Best ways to handle sleep-walkers

You get a nag to check on your little one in the dead of the night. You stealthily open the door to his room and your fear stares you in the face. His bed is empty. Your heart’s thud moves to your head because the washroom lights are off and so are those of the other rooms.

Then just before your knees give way to the anxiety that has consumed your body, he shuffles from the living room, makes his way around you without a word and peacefully slips into his bed. You ask him about it the next day, and he is convinced that you were dreaming. Then you know he was sleep-walking.

According to Betty Bagaka, a clinical psychologist at Nairobi’s Kenyatta National Hospital, sleep-walking, also known as somnambulism, often occurs during the deepest phase of sleep, which happens in the first third of the night. The episode can be as short as a few minutes and can last as long as an hour.

She says it is characterised by repeated activity during sleep such as sitting up in bed, looking around, gesticulating, getting up and walking about, among others. ‘The person seems awake as his or her eyes are usually open and can make his or her way around furniture, people and the like,’ she says.

‘Although sleep-walking can occur at any age, it is most common in children,’ the clinical psychologist further enlightens. ‘The first episodes mostly occur between four and eight years of age. Ten to 30 per cent of children have at least had a sleep-walking stint and boys are the main victims,’ explains Bagaka.

She adds that the peak of these episodes happens around 12 years of age. ‘Sleep-walking usually fades out by age 15, without treatment. If the episodes continue into early adulthood (a rare case), treatment is recommended,’ adds the psychologist. She goes on to shed light on why children sleep-walk, diagnosis, treatment and safety measures.

Why children sleep-walk
Genetics is one of the causes. Sleep-walking is said to be 10 times more likely in those closely related to sleepwalkers. These people tend to be heavy sleepers. The condition may also be sparked off by fever, which usually affects the nervous system. Other triggers include drunkenness, sleep deprivation, general illness and physiological or psychological stress.

Some types of medication have also been linked to sleep-walking. These are sleeping pills, anti-anxiety drugs, stimulants, anti-seizure medications and antihistamines (medication that help stop allergic reactions), anti-arrhythmic heart drugs (used to suppress abnormal rhythms of the heart), among others.

Diagnosis
It is important to notify your paediatrician about your child’s sleep-walking, especially if it gets dangerous to the child or someone else, or impairs the child’s ability to function (as a result of fatigue from disturbed sleep).

Since the child cannot recall the sleep-walking activity, interviews may not help much. The person who witnessed the sleep-walking behaviour needs to be present. For accurate, diagnosis, polysomnography (professional sleep study) is the preferred choice.

Polysomnography
It involves fixing electrodes to different parts of the child’s body to monitor the brain wave patterns, breathing, heart rate among other things, as the child sleeps. Sleep-walking disorder can be confused with Sleep Terror Disorder.

In both, the child makes movements as though he or she is awake, both call for a lot of effort to awaken the child and in both cases, the victim has no memory of the episode. The major difference is that Sleep Terror Disorder begins with a scream and has signs of strong panic and fear.

Treatment
Treatment is unnecessary, especially if the sleep-walking episodes are not frequent and not dangerous to the sleepwalker or others. However, if sleep-walking is recurrent and daytime fatigue is linked to disturbed sleep patterns, polysomnography may be used to confirm the ideal treatment.

If stress appears to prompt the sleep-walking in your adolescent child, there is need to address the cause of the stress. If not possible, stress management or relaxation techniques can be used.

Hypnosis (an artificially induced trance resembling sleep that has high susceptibility to suggestion) has been used to help sleep-walkers wake up as soon as their feet touch the floor.

Psychotherapy (counselling) may help children with underlying psychological issues connected to the sleep problem. Note that medication is only used in adults with severe cases, to help relax muscles. It is prescribed in the lowest dose possible and only for a limited period.

Medication may not, however, result in less sleep-walking. But some prescriptions have greatly reduced sleepwalking events, with some cases being eliminated altogether.

Bagaka says that although the percentage of sleep walking conditions in Kenya is similar to that of depression and conduct disorder, clinical psychologists give more attention to the latter than sleep-walking.

This shows that people are not aware that sleep-walking can or should be professionally attended to in the extreme cases.

Safety measures
To prevent accidents, clear the floors so that the child does not trip. Barricade stairways, lock windows, doors and the like.

Facts on sleep-walking

• During sleep-walking, the child has a blank stare; are eyes open and pupils dilated.
• He or she does not respond to communication.
• The sleep-walking child is only awakened with a lot of effort.
• The child has no memory of the sleep-walking events when he or she wakes up. If he or she does, it is a vague one.
• Sleep-walkers usually return to bed, or fall asleep in another place – not understanding how they got there.
• Should the child awaken in the process of sleepwalking, there may be a few moments of confusion, but his or her behaviour and mental activity are not impaired.
• Sleep-walking is quite common in children and therefore not a cause for concern. The sleep-walking is termed as a disorder if it extends through adolescence into adulthood

END: BL 42 / 34-35