Sleepwalking and Night Terrors

Sleepwalking and Night Terrors

Sleepwalking and Night Terrors are some of the most common parasomnias experienced by individuals across various age groups, categorized under Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders. 

These two conditions are often the first sleep-related disorders people search for, as their impact on daily life can be significant. While the formal medical terminology labels them as NREM sleep arousal disorders, terms like sleepwalking and sleep terrors are more familiar and relatable to those experiencing or observing these conditions. 

Parasomnias and NREM Sleep Arousal Disorders

Parasomnias are a category of sleep disorders that involve unusual behaviors, experiences, or physiological reactions during sleep or the transition between sleep and wakefulness. Parasomnias reflect a mixture of wakefulness and sleep, which can lead to actions that are typically automatic but potentially harmful. 

These disorders are generally classified based on the sleep stage in which they occur. The most common parasomnias are those that happen during:

• Non-Rapid Eye Movement (NREM) and 
• Rapid Eye Movement (REM) sleep stages.

NREM Sleep Arousal Disorders, which include sleepwalking and sleep terrors, are the most widely recognized of these conditions.

Sleepwalking

Sleepwalking, also known as somnambulism, is a disorder in which individuals engage in complex behaviors such as walking, talking, or performing other tasks while still asleep. This condition typically occurs during deep sleep (slow-wave sleep) and is characterized by incomplete awakening. During a sleepwalking episode, the person appears to be awake, eyes open, walking, or performing tasks, yet they remain unresponsive to external stimuli. They also exhibit a blank, vacant stare and are challenging to awaken.

How Sleepwalking Manifests

Sleepwalking episodes can vary in complexity. For some, it may involve 

• simple tasks like sitting up or walking around the room, while for others, 
• more elaborate and potentially dangerous behaviors may occur, such as leaving the house or driving a car. 

These episodes can last for a few minutes to up to an hour, depending on the individual. People who sleepwalk are often unaware of their actions and typically have no memory of the event once they wake up.

Diagnostic Criteria for Sleepwalking

The diagnostic criteria for sleepwalking involve a series of specific observations:

1. Recurrent episodes of incomplete awakening during the first third of the sleep cycle.
2. Engagement in walking or other complex behaviors while asleep.
3. Minimal or no dream recall during these episodes, indicating the absence of conscious processing.
4. Amnesia for the event upon awakening, with no memory of the actions performed during the episode.
5. Clinically significant distress caused by the episodes may impair social, occupational, or other important areas of functioning.
6. Exclusion of substance use or other medical conditions that could be causing similar behaviors.

Complexities and Risks of Sleepwalking

Sleepwalking presents several risks, as the individual’s lack of awareness during the episode can lead to dangerous situations. For example, sleepwalkers may attempt to leave their homes, cross streets, or even engage in high-risk activities like operating machinery or cooking, all while still asleep. This lack of conscious control can lead to accidents and injuries, not only to the sleepwalker but to others around them.

Night Terrors

Night terrors, also known as sleep terrors, are another type of NREM Sleep Arousal Disorder. They involve sudden awakenings from deep sleep with intense fear, accompanied by screaming, sweating, rapid breathing, and an elevated heart rate. These episodes can be terrifying to witness, as the person experiencing a night terror is difficult to console and may appear disoriented or confused.

How Night Terrors Manifest

Night terrors typically begin with a scream or cry, followed by intense autonomic arousal. The individual may thrash around in bed, exhibit rapid breathing, and have a pounding heart rate. Unlike nightmares, which occur during REM sleep and involve vivid dreams that can be recalled, sleep terrors occur during NREM sleep, and the person has no memory of the event upon waking.

Diagnostic Criteria for Night Terrors

Similar to sleepwalking, night terrors are diagnosed based on specific criteria:

1. Recurrent episodes of abrupt awakening from sleep, typically during the first third of the night.
2. Intense fear and autonomic arousal, such as rapid heart rate, sweating, and screaming.
3. Difficulty in consoling the individual during the episode, with minimal or no response to external stimuli.
4. Amnesia for the event, meaning the individual does not remember the episode after awakening.
5. The episodes cause significant distress or impairment in important areas of functioning, such as social or occupational settings.

The Impact of Night Terrors

Night terrors are distressing not only for the individual but also for their bed partners or family members who may be frightened by the intensity of the episode. Though the individual does not remember the event, the emotional toll on the household can be significant, leading to disrupted sleep for everyone involved.

Common Features of Sleepwalking and Night Terrors

Sleepwalking and night terrors share several common features. Both disorders:

• Occur during NREM sleep, specifically during deep, slow-wave sleep.
• Often arise in the first third of the night when slow-wave sleep is most prominent.
• Involve partial arousal, where the individual is not fully awake or aware.
• Result in amnesia for the event, meaning the individual does not remember their actions once fully awake.

These shared characteristics can make it difficult to distinguish between different types of NREM Sleep Arousal Disorders. However, sleepwalking typically involves complex motor behaviors, while sleep terrors are marked by intense fear and autonomic arousal.

Causes and Risk Factors for Sleepwalking and Night Terrors

Several factors can contribute to the development of sleepwalking and sleep terrors. 

Environmental Triggers

Sleep deprivation is one of the most common triggers for NREM Sleep Arousal Disorders. When individuals do not get enough rest or have disrupted sleep patterns, they are more likely to experience episodes of sleepwalking or night terrors. The lack of adequate sleep makes the brain more vulnerable to these parasomnias, as the normal sleep cycle is disrupted. This can lead to abnormal transitions between different sleep stages, increasing the likelihood of these events.

Another significant factor that contributes to NREM Sleep Arousal Disorders is stress and anxiety. Emotional distress can exacerbate sleep disorders, leading to more frequent occurrences of sleepwalking or night terrors. During periods of heightened stress, individuals are more susceptible to these parasomnias because their mental and emotional state impacts their sleep quality. The stress-induced disturbances in sleep make it harder for the body to maintain a consistent and restorative sleep cycle.

In addition, irregular sleep schedules can play a major role in triggering these disorders. Disruptions in the sleep-wake cycle, such as those caused by shift work or frequent travel across time zones, can increase the risk of parasomnias. When the natural circadian rhythm is disturbed, the body struggles to regulate sleep properly, making parasomnias like sleepwalking and night terrors more likely to occur. The inconsistency in sleep timing can throw off the body’s internal clock, further complicating the sleep cycle.

Lastly, sleeping in a disrupted environment can also contribute to episodes of sleepwalking or night terrors. When individuals sleep in unfamiliar or noisy environments, they may find it difficult to enter deep, restorative sleep. This can trigger parasomnias, as the brain remains partially alert, unable to fully relax and progress through the sleep stages smoothly. Consequently, disturbances in the sleeping environment may provoke these disorders, particularly in individuals who are already predisposed to them.

Genetic Factors

Sleepwalking and night terrors tend to run in families, indicating a genetic component to these disorders. If both parents have a history of sleepwalking or night terrors, their children are significantly more likely to develop these conditions.

Medications and Substances

Certain medications, particularly sedatives and hypnotics, can trigger episodes of sleepwalking or night terrors. Additionally, substances like alcohol can disrupt normal sleep patterns, increasing the likelihood of parasomnias.

How to Handle Sleepwalking Episodes

Managing sleepwalking can be challenging, particularly when episodes are frequent or involve complex behaviors. It is important to approach sleepwalkers with care. 

Do not attempt to startle or abruptly awaken the person, as sleepwalkers are often confused and disoriented. Sudden awakening can lead to aggressive or agitated behavior. Instead, gently guide them back to bed, speaking calmly and softly, without making sudden movements or loud noises.

Creating a safe environment is crucial to prevent injuries during sleepwalking episodes. This includes locking doors, securing windows, and removing objects that could cause harm. Additionally, installing baby gates or alarms can be helpful to alert others if the person leaves their room. If the episodes are frequent or involve dangerous behaviors, it is essential to try some form of therapy, such as cognitive-behavioral therapy (CBT), to manage the condition effectively.

How to Handle Night Terrors

Dealing with night terrors requires a thoughtful approach, as these episodes are characterized by intense fear and physical arousal. The first step is to remain calm, even though witnessing a night terror can be distressing. The individual is unaware of their surroundings and will not respond to attempts to soothe them. It is also crucial not to try to wake the person. Similar to sleepwalking, waking someone during a night terror can lead to confusion or agitation. Instead, focus on ensuring their safety and wait for the episode to pass.

It’s helpful to monitor the duration of the episode. Most night terrors last only a few minutes, but if the episodes are prolonged or violent, it may be necessary to seek medical advice. Additionally, creating a calming bedtime routine can reduce the frequency of night terrors. Reducing stress and maintaining a consistent sleep schedule can be effective in minimizing these occurrences.

Prevalence of Sleepwalking and Night Terrors

Both sleepwalking and night terrors are more common in children than in adults. Research suggests that 10%–30% of children will experience at least one episode of sleepwalking, with recurrent episodes affecting 1%–5% of children. In adults, sleepwalking is less common, affecting 1%–7% of the population.

Night terrors are also more prevalent in children, affecting 36.9% of children at 18 months and 19.7% at 30 months. As children grow older, the incidence of night terrors decreases, affecting only 2.2% of adults.

Treatment of Sleepwalking and Night Terrors

While many children outgrow sleepwalking and night terrors, some individuals continue to experience these episodes into adulthood. In such cases, treatment may be necessary to manage the condition.

Cognitive-behavioral therapy (CBT) is effective in reducing the frequency and severity of parasomnias. One study evaluated the long-term effectiveness of a Cognitive Behavioral Therapy program for Non-Rapid Eye Movement Parasomnias (CBT-NREMP) after the COVID-19 lockdown. It found that the therapy’s benefits, including reduced parasomnia, insomnia, anxiety, and depression, remained stable even three years post-intervention, with no significant changes during the pandemic lockdown. This supports CBT-NREMP’s sustainability over time, despite stressors like the lockdown.

The systematic review in Sleep Medicine analyzed 72 publications on behavioral and psychological treatments for NREM parasomnias, such as sleepwalking and sleep terrors. The most common treatments were hypnosis, psychotherapy, and sleep hygiene. The review found that multicomponent cognitive behavioral therapy (CBT) is emerging as a favored approach.

Improving sleep hygiene is a key part of managing NREM Sleep Arousal Disorders. This involves maintaining a consistent sleep schedule, by going to bed and waking up at the same time every day, which helps regulate the body’s internal clock and reduces disruptions that can trigger parasomnias like sleepwalking and sleep terrors. Establishing a relaxing bedtime routine, such as reading, meditating, or listening to soft music, signals to the brain that it’s time to relax, lowering stress levels and potentially preventing episodes.

Creating a comfortable sleep environment, with reduced noise, a cool room, and a comfortable mattress, can promote restful sleep while minimizing the risk of injury during sleepwalking. Additionally, avoiding stimulants like caffeine, nicotine, and alcohol, especially in the evening, helps reduce arousal and sleep disruptions that may lead to parasomnias.

For individuals, particularly children, who experience frequent night terrors, scheduled awakenings may be recommended. This involves waking the individual about 15 to 30 minutes before the time they usually experience a parasomnia episode and keeping them awake for a few minutes. This method can help break the cycle of night terrors by preventing the brain from entering the stage of sleep where they typically occur.

How The Sintelly App Can Help

For those who experience night terrors due to underlying stress or anxiety, the app’s CBT-based exercises can be especially helpful. These exercises guide users through identifying and challenging negative thoughts that may be contributing to anxiety. For example, if a user is prone to stress that manifests as nightmares or night terrors, the app can provide techniques to reframe these thoughts in a more positive or neutral light, ultimately helping to reduce anxiety-induced sleep disturbances.

Additionally, the app includes specific sleep exercises designed to promote better quality sleep and minimize parasomnias. Improving sleep hygiene is a crucial part of managing sleepwalking and night terrors. The Sintelly app offers practical guidance on establishing healthy sleep routines, such as maintaining a consistent sleep schedule and creating a relaxing bedtime environment. Users can track their sleep habits, and the app will provide personalized insights to help improve their sleep quality.

Stress is often a significant contributor to sleep disturbances like night terrors. The app’s mindfulness exercises can help users become more aware of their thoughts and feelings, enabling them to manage stress more effectively. Mindfulness practices such as body scans and relaxation techniques can reduce the build-up of stress and anxiety throughout the day, ultimately contributing to more peaceful and undisturbed sleep.

The Sintelly app also offers a real-time interactive chatbot, which can provide users with instant support if they feel anxious about sleepwalking or night terrors. The chatbot might suggest relaxation exercises or provide helpful tips on improving sleep hygiene, all aimed at reducing parasomnia episodes.

The Sintelly app also offers progress-tracking features that allow users to monitor their sleep patterns and emotional states over time. By tracking factors such as the frequency of night terrors or sleepwalking episodes and accompanied moods, users can gain insight into what might be triggering these events. The app helps individuals spot patterns, such as nights where stress or poor sleep hygiene contributed to their symptoms, so they can make adjustments to prevent future occurrences.