep episodes of non-REM sleep.

What are the Symptoms?

  • Long sleep periods
  • Excessive sleepiness or excessively deep sleep
  • The onset is insidious (gradually, so you are not aware of it at first)
  • Typically appears before age 25
  • Has been present for at lest six months

How does a doctor determine that I have hypersomnia?

The first step is to consult a sleep specialist. The specialist will probably order a polysomnography test (sleep study) where you stay overnight while Technologists monitor your muscle movement, heartbeat, eye movement, leg movements and respiration. The specialist may also want to do a Multiple Sleep Latency Test (MSLT) that tests how sleepy you are.

How can it be treated?

Since the cause is still unknown, treatment consists of behavioral changes, good sleep hygiene and taking stimulants to help you be more alert. Limit your naps to one (preferably in the afternoon) lasting no longer than 45 minutes. Get at least 81/2 hours of sleep. Avoid shiftwork, alcohol and caffeine. Your doctor will determine the amount and type of stimulant you should take.

Books to read:

Go to The SleepMall and click on Sandman's Bookstore. Most books that focus
on many unusual sleep disorders will be in the General and Misc. Sleep Books category.

 

Much of the above information was provided by dipping into Dr. William C. Dement's SleepWell.

 

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