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Sleep Disorders

Sleeptalking in multiple voices

05/06/2008

Question:

I am a 54 year old male suffering from Epilepsy (Complex Partial Seizures) and depression.

While I have talked in my sleep off and on for my entire life this past week my wife told me that I talked in my sleep in three different voices. One voice was mine, the second a females and the third was not distinguishable.

To me this seems very strange. Is this unusual? Is it a indication of some other possible disorder?

Answer:

Sleep-talking, also known as somniloquy, is a common sleep behavior. Unlike other common forms of sleep behavior, such as sleep walking and night terrors, which are more prevalent in children and adolescents, sleep talking is common in all age groups. While we don’t know exactly how common talking in sleep is, it is estimated to occur in about half of all children and in about 5% of adults.

Sleep talking can range from infrequent quite sounds to full spoken sentences to singing and shouting. Often, the speech cannot be understood and may sound like mutterings or gibberish. It can be related to dream context in some cases, although it may not necessarily have full concordance with the dream. Individuals who manifest sleep talking in the context of a dream may appear to vocalize statements attributable to any number of subjects involved in the dream plot. For example, an individual who has a dream of persecution may recall screaming for help during the nightmare, but may be heard vocalizing a different statement representing other actors in the dream plot.

The cause of talking in sleep is not entirely known. Most of the time, the cause of this sleep behavior can not be linked to any identifiable underlying problem or disease and is considered “benign.” And in most cases, the problem is not serious and may resolve over time or with age. However, in some cases, it has been found to be associated with other sleep-related disorders, such as sleep walking, REM behavior disorder (an unusual disorder in which individuals tend to act out their dreams while asleep), sleep-related epilepsy, post-traumatic stress disorder and the nighttime sleep eating syndrome. Sleep talking may also be a manifestation of a disturbance in your sleep pattern. This may be caused by medication, sleep deprivation, depression, stress, medical illness, or pain.

Patients with complex partial seizures can certainly express vocalization and certain behaviors that may be automatic stereotypical or even more complex and synthesized. While sleep disruption may give rise to sleep talking in predisposed individuals, the same disruption may worsen control of a seizure disorder. It is important that you review your epilepsy control and any new medication you may have been started on with your neurologist. In the meantime adequate sleep hygiene is essential.

It is possible that your sleep talking is not related to any significant underlying problem. However, if you would like to determine if there is an identifiable cause for your problem, a thorough history and physical examination are needed. A referral to a Sleep Specialist by your primary care physician may be necessary to help sort out whether further testing is needed. Once a history and physical examination have been performed, the Sleep Specialist will decide if further evaluation by a sleep study is necessary. This may be required to determine the presence or the absence of the conditions mentioned above. Specific treatments for each condition are available and will depend upon the results of the evaluation, though as mentioned, most cases of sleep talking do not require any treatment.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University