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Sleep Disorders

Worsening Sleep Disorder Symptoms

10/28/2008

Question:

Hi-

I have a partner who I believe has some kind of sleep disorder and seems unwilling to seek medical attention, he doesnt think its anything to worry about, I disagree.

A few months ago it started with him pulling me agressively down when I tried to get out of bed to use the restroom, he had no recollection of the event.

Then, over time he began to routinely sit up in bed, eyes open and glazed over talking complete nonsense in his sleep. Some recollection on these events.

More recently this turned into jumping up from the bed suddenly and walking briskly out of the room then jogging down the stairs before walking back into the room calmly and going back to sleep. He remembers doing this but doesnt know why he did it.

Last night he woke up, sat up very angry and threw his pillow clear across the room and out the hallway very aggresively. Then proceeding to lay back down telling me not to egg him on...He had no recollection of the pillow throwing but knew he had done something (likely because he knows if I am awake in the middle of the night it is probably because he did something odd).

Needless to say I am concerned for his safety and my own and I think these behaviors warrant a visit to a sleep center. My quality of sleep has also deteriorated as I do not fall asleep easily after his episodes.

I would like a medical opinion as to whether I should just accept this behavior as `sleepwalking` or should push harder that he seek medical help.

Answer:

It sounds as though you have a very complex situation on your hands that really requires a thorough evaluation by a Sleep Specialist. The type of behavior you describe, sleepwalking and violent behavior in sleep, suggests a possible parasomnia. Parasomnias are a group of disorders characterized by undesirable physical events or experiences that occur during entry into sleep, within sleep or during arousal from sleep. There are a number of different parasomnias, ranging from sleepwalking and sleep terrors to behaviors associated with dreams to a number of other sleep-related behaviors (such as eating during sleep, bedwetting, etc). The causes of these parasomnias are not entirely known. Many cases of these conditions are idiopathic, meaning we don’t know for sure what causes these behaviors.

While additional information and probably testing will be needed in order to make a diagnosis, the symptoms you describe in your partner are unlikely to simply represent sleep walking and seem more likely to suggest possible REM behavior sleep disorder (dream sleep-related disorder).

Sleepwalking, also known as somnambulism, occurs in somewhere around 1-15% of the general population with a peak incidence between the ages of 4 and 8. It tends to resolve with aging. If sleep walking starts in adulthood, it may suggest an underlying psychiatric or psychological disorder, excessive stress or substance abuse. In most cases, sleep walking is not serious and resolves over time. However, some sleep-related conditions can present with sleep walking as their primary symptom, and thus in some cases, additional evaluation and treatment is needed. Obstructive sleep apnea, a seizure disorder and REM behavior disorder all may have sleep walking as part of their presentation. Typically, in benign sleep walking, the individual does not act out violently in their sleep, though aggressive behavior may occur if the sleep walker is confronted with strong stimuli. Based on the information you provide, this does not appear to be the case with your partner.

REM behavior disorder is an uncommon condition in which individuals lose the muscle paralysis that usually accompanies REM sleep and thus may act out their dreams. This tends to occur later in the night and most individuals have some recall of what they were doing. Depending on the nature of the dream, this can lead to injurious behavior to the patient (from falling out of bed, running into walls or furniture or hitting objects) or their bed partner. It is more commonly seen in middle to older aged men, but can occur in women as well.

In order to determine if there is an identifiable cause for your partner’s symptoms, a detailed history and physical examination are needed, and probably a sleep study as well. Your partner should definitely be evaluated by a Sleep Specialist (perhaps one with a Neurology or Psychiatry background) to make sure the appropriate type of sleep study is performed.

In the meantime, here are some general guidelines for helping to protect sleepwalkers:

1) Remove dangerous, sharp or pointed objects from the room.

2) Consider adding locks to the windows and doors.

3) Put heavy drapes in front of windows and glass doors.

4) If around when he is sleep walking, gently attempt to guide the sleepwalker back to bed without waking them.

5) AVOID strong stimuli - this could cause aggressive behavior.

Other more specific treatments are available and will depend upon the results of your partner’s evaluation. In your situation, for your own safety, you might want to also consider sleeping in a separate locked room until this is completely evaluated.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need be.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

James   Knepler, MD James Knepler, MD
Formerly, Assistant Professor
College of Medicine
University of Cincinnati