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The dangers of sleepwalking and REM behavior disorder

Photo: Mikelo via Flickr

Last month, Health Talk contributor Michael Howell, M.D., assistant professor with the Department of Neurology, shared five sleep resolutions for 2013. So now that you’re following Dr. Howell’s advice and sleeping better, there is something else that affects an estimated 10 percent of Americans and often goes unreported and undiagnosed, but can have painful consequences and lead to a life-threatening disorder: sleepwalking.

Most of us know someone who occasionally sleepwalks or maybe you’ve even done it yourself. For the most part, sleepwalking is fairly mild and primarily occurs in younger people. The condition falls under the medical category of parasomnias, or abnormal behaviors occurring during or emanating out of sleep.

These mild instances of parasomnia could lead to a much more severe and life-threatening disorder called REM behavior disorder. The Parasomnia Clinic at the University of Minnesota seeks to understand, treat and prevent these conditions.

“If REM behavior disorder is left undiagnosed and untreated, our clinic has seen high instances of Parkinson’s disease in many of our patients,” said Howell.

While most episodes are nonviolent, Howell has seen many patients hurt themselves and others during a sleepwalking or REM behavior disorder episode. Below are just a few examples.

Toga, Toga, Toga – A 29-year-old graduate student with a lifelong history of sleepwalking has an unfortunate episode while traveling at a conference.  Only vaguely aware of his surroundings, he awakens after leaving his hotel room to find that he is locked outside and without clothing.  Fortunately prior to being discovered he found an unused bed sheet that he turned into a toga.

Spiderman – A 19-year-old male had a minimal history of sleepwalking.  The night began after several days of sleep deprivation related to school activities, but ended at about 3 a.m. after a night of drinking alcohol and watching the movie Spiderman.  At 4 a.m. his roommate awoke to see the patient’s naked profile silhouetted in the open window.  This somewhat alarming situation became much more serious when the patient jumped from the second-story window.

Sleep sex, smoking, and eating – A 39-year-old woman arrived in clinic with a distressed husband who claimed that she was undertaking a myriad of unremembered nocturnal behaviors.

Six months prior she had started the medication zolpidem (Ambien) for difficulty sleeping.  Her husband stated that soon thereafter she would awaken him to initiate sexual intercourse. In the morning she would deny memory of the events and in fact thought her husband was joking.

On another night he came down to the kitchen to find her smoking cigarettes and drinking a large quantity of alcohol. In the morning he was shocked that his wife (typically sensitive to the effects of alcohol) felt as she put it, “fantastic.” The final sleepwalking event occurred when her husband came downstairs to find the stove had been left on after she prepared a meal.

“These disorders arise when the brain fails to awaken after an arousal from sleep.  Of the many fascinating aspects of the human nervous system is its ability to, under normal circumstances, fully awaken 100 billion neurons within a few seconds and is one of the greatest physiological tricks,” said Howell.

“However, in certain susceptible individuals there is a failure of the brain to fully arouse.  Parts of the brain are awake, such as those controlling vision and movement; others are still asleep, the regions effecting memory and judgment.”

According to Howell, it’s important to point out that patients who experience parasomnias should know that if they signify other underlying sleep disorders, that these disorders are readily identifiable and treatable.

To learn more about REM behavior disorder make sure to check out Dr. Howell’s recent segment on KMSP-TV.