Sleepwalking

Sleepwalking (SW) is a parasomnia, an abnormal behavior occurring during sleep. SW is a non-REM sleep parasomnia, an arousal disorder, like sleep terrors and confusional arousals. SW results from an incomplete arousal from slow-wave sleep, some regions of the cerebral cortex being awake and allowing movement and vision for example and others being asleep, preventing memorization or judgment. Usually, SW is a quiet wandering of a child that occurs rarely (several times a month or a year), requiring no medical advice and treatment. To reassure the family and to secure the environment are the only things to do. However, sometimes, SW can become crippling because of its frequency (several times a week or a night) because of the risks associated with the behavior (going outside, manipulating sharp objects, etc.) or violence (throwing objects, using weapons, etc.) or because of its consequences on everyday quality of life (sleepiness, fatigue, insomnia, anxiety, and depressive symptoms). In these conditions, treatment is required. It first associates sleep hygiene, reduction of alcohol consumption, and interruption of the treatments that could have promoted the episodes and the securing of the environment. The treatment of precipitants inducing sleep fragmentation such as sleep disordered breathing can be beneficial, reducing the number of events. If episodes persist or are too dangerous, medical treatment is needed. No adequate large controlled trial of drugs has yet been conducted in SW so that no medication has been evaluated properly for efficacy or side effects. However, experts in the field use clonazepam. This treatment is in our experience often effective. If inefficacious, antidepressants can also be proposed. Psychotherapy should be associated to improve anxiety and sometimes insomnia. Few published cases have described that deep relaxation, hypnosis, and cognitive behavioral therapy could be effective.