somnambulism

(säm′näm·byə′liz·əm)

(physiology) Sleepwalking. The performance of any fairly complex act while in a sleeplike state or trance.

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(somnam′byōōlizəm)
n

Habitual walking in the sleep; a hypnotic state in which the subject has full possession of senses but no subsequent recollection.

Definition

Somnambulism is also known as sleepwalking. It is a common disorder among children that involves getting out of bed and moving about while still asleep.

Description

Somnambulism is similar to pavor nocturnus (night terrors) in that it occurs during the non-dreaming stage of sleep, usually within an hour or two of going to bed. The sleepwalking child feels an intense need to take action and may appear alert, purposeful, or anxious as he or she moves about. For many years, people believed that it was dangerous to awaken a sleepwalker, but there is no basis for this view. There is, however, little reason to awaken a sleepwalking child, and it may be impossible to do so. Episodes of sleepwalking may be signs of a child's heightened anxiety about something.

Demographics

Somnambulism, or sleepwalking, affects an estimated 15 percent of children in their early school years. It decreases in frequency with increasing age. It is very uncommon among adults.

Causes and Symptoms

The root cause of sleepwalking is not known. Anxiety and stress are the most commonly given reasons for sleepwalking.

If sleepwalking is common among family members, it is more likely that the child may respond to even slight increases in anxiety with sleepwalking behavior.

When to Call the Doctor

A doctor or other health care provider should be called when episodes of sleepwalking cannot be comfortably managed in the home.

Diagnosis

A diagnosis of somnambulism is made by observation and history. There are no laboratory tests. An electroencephalogram may be used as a part of an analysis in a sleep laboratory, but this is the exception rather than the rule.

Treatment

Sleepwalking children should be gently guided back to bed. They will usually be cooperative in this effort.

Prognosis

The prognosis for sleepwalking is good. Most children experience a few episodes of somnambulism and then simply stop, often when a source of stress or anxiety is removed. Sleepwalking rarely affects persons outside of one's own family circle.

Prevention

There is no known way to prevent episodes of sleepwalking.

Nutritional Concerns

There is no known link between sleepwalking and nutrition.

Parental Concerns

Parents should give careful consideration to events and environmental changes that may have triggered the onset of sleepwalking. Potential hazards that may injure children should be removed from their sleeping areas.

Resources

Books

Carney, Paul R. et al. Clinical Sleep Disorders. Philadelphia: Lippincott Williams & Wilkins, 2004.

Hertz, Grett J. J. et al. Olie's Bedtime Walk. Long Island City, NY: Star Bright Books, 2002.

Lee-Ching, Teofilo L. et al. Sleep Medicine. Amsterdam: Elsevier, 2002.

Silber, Michael H. et al. Sleep Medicine in Clinical Practice. London: Taylor & Francis, 2004.

Periodicals

Cartwright, R. "Sleepwalking violence: a sleep disorder, a legal dilemma, and a psychological challenge." American Journal of Psychiatry 161, no. 7 (2004): 1149–58.

Guilleminault, C, et al. "Sleepwalking and sleep terrors in prepubertal children: what triggers them?" Pediatrics 111, no. 1 (2003): e17–25.

Kantha, S.S. "Is somnambulism a distinct disorder of humans and not seen in non-human primates?" Medical Hypotheses 61, no. 5–6 (2003): 517–18.

Lecendreux, M., et al. "HLA and genetic susceptibility to sleepwalking." Molecular Psychiatry 8, no. 1 (2003): 114–17.

Remulla, A., and C. Guilleminault. "Somnambulism (sleepwalking)." Expert Opinion on Pharmacotherapy 5, no. 10 (2004): 2069–74.

Zadra A, et al. "Analysis of postarousal EEG activity during somnambulistic episodes." Journal of Sleep Research 13, no. 3 (2004): 279–84.

Organizations

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. fp@aafp.org. www.aafp.org

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000, Fax: (847) 434-8000. kidsdoc@aap.org. www.aap.org/default.htm

American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901. (507) 287-6006. Fax: (507) 287-6008. info@aasmnet.org. www.asda.org

American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546, x2600 or (215) 351-2600. www.acponline.org

Other

"Sleep Disorders and Sleep Problems in Childhood." American Academy of Family Physicians. Available online at www.aafp.org/afp/20010115/277.html.

"Sleep Walking." Family Practice Notebook. Available online at www.fpnotebook.com/PSY142.htm.

"Sleep Walking." National Library of Medicine. www.nlm.nih.gov/medlineplus/ency/article/000808.htm "Somnambulism (Sleep Walking)." eMedicine. Available online at www.emedicine.com/neuro/topic638.htm.

[Article by: L. Fleming Fallon, Jr., M.D., Dr.PH.]

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Somnambulism (or sleepwalking) describes an apparently aimless nighttime walking in an unconscious state, accompanied by motor activity of varying degrees of complexity. The next day, the sleeper has no memory of the episode. Sleepwalking episodes, which occur during the first part of the night, last from a few seconds to around thirty minutes. They begin in the latency period and generally stop after puberty.

Owing to the amnesia that follows episodes of sleepwalking, no secondary revision can be made by the sleeper. This did not prevent Sigmund Freud from taking an interest in the phenomenon. In 1907 he spoke about it to the Vienna Psychoanalytic Society (Nunberg and Federn): He believed that sleepwalking was related to the fulfillment of sexual wishes and was thus surprised that there could be mobility without interruption of the dream life. Finally, at that time, he suggested that the essence of this phenomenon was the desire to go to sleep where the individual had slept in childhood.

Ten years later, he again speculated about somnambulism in the article "A Metapsychological Supplement to the Theory of Dreams" (1916-17 [1915]). In this essay, where he proposed to clarify and expand his hypothetical ideas on dreams, the dream is a fragile equilibrium that is only partially successful: first, because the repressed unconscious impulses of the unconscious system, which do not obey the wishes of the ego and maintain their countercathexis, mean that "some amount of the expenditure on repression (anticathexis) would have to be maintained throughout the night, in order to meet the instinctual danger" (p. 225); and second, because certain preconscious daytime thoughts can be resistant, and these, too, retain a part of their cathexis. It is thus apparent how unconscious impulses and day residues can come together and result in a conflict.

Freud then wondered about the outcome of this wishful impulse, which represents an unconscious instinctual demand and which becomes a dream wish in the preconscious. Further, he envisioned the case in which this unconscious impulse could be expressed as mobility during sleep. This would be what is observed in somnambulism, though what actually makes it possible remains unknown.

More recently, based on data from electrophysiological sleep studies showing that sleepwalking episodes occur in the early phases of sleep (phases III and IV), the psychoanalyst Didier Houzel has leaned in the direction of the Freud's hypotheses, positing that the slow sleep phase, by interfering with the phase of paradoxical sleep that follows and interrupts the latter, prevents the possibility of dream work. Somnambulism thus results from a blocking of the possibilities of mentalization and a diversion of the instinctual energy onto paths of motor discharge. Houzel's viewpoint posits equivalences between night terrors, sleepwalking, and nocturnal enuresis, all of which have the same relationship to paradoxical sleep.

Bibliography

Freud, Sigmund. (1916-17f [1915]). A metapsychological supplement to the theory of dreams. SE, 14: 217-235.

Houzel, Didier. (1980). Rêve et psychopathologie de l'enfant. Neuropsychiatrie de l'enfance et de l'adolescence, 28, 155-164.

Nunberg, Hermann, and Federn, Ernst. (1962-1975). Minutes of the Vienna Psychoanalytic Society. New York: International Univeristies Press.

—PHILIPPE METELLO

Term derived from Latin somnus (sleep) and ambulare (to walk). A state of sleep, or half-waking trance, spontaneously or artificially induced, in which subconscious faculties take the place of normal consciousness and direct the body in the performance of various actions from the erratic (sleep walking) to the highly intellectual (solving problems). Somnambulism may start as an exaggerated dream and lead to the development of what resembles a secondary personality with a chain of memory of its own. This chain of memory will often be found as part of the hypnotic memory. The personality itself, in some cases, may exhibit wisdom beyond that of the waking subject and perform paranormal feats.

The somnambulist may have his or her eyes closed, and ears deaf to auditory impressions or sense impressions, without awakening any gleam of consciousness. This lack of attention to sensory impressions may have some effect in rousing new trains of association and suggesting a new line of action. It is suggested that the sleepwalker may see only a mental picture of what he or she is doing as in a dream instead of objective reality, and certain experimental tests have suggested that this occurs in some cases.

The somnambulic state was the discovery of the Marquis Chastenet de Puysègur in 1784 in the context of mesmerism and animal magnetism. He induced it by passes, and finally, by a simple act of will. The Abbé Faria brought it on by shouting; Chevalier de Barbarin by praying; and James Braid by staring at a bright object, usually his lancet case.

The nineteenth-century physician Alexandre Bertrand assigned somnambulism to four causes: (1) A particular nervous temperament that predisposes individuals otherwise in good health to paroxysm of somnambulism during their ordinary sleep. (2) It is sometimes produced in the course of certain diseases of which it may be considered a symptom of a crisis. (3) It is often seen in the course of the proceedings necessary to bring on the condition known as animal magnetism. (4) It may result as a consequence of a high degree of mental exaltation. Accordingly, he distinguished four kinds of somnambulism: the natural, the symptomatic, the artificial, and ecstatic. Hypnotism would fall under the artificial category, and trance under the ecstatic.

Physiologically, somnambulism differs from sleep in that the muscles retain the ordinary tension of the waking life. The eyeballs are usually in an unnatural position, drawn upward and inward so that the vision is directed to the top of the forehead. There is an insensibility to pain; taste and smell are paralyzed. The external senses are perfectly sealed. No memory is carried into the waking state.

There are various degrees of somnambulism. Charles Richet spoke of semi-somnambulism, the state in which the medium retains consciousness while automatic manifestations take place. Catalepsy is a deep stage of somnambulism. The fakirs and yogis of India induced it by an effort of will.

The mildest form of somnambulism is typified in the inarticulate murmurings or vague gestures of a dreaming child, while in the most extreme cases where all the senses are active and the actions apparently as purposive as in the normal waking state, it borders on the condition of spontaneous hypnotism.

Its affinity with hypnosis was recognized early, when the hypnotic subjects of the animal magnetists were designated "somnambules." It is remarkable that somnambulists may walk in dangerous paths with perfect safety, but if they are suddenly awakened they are liable to fall. Spontaneous somnambulism generally indicates some tendency of the nervous system, since as a rule, only in some abnormal state could the dream ideas exercise so exciting an influence on the brain as to rouse to activity centers normally controlling voluntary movements.

Sylvan J. Muldoon (with Hereward Carrington) in The Projection of the Astral Body (1929) writes of "astral somnambulism," a state of unconscious astral projection that, according to Muldoon, was far more common than generally supposed. It mostly occurred in the dream state.

It should be noted that in the wake of contemporary language concerning altered states of consciousness, somnambulism has dropped out of the language of psychology and parapsychology.

Sources:

Belden, L. W. Somnambulism: The Extraordinary Case of J. C. Rider, the Springfield Somnambulist. London, 1834.

Bertrand, A. Traité du Somnambulisme. Paris, 1824.

Braid, James. Neurpnology; Or, The Rationale of Nervous Sleep. London, 1843. Reprint, New York: Arno Press, 1975.

Cahagnet, L. A. The Celestial Telegraph; Or, Secrets of the Life to Some Revealed Through Magnetism. London, 1850. Reprint, New York: Arno Press, 1976.

Colquhoun, J. C. Report of the Experiments on Animal Magnetism; Made By a Committee of the Medical Section of the French Royal Academy of Sciences … 1831. Edinburgh, 1833. Reprint, New York: Arno Press, 1975.

Esdaile, James. Natural and Mesmerism Clairvoyance. London, a 1852. Reprint, New York: Arno Press, 1975.

Haddock, Joseph W. Somnolism and Psycheism; Or, The Science of the Soul and the Phenomena of Nervation as Revealed by Vital Magnetism or Mesmerism. London, 1851. Reprint, New York: Arno Press, 1975.

Fahnestock, W. B. Statuvolism: Artificial Somnambulism. Chicago: Religio-Philosophical Publishing House, 1871.

Tuke, W. H. Sleep-walking and Hypnotism. Philadelphia: Blakiston; London: Churchill, 1884.

Weinhold, Arnold. Seven Lectures on Somnambulism. Edinburgh, Scotland, 1845.

A sleeper may engage in a variety of more or less coherent activities. He may talk, for instance, or move purposefully, or get up and walk. He then appears dazed, preoccupied, and unresponsive to much that goes on round him. He tends to avoid obstacles, but may incur danger because he is clumsy and unreliable. He may return to bed on his own. After waking he has no memory of the incident. A child may walk half-asleep to the lavatory and return to bed, but usually somnambulism is less purposeful. Sometimes, but not typically, a sleepwalker appears to be acting out, like Lady Macbeth, fragmentary and irrational dream experiences.

Somnambulism is not uncommon among children. It may be repeated several times over a short period and then not occur again. It is said to run in families. It tends to occur early in the night, during 'orthodox' sleep, when large, slow waves are to be seen on the electroencephalogram. Somnambulism is distinct from the night terrors shown by children. When it is associated with persistent and severe disturbance of behaviour, as in the case of Lady Macbeth, it may be regarded as a manifestation of the 'twilight state' which occurs in some forms of mental illness.

Although it is very unusual for a sleepwalker to harm anyone else, there are cases on record where it has been claimed that acts of homicide have taken place during an episode of sleepwalking. In some of these the accused person had been drinking before falling asleep, only to wake later to find that he had killed his bedmate. It is difficult to believe that sleepwalking in an undrugged state could possibly persist throughout a violent struggle such as would occur if the victim of a homicidal assault made every effort to resist. Furthermore, because sleepwalking takes place during orthodox sleep, and not during dreaming REM sleep, the sleepwalker who acts violently would be unlikely to be acting out a dream in which he might believe that he is defending himself against attack. None the less, pleas of somnambulism have been accepted as defences against charges of murder both in the UK and in the USA.

(Published 1987)

— Derek Russell Davis

Bibliography
• Oswald, I. (1980). Sleep.

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Somnambulism

Dansk (Danish)
n. - somnambulisme, søvngængeri

Nederlands (Dutch)
somnambulisme, slaapwandelen

Français (French)
n. - somnambulisme

Deutsch (German)
n. - Somnambulismus, Schlafwandeln

Ελληνική (Greek)
n. - υπνοβασία

Italiano (Italian)
sonnambulismo

Português (Portuguese)
n. - sonambulismo (m)

Русский (Russian)
сомнамбулизм, гипнотизм, гипноз

Español (Spanish)
n. - sonambulismo, noctambulismo

Svenska (Swedish)
n. - sömngång, benägenhet för sömngång

中文（简体）(Chinese (Simplified))
梦游病, 催眠梦游症

中文（繁體）(Chinese (Traditional))
n. - 夢遊病, 催眠夢遊症

한국어 (Korean)
n. - 몽유병

日本語 (Japanese)
n. - 夢遊病

العربيه (Arabic)
‏(الاسم) ألسير خلال ألنوم‏

עברית (Hebrew)
n. - ‮סהרוריות‬

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