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Sleepwalking

June 11th, 2015 Raquel Rothe

From Mayo Clinic

Sleepwalking — also known as somnambulism — involves getting up and walking around while in a state of sleep. More common in children than adults, sleepwalking is usually outgrown by the teen years. Isolated incidents of sleepwalking often don’t signal any serious problems or require treatment. However, recurrent sleepwalking may suggest an underlying sleep disorder.

Sleepwalking is less common in adults and has a higher chance of being confused with or coexisting with other sleep disorders as well as medical and mental health conditions.

If anyone in your household sleepwalks, it’s important to protect him or her from sleepwalking-related injuries.

Symptoms

Sleepwalking is classified as a parasomnia — an undesirable behavior or experience during sleep. Sleepwalking is a disorder of arousal, meaning it occurs during slow wave sleep, the deepest stage of dreamless (non-rapid eye movement, or NREM) sleep. Another NREM disorder is sleep terrors, which can occur together with sleepwalking.

Sleepwalking usually occurs early in the night — often one to two hours after falling asleep. It’s unlikely to occur during naps. A sleepwalking episode can occur rarely or often, and an episode generally lasts several minutes, but can last longer.

Someone who is sleepwalking may:

  • Get out of bed and walk around
  • Sit up in bed and open his or her eyes
  • Have a glazed, glassy-eyed expression
  • Do routine activities, such as getting dressed, talking or making a snack
  • Not respond or communicate with others
  • Be difficult to wake up during an episode
  • Be disoriented or confused for a short time after being awakened
  • Quickly return to sleep
  • Not remember the episode in the morning
  • Sometimes have problems functioning during the day because of disturbed sleep
  • Have sleep terrors in addition to sleepwalking

Rarely, a person who is sleepwalking will:

  • Leave the house
  • Drive a car
  • Engage in unusual behavior, such as urinating in a closet
  • Engage in sexual activity without awareness
  • Get injured, for example, by falling down the stairs or jumping out a window
  • Become violent during the confused period after awakening or, occasionally, during the event

When to see a doctor

Occasional episodes of sleepwalking aren’t usually a cause for concern. You can simply mention the sleepwalking at a routine physical or well-child exam. However, consult your doctor if the sleepwalking episodes:

  • Occur often — for example, more than one to two times a week
  • Lead to dangerous behavior or injury to the person who sleepwalks (which may occur, for example, after leaving the house) or to others
  • Cause significant sleep disruption to household members or embarrassment to the person who sleepwalks
  • Start for the first time in an adult
  • Continue into your child’s teen years

Causes

Many factors can contribute to sleepwalking, including:

  • Sleep deprivation
  • Fatigue
  • Stress
  • Depression
  • Anxiety, such as separation anxiety in children
  • Fever
  • Sleep schedule disruptions
  • Some medications and substances, such as short-acting hypnotics, sedatives or combinations of different drugs prescribed for psychiatric illnesses, as well as alcohol

Sometimes sleepwalking can by triggered by underlying conditions that interfere with sleep, such as:

  • Sleep-disordered breathing — a group of disorders characterized by abnormal breathing patterns during sleep (for example, obstructive sleep apnea)
  • Narcolepsy
  • Restless legs syndrome
  • Gastroesophageal reflux disease (GERD)
  • Migraines
  • Medical conditions such as hyperthyroidism, head injury or stroke
  • Travel

Risk factors

Factors that may increase the risk of sleepwalking include:

  • Genetics. Sleepwalking appears to run in families. It’s more common if you have one parent who has a history of sleepwalking, and much more common if both parents have a history of the disorder.
  • Age. Sleepwalking occurs more often in children than adults, and onset in adulthood is more likely related to other health conditions.

Complications

Sleepwalking itself isn’t necessarily a concern, but sleepwalkers can:

  • Easily hurt themselves — especially if they walk near furniture or stairs, wander outdoors, drive a car or eat something inappropriate during a sleepwalking episode
  • Experience prolonged sleep disruption, which can lead to excessive daytime sleepiness and possible school or behavior issues
  • Be embarrassed or experience problems with social relationships
  • Disturb others’ sleep
  • Injure someone who is close by during the period of brief confusion immediately after waking or occasionally during the event

Preparing for your appointment

If you have concerns about safety or underlying conditions, you may want to see your doctor. Your doctor may refer you to a sleep specialist.

What you can do

Here’s some information to help you prepare for your appointment.

  • Keep a sleep diary for two weeks before the appointment to help your doctor understand what’s causing the sleepwalking. In the morning, record as much as you know of bedtime rituals, quality of sleep, and so on. At the end of the day, record behaviors that may affect sleep, such as sleep schedule disruptions, caffeine intake and any medications taken.
  • Make a list of any symptoms experienced, including any that may seem unrelated to the reason for the appointment.
  • Make a list of key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or other supplements currently being taken, and the dosages.
  • Bring a family member or friend along, if possible, to help you remember what the doctor says.
  • Prepare questions to ask your doctor to help you make the most of your time together.

Some basic questions to ask your doctor include:

  • What is likely causing the symptoms or condition?
  • What are other possible causes?
  • What kinds of tests are needed?
  • Is the condition likely temporary or chronic?
  • What’s the best course of action?
  • What are the alternatives to the primary approach you’re suggesting?
  • Are there any restrictions that need to be followed?
  • Is referral to a specialist needed?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did you begin experiencing or noticing symptoms?
  • Have you or your child had sleep problems in the past?
  • Does anyone else in your family have sleep problems?
  • What problems have you noticed related to the sleepwalking, such as awakening in unusual locations of the house?

Tests and diagnosis

Unless you live alone and are completely unaware of your sleepwalking, chances are you’ll make the diagnosis of sleepwalking for yourself. If your child sleepwalks, you’ll know it.

Your doctor may do a physical or psychological exam to identify any conditions that may be confused with sleepwalking, such as nighttime seizures, other sleep disorders or panic attacks. In some cases, a sleep study in an overnight sleep lab may be recommended.

Sleep studies

To participate in a sleep study, also known as a polysomnogram, you’ll likely spend the night in a sleep lab. A technologist places sensors on your scalp, temples, chest and legs using a mild adhesive, such as glue or tape. The sensors are connected by wires to a computer. A small clip is placed on your finger or ear to monitor the level of oxygen in your blood.

Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study. Technologists monitor you throughout the night while you sleep.

Your doctor will review the information to determine whether you have any sleep disorders.

Treatments and drugs

Treatment for occasional sleepwalking usually isn’t necessary. In children who sleepwalk, it typically goes away by the teen years.

If you notice your child or anyone else in your household sleepwalking, gently lead him or her back to bed. It’s not dangerous to the sleepwalker to be awakened, but it can be disruptive — the person may become confused and disoriented, and possibly agitated.

Treatment may be needed if there are negative consequences for the sleepwalking, such as risk of injury or embarrassment, or if there’s distress for others.

Treatment may include:

  • Treating the underlying condition, if the sleepwalking is associated with sleep deprivation or an underlying sleep disturbance, medical condition or a mental health disorder
  • A change of medication, if it’s thought that the sleepwalking results from a drug
  • Anticipatory awakenings ― waking the sleepwalker about 15 minutes before the person usually sleepwalks, then staying awake for five minutes before falling asleep again
  • Medication, such as benzodiazepines or certain antidepressants, if the sleepwalking leads to the potential for injury, is disruptive to family members, or results in embarrassment or sleep disruption for the person who sleepwalks
  • Learning self-hypnosis

Lifestyle and home remedies

If sleepwalking is a problem for you or your child, try these suggestions.

  • Make the environment safe for sleepwalking. If sleepwalking has led to injuries or has the potential to do so, consider some of these precautions to prevent injury: Close and lock all windows and exterior doors at night. You might even lock interior doors or place alarms or bells on the doors. Block doorways or stairways with a gate, and move electrical cords or other objects that pose a tripping hazard. Sleep in a ground floor bedroom, if possible. Place any sharp or fragile objects out of reach, and lock up all weapons. If your child sleepwalks, don’t let him or her sleep in a bunk bed.
  • Get more sleep. Fatigue can contribute to sleepwalking. If you’re sleep deprived, try an earlier bedtime, a more regular sleep schedule or a short nap, especially for toddlers.
  • Establish a regular, relaxing routine before bedtime. Do quiet, calming activities before bed, such as reading books, doing puzzles or soaking in a warm bath. Meditation or relaxation exercises may help, too.
  • Put stress in its place. Identify the issues that cause stress, and brainstorm possible ways to handle the stress. Talk about what’s bothering you. Or if your child seems anxious or stressed, talk with him or her about any concerns.
  • Look for a pattern. For several nights, note ― or have another person in your home note ― how many minutes after bedtime a sleepwalking episode occurs. If the timing is fairly consistent, this information is useful in planning anticipatory awakenings.

Try to be positive. However disruptive, sleepwalking usually isn’t a serious condition — and it usually goes away on its own.


Updated: 2014-07-31

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Ambien Use-Related ER Visits Rise Sharply

May 23rd, 2013 Raquel Rothe
Published on Wednesday, 08 May 2013 13:15

shutterstock 109584719A new report shows that the number of emergency department visits involving adverse reactions to the sleep medication zolpidem rose nearly 220% from 6,111 visits in 2005 to 19,487 visits in 2010. The Substance Abuse and Mental Health Services Administration (SAMHSA)report also finds that 2,010 patients aged 45 or older represented about three-quarters of all emergency department visits involving adverse reactions to zolpidem.

In 2010, there were a total of 4,916,328 drug-related visits to emergency departments throughout the nation.

From 2005 to 2010, there was a 274% increase in the number of female visits to the emergency department involving zolpidem (from 3,527 visits in 2005 to 13,130 in 2010) in comparison to a 144% increase among males during the same period (2,584 visits in 2005 to 6,306 in 2010). In 2010, females accounted for more than two-thirds (68%) of all emergency department visits related to zolpidem.

Zolpidem is an FDA-approved medication used for the short-term treatment of insomnia and is the active ingredient in drugs such as Ambien, Ambien CR, Edluar, and Zolpimist. These drugs have been used safely and effectively by millions of Americans; however, in January 2013, FDA responded to increasing numbers of reports of adverse reactions by requiring manufacturers of drugs containing Zolpidem to halve the recommended dose for females. FDA also suggested that manufacturers reduce the recommended dose for men.

Adverse reactions associated with the medication include daytime drowsiness, dizziness, hallucinations, agitation, sleep-walking, and drowsiness while driving. When zolpidem is combined with other substances, the sedative effects of the drug can be dangerously enhanced. This is especially true when zolpidem is combined with certain anti-anxiety medications and narcotic pain relievers that depress the central nervous system. The report finds that in 2010 half of all emergency department visits related to zolpidem involved its use with other drugs. In 37% of all emergency department visits involving zolpidem, it was used in combination with drugs that depress the central nervous system.

NSF reports a gene that regulates how long we sleep

January 8th, 2012 Raquel Rothe

Researchers Trail Twitter to Track World’s Mood Swings: Work, Sleep and Daylight Play Role

November 5th, 2011 Raquel Rothe

Researchers Trail Twitter to Track World’s Mood Swings: Work, Sleep and Daylight Play Role

October 18, 2011

Using Twitter to monitor the attitudes of 2.4 million people in 84 countries, Cornell University researchers found that people all over the world awaken in a good mood – but globally that cheer soon deteriorates once the workday progresses.

By tracking Twitter tweets over two-years, researchers determined that work, sleep and the amount of daylight all play a role in shaping cyclical emotions such as enthusiasm, delight, alertness, distress, fear and anger.

Researchers have long known about these affective rhythms, but have relied on small homogeneous samples and have had no practical means for hourly and long-term observation of individual behavior in large and culturally diverse populations. Before the rise of social media, these kinds of results were inconclusive, according to the researchers Scott Golder, Cornell graduate student in sociology; and Michael Macy, Cornell professor of sociology. Their paper, “Diurnal and Seasonal Mood Tracks Work, Sleep and Daylength Across Diverse Cultures,” was published in the journal Science.

Using Twitter in conjunction with language monitoring software, Golder and Macy discovered two daily peaks in which tweets represented a positive attitude – relatively early in the morning and again near midnight, suggesting mood may be shaped by work-related stress. Positive tweets were also more abundant on Saturdays and Sundays, with the morning peaks occurring about two hours later in the day. This implies people awaken later on weekends.

These patterns were reflected in cultures and countries throughout the world, but shifted with the difference in time and work schedule. For example, positive tweets and late-morning mood peaks were more prominent on Fridays and Saturdays in the United Arab Emirates, where the traditional workweek is Sunday through Thursday, according to the paper.

Golder and Macy also tracked global attitude on a seasonal basis to determine if “winter blues” is represented in Twitter messages. While no correlation was discovered between absolute daylight and mood, there was a correlation when examining relative daylight, such as the gradually decreasing daylength between the summer and winter solstices.

From: National Sleep Foundation publication

Words to expand your sleep vocabulary-#13

July 9th, 2011 Raquel Rothe

Circadian

From the Latin meaning “about a day,” circadian refers to numerous phenomena (especially biological rhythms) that have an interval length of approximately 24 hours. It may be used in reference to circadian rhythm sleep disorders.

Words to expand your sleep vocabulary-#9

June 26th, 2011 Raquel Rothe

Jet lag

Jet lag is a temporary condition that is caused by rapid travel across time zones — as may occur with jet trips — and may leave an individual experiencing fatigue, insomnia, nausea, or other symptoms as a result of the internal circadian rhythm, or biological clock, being misaligned with local time.

Words to expand your sleep vocabulary-#3

May 2nd, 2011 Raquel Rothe

Sleep architecture

Sleep architecture represents the structure of sleep and is generally composed of a somewhat cyclical pattern of the various non-rapid eye movement (NREM) and rapid eye movement (REM) sleep stages. It can be summarized with a chart called a hypnogram.

Sleep disorders: How many hours of sleep do you get on average?

March 24th, 2011 Raquel Rothe

Learn About Sleep Deprivation and Obesity Explore the Research Surrounding an Unexpected Relationship By Brandon Peters, M.D., About.com Guide

February 22nd, 2011 Raquel Rothe

What is the relationship between sleep deprivation and obesity? More than one-third of American adults are now obese. This epidemic has been worsening over the past several decades. There are a number of contributing factors, including: excessive caloric intake, decreased physical activity, the interaction between genes and environment, and cultural influences. Over this same period of time, Americans have been sleeping less, and some researchers have begun investigating whether sleep deprivation might contribute to obesity.

We sleep as much as one-quarter less than our ancestors did, with average total sleep time decreasing from 9 hours in 1900 to less than 7 hours over the past 10 years. In 2001, researchers found that sleeping less than 6 hours per night and remaining awake past midnight increased the likelihood of obesity. In 2002, a study of 1.1 million people found that increasingbody mass index (BMI) occurred when habitual sleep amounts fell below 7 to 8 hours.

A study done in Virginia in 2005 showed that overweight and obese individuals slept less than subjects of normal weight. Another study in Wisconsin in 2004 showed that when sleeping less than 8 hours, the increase in BMI was proportional to the amount of decreased sleep.

Since 1992, 13 studies of more than 45,000 children have supported the inverse relationship between hours of sleep and risk of obesity. As children sleep less, they are more at risk of becoming obese. In an interesting 2005 study, Reilly reported in the British Medical Journal that short sleep duration at age 30 months predicts obesity at age 7 years, suggesting that poor sleep may have a permanent impact on part of the brain called the hypothalamus that regulates both appetite and energy expenditure.

Laboratory studies tend to support the data from all these population studies. As early as 1999, Spiegel examined sleep restriction and the effect on metabolism by sleep restricting subjects to 4 hours per night for one week. This led to impaired glucose tolerance (a marker of insulin resistance and diabetes) and changes in hormones related to weight gain and hypertension. The changes were reversible with normal sleep times.

In 2004, Spiegel examined the effect of sleep restriction on hormones related to hunger and appetite. It was found that sleep restriction reduced the hormone leptin, which suppresses appetite, by 18%. It also increased the hormone ghrelin, which increases appetite, by 28%. For comparison, 3 days of underfeeding by 900 calories per day causes leptin to decrease by 22%. Moreover, subjects showed subjectively increased appetite for calorie-dense foods with high carbohydrate content.

How might disruption of the body’s natural clock, called the circadian rhythm, through sleep deprivation affect metabolic hormones that regulate appetite? This is the cutting edge of the current research, and a question that has yet to be answered.

Sources:

Ogden CL, Carroll MD, McDowell MA, Flegal KM. Obesity among adults in the United States – no change since 2003—2004. NCHS data brief no 1. National Center for Health Statistics

Sleep disorders and work performance-Abstract

November 5th, 2010 admin

J Sleep Res. 2010 Sep 30. doi: 10.1111/j.1365-2869.2010.00890.x. [Epub ahead of print]
Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll.
Swanson LM, Arnedt JT, Rosekind MR, Belenky G, Balkin TJ, Drake C.

Department of Psychiatry, University of Michigan, Ann Arbor, MI Alertness Solutions, Cupertino, CA Sleep Performance Research Center, Washington State University, WA Department of Behavioral Biology, Walter Reed Institute of Research, Silver Spring, MD Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA.
Abstract
Chronic sleep deprivation is common among workers, and has been associated with negative work outcomes, including absenteeism and occupational accidents. The objective of the present study is to characterize reciprocal relationships between sleep and work. Specifically, we examined how sleep impacts work performance and how work affects sleep in individuals not at-risk for a sleep disorder; assessed work performance outcomes for individuals at-risk for sleep disorders, including insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS); and characterized work performance impairments in shift workers (SW) at-risk for shift work sleep disorders relative to SW and day workers. One-thousand Americans who work 30 h per week or more were asked questions about employment, work performance and sleep in the National Sleep Foundation’s 2008 Sleep in America telephone poll. Long work hours were associated with shorter sleep times, and shorter sleep times were associated with more work impairments. Thirty-seven percent of respondents were classified as at-risk for any sleep disorder. These individuals had more negative work outcomes as compared with those not at-risk for a sleep disorder. Presenteeism was a significant problem for individuals with insomnia symptoms, OSA and RLS as compared with respondents not at-risk. These results suggest that long work hours may contribute to chronic sleep loss, which may in turn result in work impairment. Risk for sleep disorders substantially increases the likelihood of negative work outcomes, including occupational accidents, absenteeism and presenteeism.

© 2010 European Sleep Research Societ