Topiramate-Induced Somnambulism in a Migraineur: A Probable Idiosyncratic Adverse Effect

PubMed Central

Mathew, Thomas; Sarma, G. R. K.; Nadig, Raghunandan; Varghese, Raji

2012-01-01

Somnambulism (sleepwalking) is a disorder of arousal that falls under “parasomnia” group and is more common in children. These phenomena occur as primary sleep events or secondary to systemic disease or can be drug induced. Medications that can cause sleepwalking include neuroleptics, hypnotics, lithium, amitriptyline, and β-blockers.1 This report presents an unusual adverse effect of topiramate on sleep in a patient with migraine. Citation: Mathew T; Sarma GRK; Nadig R; Varghese R. Topiramate-induced somnambulism in a migraineur: a probable idiosyncratic adverse effect. J Clin Sleep Med 2012;8(2):197-198. PMID:22505867

Treatments for somnambulism in adults: assessing the evidence.

PubMed

Harris, Melanie; Grunstein, Ronald R

2009-08-01

Somnambulism, or sleepwalking, is a parasomnia of non-rapid eye movement (NREM) sleep where movement behaviours usually confined to wakefulness are displayed during sleep. Generally, if sleepwalking is causing distress or danger in spite of safety measures, medical or psychological treatment is indicated. Clinicians will need to assess the evidence for treatment options. MEDLINE, EMBASE, PsycINFO and the Ovid Evidence-Based Medicine Reviews (EBM) multifile databases were searched. No properly powered rigorous controlled trials were found for treatment of sleepwalking in adults. Seven reports described small trials with some kind of control arm, or retrospective case series which included 30 or more patients. With no high quality evidence to underpin recommendations for treatments of somnambulism, full discussion with patients is advised. Adequately powered, well-designed clinical trials are now needed, and multi-centre collaborations may be required to obtain the sample sizes required.

[Complex injuries associated with somnambulism].

PubMed

Sillesen, Nanna Hylleholt; Nielsen, Lisa Toft; Bonde, Christian

2010-12-13

Up to 3% of adults walk in their sleep and some perform complex behaviours. Treatment recommendations for sleepwalking are inconsistent. This case report describes a 64-year-old man who climbed out of a 2nd floor toilet window during somnambulism. He fell 6-8 meters and fractured the tibia, fibula, cervical columna, lumbal columna, calcaneus, costae and suffered a pneumothorax. Evidence to support sleepwalking treatment is lacking and besides benzodiazepines, prevention is the preferred treatment choice according to the literature.

Lord Byron's physician: John William Polidori on somnambulism.

PubMed

Finger, Stanley; Stiles, Anne

2013-01-01

John William Polidori (1795-1821) was the Edinburgh-trained physician hired by Lord Byron to accompany him to Switzerland, where he participated in the story-telling event proposed by Byron that led, with Polidori's help, to Mary Shelley's Frankenstein. Although those interested in English literature might also remember Polidori as the author of The Vampyre, one of the first extended works of fiction about vampires, his earlier interest in somnambulism and trance states is only beginning to be appreciated. Even more than students of Romantic literature, historians of science and medicine seem little aware of what Polidori had written about oneirodynia, a synonym for somnambulism, and how his thoughts from 1815 about such activities reflected the changing medical zeitgeist at this time. This chapter examines Polidori's medical thesis in a neuroscience context and compares what he wrote to the writings of several other physicians who were fascinated by nocturnal wanderings, their causes, their manifestations, and their possible treatments. © 2013 Elsevier B.V. All rights reserved.

PATERNAL DOMINATION AS A CAUSE OF SOMNAMBULISM

PubMed Central

Kahn, B. I.; Jordan, R. L.

1954-01-01

The cases of 15 men admitted to the neuropsychiatric service of a Navy hospital for somnambulism indicate that sleepwalking is an aggressive or sexual motor activity seemingly aimed primarily at a fear-inspiring father. Although the patients varied in age from 18 to 36 years and in rank from seaman to chief petty officer, eight being married and seven single, all were from small-town or rural homes in the low economic class. Their training was religious and strict. They professed great respect for their fathers, to the extent that they could not criticize them or acknowledge hostility toward them. Their relations with their mothers were in general not satisfactory. Apparently fear of the father and the inability to express resentment or aggression was applied to all situations so that the suppressed feelings could be released only in sleepwalking, nightmares and fantasies. These abnormalities, by making the patients conspicuous, increased their terror and anxiety. It is emphasized that sleepwalking activities, far from being harmless, may endanger the patient or those about him. Long-term psychotherapy is necessary for the disorders manifested by somnambulism. PMID:13116025

A preliminary survey on prevalence and knowledge about different aspects of somnambulism in Buner District of Khyber Pakhtunkhwa, Pakistan.

PubMed

Wajiha; Hasan, Zaigham; Afridi, Rabia; Rahman, Lubna; Qureshi, Naveeda Akhtar; Saeed, Kausar; Afridi, Humera

2018-01-20

Present study was aimed to investigate the prevalence and knowledge about different aspects of somnambulism in general population of Buner District, KP, Pakistan, during December 2015-November 2016. Data was collected through convenient sampling technique which was comprised of structured and detailed questionnaire. Collected data regarding different actions performed by sleepwalkers were adjusted through a weighted variable to generalize results. Univariate and multivariate logistic regression was used to evaluate association between variables related to somnambulism. Their odds ratios (ORs) were reported with their corresponding 95% CIs. In total, 11,881 individuals were surveyed, of which 448 (4%) suffered with sleep disorder. Females 256/448 (57%) were more prevalent as compared to males 192/448 (43%). Prevalence of somnambulism among children was 38% whereas 94% sufferers reported no effect on their growth. Majority of respondents reported that main cause of sleepwalking is stress and tension. Somnambulism was taken normal and mostly amusing disorder by sufferers and their families. Sleepwalking is not age specific and serious disorder. Sleepwalkers need special care during their episode due to unconsciousness.

Violent somnambulism: a parasomnia of young men with stereotyped dream-like experiences.

PubMed

Szűcs, Anna; Kamondi, Anita; Zoller, Rezső; Barcs, Gábor; Szabó, Pál; Purebl, György

2014-07-01

To characterize a subgroup of arousal parasomnias associated with violent behavior in adults. A pilot study on clinical and polysomnographic data of 13 adult patients seen in a tertiary sleep center for the suspicion of arousal parasomnia associated with violence. Nine young patients (8 males 1 female) had a common pattern of abnormalities: similar 'claustrophobic' dream-like experiences and complex, vehement dream enactments; no REM sleep without atonia on polysomnography. We call this syndrome 'violent somnambulism'. The rest of the patients had alcoholic delirium, partial epilepsy, possible REM sleep behavior disorder and a single sleep walking episode provoked by a sleeping pill. Sleep related violence needs thorough diagnostic evaluation for preventing life-threatening consequences. Violent somnambulism appears to be a distinct NREM sleep-related overlap parasomnia. Copyright © 2014 Elsevier Ltd. All rights reserved.

Zolpidem-induced amnesia and somnambulism: rare occurrences?

PubMed

Tsai, Jui-Hsiu; Yang, Pinchen; Chen, Cheng-Chung; Chung, Weilum; Tang, Tze-Chun; Wang, Shing-Yaw; Liu, Jong-Kang

2009-01-01

Zolpidem, a non-benzodiazepine hypnotic of the imidazopyridine class, is very effective in treating insomnia with previous claims of little adverse effects. However, zolpidem-induced somnambulism and amnesic sleep-related behavioral problems were begun to be reported in literature but no systemic investigation has been undertaken in non-Western cultures. In our current retrospective survey, 5.1% (13 out of 255) of Taiwanese patients reported change in sleep-related behavior as adverse effects. This serves as a reminder for clinicians to inquire regarding any unusual behavior of parasomniac activities when prescribing zolpidem.

Topiramate-induced somnambulism in a migraineur: a probable idiosyncratic adverse effect.

PubMed

Mathew, Thomas; Sarma, G R K; Nadig, Raghunandan; Varghese, Raji

2012-04-15

Somnambulism (sleepwalking) is a disorder of arousal that falls under "parasomnia" group and is more common in children. These phenomena occur as primary sleep events or secondary to systemic disease or can be drug induced. Medications that can cause sleepwalking include neuroleptics, hypnotics, lithium, amitriptyline, and β-blockers. This report presents an unusual adverse effect of topiramate on sleep in a patient with migraine.

[Rare consciousness disturbances in toxicological practice: akinetic mutism, somnambulism, locked-in syndrome, and psychogenic coma].

PubMed

Ciszowski, Krzysztof; Mietka-Ciszowska, Aneta

2013-01-01

The toxicity of xenobiotics can result inrare disorders of consciousness, such as akinetic mutism and somnambulism as well as syndromes mimicking consciousness disturbances, such as locked-in syndrome and psychogenic coma. Akinetic mutism is a condition characterized by a lack of spontaneous movements and little or no vocalization. Somnambulism include performing of complex motor activity in an automatic manner during deep sleep, without any awareness of its execution. The locked-in syndrome is a state with quadriplegia coexisting with cranial nerves palsies and mutism, but with fully preserved consciousness. Psychogenic coma is a condition in which the patient has preserved level of consciousness and awareness, but does not communicate with theenvironment and does not exhibit the external manifestations of consciousness. This paper presents the etiology, clinical characteristics, as well as diagnostic and therapeutic issues for the above syndromes.

Hypoglycaemia and somnambulism: a case report.

PubMed

Cebrián, S; Gimeno, O; Orozco, D; Pertusa, S

2012-12-01

Sleepwalking (somnambulism) is a sleep disorder classified as a parasomnia. Sleepwalkers develop motor activities that may be simple or complex: they can get out of bed, walk, urinate and even leave the house while remaining unconscious and unable to communicate. It is difficult to wake a sleepwalker, but it is not dangerous - as many people think. Sleepwalking cases have been caused by jet lag, the consumption of narcotics, sedatives and alcohol, cardiac problems such as arrhythmias, and other medical conditions, including epilepsy, asthma and apnoea. In a quick search of the literature, only one case due to hypoglycaemia has been reported, describing a patient with type 1 diabetes whose sleepwalking was triggered by nocturnal hypoglycaemia. Our present case was similar, and our report also describes how it occurred and how the condition was remedied. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Somnambulism in Verdi's Macbeth and Bellini's La Sonnambula: opera, sleepwalking, and medicine.

PubMed

Finger, Stanley; Sironi, Vittorio Alessandro; Riva, Michele Augusto

2015-01-01

The arts can provide unique ways for determining how people not directly involved in medicine were viewing and informing others about physical and mental disorders. With operas, one need only think about how various perturbations of madness have been portrayed. Somnambulism has long been a particularly perplexing disorder, both to physicians and the laity, and it features in a number of operas. Two mid-nineteenth-century masterpieces are examined in detail in this contribution: Verdi's Macbeth and Bellini's La Sonnambula. In the former, the sleepwalking scene is faithful to what Shakespeare's had written early in the seventeenth century, a time of witchcraft, superstition, and the belief that nocturnal wanderings might be caused by guilt. In Bellini's opera, in contrast, the victim is an innocent girl who suffers from a quirk of nature, hence eliciting sympathy and compassion. By examining the early literature on somnambulism and comparing this disorder in these operas, we can see how thinking about this condition has changed and, more generally, how music was helping to generate new ways of thinking about specific diseases and medicine. © 2015 Elsevier B.V. All rights reserved.

Analysis of Slow-Wave Activity and Slow-Wave Oscillations Prior to Somnambulism

PubMed Central

Jaar, Olivier; Pilon, Mathieu; Carrier, Julie; Montplaisir, Jacques; Zadra, Antonio

2010-01-01

Study Objectivies: Several studies have investigated slow wave sleep EEG parameters, including slow-wave activity (SWA) in relation to somnambulism, but results have been both inconsistent and contradictory. The first goal of the present study was to conduct a quantitative analysis of sleepwalkers' sleep EEG by studying fluctuations in spectral power for delta (1-4 Hz) and slow delta (0.5-1 Hz) before the onset of somnambulistic episodes. A secondary aim was to detect slow-wave oscillations to examine changes in their amplitude and density prior to behavioral episodes. Participants: Twenty-two adult sleepwalkers were investigated polysomnographically following 25 h of sleep deprivation. Results: Analysis of patients' sleep EEG over the 200 sec prior to the episodes' onset revealed that the episodes were not preceded by a gradual increase in spectral power for either delta or slow delta over frontal, central, or parietal leads. However, time course comparisons revealed significant changes in the density of slow-wave oscillations as well as in very slow oscillations with significant increases occurring during the final 20 sec immediately preceding episode onset. Conclusions: The specificity of these sleep EEG parameters for the occurrence and diagnosis of NREM parasomnias remains to be determined. Citation: Jaar O; Pilon M; Carrier J; Montplaisir J; Zadra A. Analysis of slow-wave activity and slow-wave oscillations prior to somnambulism. SLEEP 2010;33(11):1511-1516. PMID:21102993

A polysomnographically documented case of adult somnambulism with long-distance automobile driving and frequent nocturnal violence: parasomnia with continuing danger as a noninsane automatism?

PubMed

Schenck, C H; Mahowald, M W

1995-11-01

A case of childhood-onset somnambulism is reported in which a 43-year-old man presented with repeated sleep-related injuries incurred during violent nocturnal activity, which included frenzied running, throwing punches and wielding knives. He had also driven an automobile a long distance during a presumed somnambulistic state. His wife had been repeatedly injured, and she felt that her life was threatened by his nocturnal violence 2-3 times yearly. Polysomnography (PSG) documented multiple episodes of complex and violent behaviors arising exclusively from stage 3/4 sleep, thus confirming the diagnosis of somnambulism. Other causes of sleep-related violence were excluded. The patient responded promptly to treatment with bedtime clonazepam, and benefit was maintained at 5-year follow-up. Although this strictly clinical case did not have any legal repercussions, it does carry forensic implications, particularly when placed in the context of the published medical literature on PSG-documented parasomnias (somnambulism, rapid eye movement sleep behavior disorder) containing explicit examples of recurrent violence, at times life-threatening, directed toward the bed partner and others. Thus, a new medical-legal concept is proposed, consisting of "parasomnia with continuing danger" as a noninsane automatism. Treatment guidelines, within the context of forensic medicine, are presented.

[Sleep deprivation in somnambulism. Effect of arousal, deep sleep and sleep stage changes].

PubMed

Mayer, G; Neissner, V; Schwarzmayr, P; Meier-Ewert, K

1998-06-01

Diagnosis of parasomnias in the sleep laboratory is difficult since the nocturnal behavior reported by the patients often does not show up in the laboratory. To test the efficacy of sleep deprivation as a tool to provoke somnambulism we investigated ten patients (three women and seven men, mean age 27 +/- 3.4) with somnambulism. Their standard polysomnographies and videomonitored nocturnal behavior was compared to that of sex- and age-matched controls and to polysomnography and behavior after sleep deprivation. Patients with parasomnias and controls did not show significant differences in sleep parameters with the exception of longer arousal duration in controls, which was nonsignificant. In magnetic resonance tomography, patients with parasomnias did not reveal abnormality of the brain that might explain release of nocturnal behavior. Sleep deprivation led to significantly reduced number of arousals, reduced arousal index, significantly prolonged arousal duration and more stage shifts from all sleep stages (nonsignificant). Complex behavior during sleep increased under sleep deprivation, whereas sleepwalking did not increase. The majority of complex behavior during sleep is triggered by stage shifts and not by arousal in the sense of the arousal definition of the American Sleep Disorder Society. Complex behavior in sleep is stereotypical and nonviolent. Its complexity seems to depend on the duration and intensity of arousals. Sleep deprivation can be recommended as an efficacious method of increasing complex behavior in sleep, which is a preliminary stage of sleepwalking. Concerning the underlying pathology it seems to be important to register the quality and duration of stimuli that trigger arousals instead of focusing the number of arousals alone.

[Investigations of psychic/spiritual phenomena in the nineteenth century: somnambulism and spiritualism, 1811-1860].

PubMed

Pimentel, Marcelo Gulão; Alberto, Klaus Chaves; Moreira-Almeida, Alexander

2016-01-01

In the early nineteenth century, investigations into the nature of psychic/spiritual phenomena, like trances and the supposed acquisition of information unattainable using normal sensory channels, prompted much debate in the scientific arena. This article discusses the main explanations offered by the researchers of psychic phenomena reported between 1811 and 1860, concentrating on the two main movements in the period: magnetic somnambulism and modern spiritualism. While the investigations of these phenomena gave rise to multiple theories, they did not yield any consensus. However, they did have implications for the understanding of the mind and its disorders, especially in the areas of the unconscious and dissociation, constituting an important part of the history of psychology and psychiatry.

Desensitization of GABAergic receptors as a mechanism of zolpidem-induced somnambulism.

PubMed

Juszczak, Grzegorz R

2011-08-01

Sleepwalking is a frequently reported side effect of zolpidem which is a short-acting hypnotic drug potentiating activity of GABA(A) receptors. Paradoxically, the most commonly used medications for somnambulism are benzodiazepines, especially clonazepam, which also potentiate activity of GABA(A) receptors. It is proposed that zolpidem-induced sleepwalking can be explained by the desensitization of GABAergic receptors located on serotonergic neurons. According to the proposed model, the delay between desensitization of GABA receptors and a compensatory decrease in serotonin release constitutes the time window for parasomnias. The occurrence of sleepwalking depends on individual differences in receptor desensitization, autoregulation of serotonin release and drug pharmacokinetics. The proposed mechanism of interaction between GABAergic and serotonergic systems can be also relevant for zolpidem abuse and zolpidem-induced hallucinations. It is therefore suggested that special care should be taken when zolpidem is used in patients taking at the same time selective serotonin reuptake inhibitors. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Fratricide occurring during a nocturnal episode of somnambulism: a case report].

PubMed

Alkassar, Z; Couvez, A; Guieu, J D

2000-01-01

Occasionally, some people developed violent acts during their sleeping. Fortunately, these acts remain virtual and do not have serious life consequences. However, the execution of the dramatical act may happen in setting automatic activities. The manifestations of these acts are exceptional but very often misappreciated. Among them, we have been confronted to a case of "fratricide expertise" in the north of France. The person concerned is a teenager of 17, accused of the murder of his young brother, by several stabs, in the night. This homicide could be the consequence of multitude of factors. Though he hasn't shown clinical somnambulism, the results of electroencephalogram tracing were symptoms of predisposing factors. We can also imagine the facilitating effect of other factors, ephedrine, more particularly. The rapport with the relevant documents follows an expert's report and can be added to the cases published in the literature in which it was shown that the automatic activity may be at the origin of the medico-legal act of somnambulistic patients. Finally, we have been able to deduce two classes of factors, which may be responsible for violent act execution.

A review of sleepwalking (somnambulism): the enigma of neurophysiology and polysomnography with differential diagnosis of complex partial seizures.

PubMed

Hughes, John R

2007-12-01

The goal of this report is to review all aspects of sleepwalking (SW), also known as somnambulism. Various factors seem to initiate SW, especially drugs, stress, and sleep deprivation. As an etiology, heredity is important, but other conditions include thyrotoxicosis, stress, and herpes simplex encephalitis. Psychological characteristics of sleepwalkers often include aggression, anxiety, panic disorder, and hysteria. Polysomnographic characteristics emphasize abnormal deep sleep associated with arousal and slow wave sleep fragmentation. In the differential diagnosis, the EEG is important to properly identify a seizure disorder, rather than SW. Associated disorders are Tourette's syndrome, sleep-disordered breathing, and migraine. Various kinds of treatment are discussed, as are legal considerations, especially murder during sleepwalking.

Analysis of slow-wave activity and slow-wave oscillations prior to somnambulism.

PubMed

Jaar, Olivier; Pilon, Mathieu; Carrier, Julie; Montplaisir, Jacques; Zadra, Antonio

2010-11-01

STUDY OBJECTIVIES: several studies have investigated slow wave sleep EEG parameters, including slow-wave activity (SWA) in relation to somnambulism, but results have been both inconsistent and contradictory. The first goal of the present study was to conduct a quantitative analysis of sleepwalkers' sleep EEG by studying fluctuations in spectral power for delta (1-4 Hz) and slow delta (0.5-1 Hz) before the onset of somnambulistic episodes. A secondary aim was to detect slow-wave oscillations to examine changes in their amplitude and density prior to behavioral episodes. twenty-two adult sleepwalkers were investigated polysomnographically following 25 h of sleep deprivation. analysis of patients' sleep EEG over the 200 sec prior to the episodes' onset revealed that the episodes were not preceded by a gradual increase in spectral power for either delta or slow delta over frontal, central, or parietal leads. However, time course comparisons revealed significant changes in the density of slow-wave oscillations as well as in very slow oscillations with significant increases occurring during the final 20 sec immediately preceding episode onset. the specificity of these sleep EEG parameters for the occurrence and diagnosis of NREM parasomnias remains to be determined.

Objective daytime sleepiness in patients with somnambulism or sleep terrors.

PubMed

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2014-11-25

To objectively measure daytime sleepiness and to assess for clinical and polysomnographic determinants of mean sleep latency in adult patients with somnambulism (sleepwalking [SW]) or sleep terrors (ST) compared with controls. Thirty drug-free adult patients with primary SW or ST, and age-, sex-, and body mass index-matched healthy controls underwent a standardized clinical interview, completed questionnaires including the Epworth Sleepiness Scale, and underwent one night of video polysomnography followed by the Multiple Sleep Latency Test (MSLT). Excessive daytime sleepiness defined as Epworth Sleepiness Scale score >10 was reported in 66.7% of patients and 6.7% of controls. The temporal pattern of sleep latencies in individual MSLT trials differed between patients and controls, with progressive increased sleep latency in patients across the trials in contrast to a "U curve" for controls. We did not find between-group differences regarding the mean sleep latency on the 5 MSLT trials, but did observe reduced sleep latencies in patients for the first 2 trials. Despite increased slow-wave sleep disruptions found in patients (i.e, more micro-arousals and hypersynchronous high-voltage delta waves arousals), we did not find polysomnographic characteristic differences when comparing sleepy patients for either subjective or objective daytime sleepiness on the MSLT compared with alert patients. Excessive daytime sleepiness is a common complaint in subjects with SW or ST and shorter sleep latencies in the early morning hours. Despite an increased slow-wave sleep fragmentation found in these patients, we did not identify any association with the level of daytime sleepiness. © 2014 American Academy of Neurology.

Polysomnographic diagnosis of sleepwalking: effects of sleep deprivation.

PubMed

Zadra, Antonio; Pilon, Mathieu; Montplaisir, Jacques

2008-04-01

Somnambulism affects up to 4% of adults and constitutes one of the leading causes of sleep-related violence and self-injury. Diagnosing somnambulism with objective instruments is often difficult because episodes rarely occur in the laboratory. Because sleep deprivation can precipitate sleepwalking, we aimed to determine the effects of 25 hours of sleep deprivation on the frequency and complexity of somnambulistic episodes recorded in the laboratory. Thirty consecutive sleepwalkers were evaluated prospectively by video-polysomnography for one baseline night and during recovery sleep after 25 hours of sleep deprivation. Ten sleepwalkers with a concomitant sleep disturbance were investigated with the same protocol. Sleepwalkers experienced a significant increase in the mean frequency of somnambulistic episodes during postdeprivation recovery sleep. Postsleep deprivation also resulted in a significantly greater proportion of patients experiencing more complex forms of somnambulism. Sleep deprivation was similarly effective in 9 of the 10 patients presenting with a comorbid sleep disturbance. Combining data from all 40 patients shows that whereas 32 episodes were recorded from 20 sleepwalkers (50%) at baseline, recovery sleep resulted in 92 episodes being recorded from 36 patients (90%). The findings support the view that sleepwalkers suffer from a dysfunction of the mechanisms responsible for sustaining stable slow-wave sleep and suggest that these patients are particularly vulnerable to increased homeostatic sleep pressure. Strong evidence is provided that 25 hours of sleep deprivation can be a valuable tool that facilitates the polysomnographically based diagnosis of somnambulism in predisposed patients.

Sleepwalking through history: medicine, arts, and courts of law.

PubMed

Umanath, Sharda; Sarezky, Daniel; Finger, Stanley

2011-10-01

Somnambulism, or sleepwalking, has always been of interest to theologians, writers, philosophers, physicians, and others fascinated by unusual behaviors. This parasomnia, which was defined less precisely in the past than it is today, has long been featured in medical dissertations and books of medicine. Further, Shakespeare, Bellini, and Brown, among others, incorporated it into their plays, operas, and novels. Because some somnambulists turned violent and committed other acts detrimental to society, sleepwalking also demanded attention from legal systems, and guidelines were set for whether somnambulists could be held responsible for their actions. This historical review focuses on these developments pertaining to somnambulism through the seventeenth, eighteenth, and nineteenth centuries.

Quetiapine-induced sleep-related eating disorder-like behavior: a case series.

PubMed

Tamanna, Sadeka; Ullah, M Iftekhar; Pope, Chelle R; Holloman, Garland; Koch, Christian A

2012-11-06

Somnambulism or sleepwalking is a disorder of arousal from non-rapid eye movement sleep. The prevalence of sleep-related eating disorder has been found to be approximately between 1% and 5% among adults. Many cases of medication-related somnambulism and sleep-related eating disorder-like behavior have been reported in the literature. Quetiapine, an atypical antipsychotic medication, has been associated with somnambulism but has not yet been reported to be associated with sleep-related eating disorder. Case 1 is a 51-year-old obese African American male veteran with a body mass index of 34.11kg/m2 and severe sleep apnea who has taken 150mg of quetiapine at bedtime for more than one year for depression. He developed sleepwalking three to four nights per week which resolved after stopping quetiapine while being compliant with bi-level positive pressure ventilation therapy. At one year follow-up, his body mass index was 32.57kg/m2.Case 2 is a 50-year-old African American female veteran with a body mass index of 30.5kg/m2 and mild sleep apnea who has taken 200mg of quetiapine daily for more than one year for depression. She was witnessed to sleepwalk three nights per week which resolved after discontinuing quetiapine while being treated with continuous positive airway pressure. At three months follow-up, her body mass index was 29.1kg/m2. These cases illustrate that quetiapine may precipitate complex motor behavior including sleep-related eating disorder and somnambulism in susceptible patients. Atypical antipsychotics are commonly used in psychiatric and primary care practice, which means the population at risk of developing parasomnia may often go unrecognized. It is important to recognize this potential adverse effect of quetiapine and, to prevent injury and worsening obesity, discuss this with the patients who are prescribed these medications.

Quetiapine-induced sleep-related eating disorder-like behavior: a case series

PubMed Central

2012-01-01

Introduction Somnambulism or sleepwalking is a disorder of arousal from non-rapid eye movement sleep. The prevalence of sleep-related eating disorder has been found to be approximately between 1% and 5% among adults. Many cases of medication-related somnambulism and sleep-related eating disorder-like behavior have been reported in the literature. Quetiapine, an atypical antipsychotic medication, has been associated with somnambulism but has not yet been reported to be associated with sleep-related eating disorder. Case presentation Case 1 is a 51-year-old obese African American male veteran with a body mass index of 34.11kg/m2 and severe sleep apnea who has taken 150mg of quetiapine at bedtime for more than one year for depression. He developed sleepwalking three to four nights per week which resolved after stopping quetiapine while being compliant with bi-level positive pressure ventilation therapy. At one year follow-up, his body mass index was 32.57kg/m2. Case 2 is a 50-year-old African American female veteran with a body mass index of 30.5kg/m2 and mild sleep apnea who has taken 200mg of quetiapine daily for more than one year for depression. She was witnessed to sleepwalk three nights per week which resolved after discontinuing quetiapine while being treated with continuous positive airway pressure. At three months follow-up, her body mass index was 29.1kg/m2. Conclusion These cases illustrate that quetiapine may precipitate complex motor behavior including sleep-related eating disorder and somnambulism in susceptible patients. Atypical antipsychotics are commonly used in psychiatric and primary care practice, which means the population at risk of developing parasomnia may often go unrecognized. It is important to recognize this potential adverse effect of quetiapine and, to prevent injury and worsening obesity, discuss this with the patients who are prescribed these medications. PMID:23130910

Sleep self-intoxication and sleep driving as rare zolpidem-induced complex behaviour.

PubMed

Paulke, Alexander; Wunder, Cora; Toennes, Stefan W

2015-01-01

The GABA(A) receptor agonist zolpidem has been used for treatment of insomnia since years, but special side effects have been reported. These side effects were called zolpidem-induced sleep-related complex behaviour. Such complex behaviour is associated with somnambulism and includes sleepwalking, sleep eating, sleep conversation and sleep driving. Two cases of zolpidem-induced sleep-related complex behaviour following self-intoxication, sleep driving and amnesia are presented. In both cases, the subjects reported the voluntary intake of only one zolpidem tablet of 10 mg and amnesia for the time afterwards. Shortly after the onset of the drug's action, both individuals drifted into a somnambulism-like state and toxicological blood analysis suggested the intake of the remaining zolpidem tablets which might be called "sleep intoxication". Later, the subjects were arrested by police after driving under drug influence and not realizing the situation. Retrospectively, both subjects suffered from psychiatric disorders and in case 2, the subject was treated for depression with doxepin. Consequently, these co-factors may have increased the risk for the occurrence of the sleep-related complex behaviour. Involuntary self-intoxication should be taken into account in addition to the known pattern of zolpidem-induced complex behaviour. In legal cases, the forensic expert has to assess the blood concentration of zolpidem in evaluating this strange behaviour. Amnesia and incoherence of speech, disorganization of behaviour, inability to realize the situation and mood changes may indicate a zolpidem-induced somnambulism-like state with sleep-related complex behaviour.

Shakespeare and sleep disorders.

PubMed

Furman, Y; Wolf, S M; Rosenfeld, D S

1997-10-01

Shakespeare was a consummate dramatist and profound observer of human behavior. He vividly described many clinical disorders, including those of sleep. His characters suffered from somnambulism, sleep apnea, insomnia, and nightmares. Sleep, to Shakespeare, was a blessing denied to many of his protagonists.

'Il Sonnambulo' by Michele Carafa: A Forgotten Romantic Opera with Sleepwalking.

PubMed

Riva, Michele Augusto; Mazzocchi, Caterina; Cesana, Giancarlo; Finger, Stanley

2016-01-01

Romantic operas provide a useful tool for historians to understand the perception of some medical disorders that existed during the nineteenth century. Somnambulism was still a mysterious condition during this time, since its pathogenesis was unknown. Hence, it comes as no surprise that somnambulism features in a number of operas, the best known of which are Verdi's 'Macbeth' and Bellini's 'La Sonnambula', both the subject of recent scholarship. Here we examine a more obscure opera in which sleepwalking is depicted. Dating from 1824, 'Il Sonnambulo' by the Italian composer Michele Carafa is based on a libretto by Felice Romani. Although it shares some features with the Verdi and Bellini operas, it also presents original elements. Our analysis of this forgotten opera supports the contention that studying operas can shed light on medical theories and practices, and on how ideas about mind and body disorders were transmitted to the laity in times past. © 2016 S. Karger AG, Basel.

Brain tumor presenting as somnambulism in an adolescent.

PubMed

Prashad, Priya S; Marcus, Carole L; Brown, Lawrence W; Dlugos, Dennis J; Feygin, Tamara; Harding, Brian N; Heuer, Gregory G; Mason, Thornton B Alexander

2013-09-01

Sleepwalking is typically a benign and self-limited non-rapid eye movement parasomnia of childhood. We describe an unusual 15-year-old boy referred to our sleep center for new-onset sleepwalking. An overnight polysomnogram was normal from a respiratory standpoint, but a concurrent extended electroencephalogram montage showed frequent epileptiform discharges from the right parietal-temporal region and two electroclinical seizures arising from the right-frontal-central-temporal region during sleep. Magnetic resonance imaging scan revealed a right parasagittal parietal region lesion consistent with a low-grade neoplasm, and surgical resection of the lesion demonstrated a right parietal dysembryoplastic neuroepithelial tumor. Complex partial seizures and sleepwalking remitted completely with anticonvulsant therapy following surgery. This patient highlights the differential diagnosis of nocturnal events appearing to be typical parasomnias, especially when they arise abruptly at an older age. Copyright © 2013 Elsevier Inc. All rights reserved.

Note on online books and articles about the history of dissociation.

PubMed

Alvarado, Carlos S

2008-01-01

Students of the history of dissociation will be interested in the materials on the subject available in the digital document database Google Book Search. This includes a variety of books and journals covering automatic writing, hypnosis, mediumship, multiple personality, trance, somnambulism, and other topics. Among the authors represented in the database are: Eugène Azam, Alfred Binet, James Braid, Jean-Martin Charcot, Pierre Janet, Frederic W.H. Myers, Morton Prince, and Boris Sidis, among others. The database includes examples of case reports, conceptual discussions, and psychiatric and psychological textbook literature.

Sleep and wakefulness in somnambulism: a spectral analysis study.

PubMed

Guilleminault, C; Poyares, D; Aftab, F A; Palombini, L; Abat, F

2001-08-01

The sleep structure and the dynamics of EEG slow-wave activity (SWA) were investigated in 12 young adults and age- and gender-matched controls. Polysomnography was performed in subjects with well-documented chronic sleepwalking and in matched controls. Blinded visual scoring was performed using the international criteria from the Rechtschaffen and Kales atlas [A manual of standardized technology, techniques and scoring systems for sleep stages of human subjects. Los Angeles: UCLA Brain Information Service, Brain Research Institute, 1968.] and by determining the presence of microarousals as defined in the American Sleep Disorders Association (ASDA) atlas [Sleep 15 (1992) 173.]. An evaluation of SWA overnight was performed on total nocturnal sleep to determine if a difference existed between groups of subjects, since sleepwalking usually originates with slow-wave sleep. Investigation of the delta power in successive nonoverlapping 4-second windows in the 32 seconds just prior to EMG activity associated with a confusional arousal was also conducted. One central EEG lead was used for all analyses. Somnambulistic individuals experienced more disturbed sleep than controls during the first NREM-REM sleep cycle. They had a higher number of ASDA arousals and presented lower peak of SWA during the first cycle that led to a lower SWA decline overnight. When the investigation focused on the short segment immediately preceding a confusional arousal, they presented an important increase in the relative power of low delta (0.75-2 Hz) just prior to the confusional arousal. Sleepwalkers undergo disturbed nocturnal sleep at the beginning of the night. The increased power of low delta just prior to the confusional arousal experienced may not be related to Stages 3-4 NREM sleep. We hypothesize that it may be translated as a cortical reaction to brain activation.

Varenicline and abnormal sleep related events.

PubMed

Savage, Ruth L; Zekarias, Alem; Caduff-Janosa, Pia

2015-05-01

To assess adverse drug reaction reports of "abnormal sleep related events" associated with varenicline, a partial agonist to the α4β2 subtype of nicotinic acetylcholine receptors on neurones, indicated for smoking cessation. Twenty-seven reports of "abnormal sleep related events" often associated with abnormal dreams, nightmares, or somnambulism, which are known to be associated with varenicline use, were identified in the World Health Organisation (WHO) Global Individual Case Safety Reports Database. Original anonymous reports were obtained from the four national pharmacovigilance centers that submitted these reports and assessed for reaction description and causality. These 27 reports include 10 of aggressive activity occurring during sleep and seven of other sleep related harmful or potentially harmful activities, such as apparently deliberate self-harm, moving a child or a car, or lighting a stove or a cigarette. Assessment of these 17 reports of aggression or other actual or potential harm showed that nine patients recovered or were recovering on varenicline withdrawal and there were no consistent alternative explanations. Thirteen patients experienced single events, and two had multiple events. Frequency was not stated for the remaining two patients. The descriptions of the reports of aggression during sleep with violent dreaming are similar to those of rapid eye movement sleep behavior disorder and also nonrapid eye movement (NREM) sleep parasomnias in some adults. Patients who experience somnambulism or dreams of a violent nature while taking varenicline should be advised to consult their health providers. Consideration should be given to clarifying the term sleep disorders in varenicline product information and including sleep related harmful and potentially harmful events. © 2015 Associated Professional Sleep Societies, LLC.

Varenicline and Abnormal Sleep Related Events

PubMed Central

Savage, Ruth L.; Zekarias, Alem; Caduff-Janosa, Pia

2015-01-01

Study Objectives: To assess adverse drug reaction reports of “abnormal sleep related events” associated with varenicline, a partial agonist to the α4β2 subtype of nicotinic acetylcholine receptors on neurones, indicated for smoking cessation. Design: Twenty-seven reports of “abnormal sleep related events” often associated with abnormal dreams, nightmares, or somnambulism, which are known to be associated with varenicline use, were identified in the World Health Organisation (WHO) Global Individual Case Safety Reports Database. Original anonymous reports were obtained from the four national pharmacovigilance centers that submitted these reports and assessed for reaction description and causality. Measurements and Results: These 27 reports include 10 of aggressive activity occurring during sleep and seven of other sleep related harmful or potentially harmful activities, such as apparently deliberate self-harm, moving a child or a car, or lighting a stove or a cigarette. Assessment of these 17 reports of aggression or other actual or potential harm showed that nine patients recovered or were recovering on varenicline withdrawal and there were no consistent alternative explanations. Thirteen patients experienced single events, and two had multiple events. Frequency was not stated for the remaining two patients. Conclusions: The descriptions of the reports of aggression during sleep with violent dreaming are similar to those of rapid eye movement sleep behavior disorder and also nonrapid eye movement (NREM) sleep parasomnias in some adults. Patients who experience somnambulism or dreams of a violent nature while taking varenicline should be advised to consult their health providers. Consideration should be given to clarifying the term sleep disorders in varenicline product information and including sleep related harmful and potentially harmful events. Citation: Savage RL, Zekarias A, Caduff-Janosa P. Varenicline and abnormal sleep related events. SLEEP 2015

Precipitating factors of somnambulism: impact of sleep deprivation and forced arousals.

PubMed

Pilon, Mathieu; Montplaisir, Jacques; Zadra, Antonio

2008-06-10

Experimental attempts to induce sleepwalking with forced arousals during slow-wave sleep (SWS) have yielded mixed results in children and have not been investigated in adult patients. We hypothesized that the combination of sleep deprivation and external stimulation would increase the probability of inducing somnambulistic episodes in sleepwalkers recorded in the sleep laboratory. The main goal of this study was to assess the effects of forced arousals from auditory stimuli (AS) in adult sleepwalkers and control subjects during normal sleep and following post-sleep deprivation recovery sleep. Ten sleepwalkers and 10 controls were investigated. After a baseline night, participants were presented with AS at predetermined sleep stages either during normal sleep or recovery sleep following 25 hours of sleep deprivation. One week later, the conditions with AS were reversed. No somnambulistic episodes were induced in controls. When compared to the effects of AS during sleepwalkers' normal sleep, the presentation of AS during sleepwalkers' recovery sleep significantly increased their efficacy in experimentally inducing somnambulistic events and a significantly greater proportion of sleepwalkers (100%) experienced at least one induced episode during recovery SWS as compared to normal SWS (30%). There was no significant difference between the mean intensity of AS that induced episodes during sleepwalkers' SWS and the mean intensity of AS that awakened sleepwalkers and controls from SWS. Sleep deprivation and forced arousals during slow-wave sleep can induce somnambulistic episodes in predisposed adults. The results highlight the potential value of this protocol in establishing a video-polysomnographically based diagnosis for sleepwalking.

Hypersynchronous delta waves and somnambulism: brain topography and effect of sleep deprivation.

PubMed

Pilon, Mathieu; Zadra, Antonio; Joncas, Steve; Montplaisir, Jacques

2006-01-01

Hypersynchronous delta activity (HSD) is usually described as several continuous high-voltage delta waves (> or = 150 microV) in the sleep electroencephalogram of somnambulistic patients. However, studies have yielded varied and contradictory results. The goal of the present study was to evaluate HSD over different electroencephalographic derivations during the non-rapid eye movement (NREM) sleep of somnambulistic patients and controls during normal sleep and following 38 hours of sleep deprivation, as well as prior to sleepwalking episodes. N/A. Sleep disorders clinic. Ten adult sleepwalkers and 10 sex- and age-matched control subjects were investigated polysomnographically during a baseline night and following 38 hours of sleep deprivation. N/A. During normal sleep, sleepwalkers had a significantly higher ratio of HSD over the time spent in stage 2, 3 and 4 on frontal and central derivations when compared with controls. Sleep deprivation resulted in a significant increase in the ratio of the time in HSD over the time in stage 4 on the frontal lead in both groups and on the central lead in controls. There was no evidence for a temporal accumulation of HSD prior to the episodes. HSD shows a clear frontocentral gradient across all subjects during both baseline and recovery sleep and has relatively low specificity for the diagnosis of NREM parasomnias. Increases in HSD after sleep deprivation may reflect an enhancement of the homeostatic process underlying sleep regulation.

Diagnosis and treatment of sleep disorders: a brief review for clinicians

PubMed Central

Abad, Vivien C.; Guilleminault, Christian

2003-01-01

Sleep disorders encompass a wide spectrum of diseases with significant individual health consequences and high economic costs to society. To facilitate the diagnosis and treatment of sleep disorders, this review provides a framework using the International Classification of Sleep Disorders, Primary and secondary insomnia are differentiated, and pharmacological and nonpharmacological treatments are discussed. Common circadian rhythm disorders are described in conjunction with interventions, including chronotherapy and light therapy. The diagnosis and treatment of restless legs syndrome/periodic limb movement disorder is addressed. Attention is focused on obstructive sleep apnea and upper airway resistance syndrome, and their treatment. The constellation of symptoms and findings in narcolepsy are reviewed together with diagnostic testing and therapy, Parasomnias, including sleep terrors, somnambulism, and rapid eye movement (REM) behavior sleep disorders are described, together with associated laboratory testing results and treatment. PMID:22033666

Sleepwalking episodes are preceded by arousal-related activation in the cingulate motor area: EEG current density imaging.

PubMed

Januszko, Piotr; Niemcewicz, Szymon; Gajda, Tomasz; Wołyńczyk-Gmaj, Dorota; Piotrowska, Anna Justyna; Gmaj, Bartłomiej; Piotrowski, Tadeusz; Szelenberger, Waldemar

2016-01-01

To investigate local arousal fluctuations in adults who received ICSD-2 diagnosis of somnambulism. EEG neuroimaging (eLORETA) was utilized to compare current density distribution for 4s epochs immediately preceding sleepwalking episode (from -4.0 s to 0 s) to the distribution during earlier 4s epochs (from -8.0 s to -4.0 s) in 20 EEG segments from 15 patients. Comparisons between eLORETA images revealed significant (t>4.52; p<0.05) brain activations before onset of sleepwalking, with greater current density within beta 3 frequency range (24-30 Hz) in Brodmann areas 33 and 24. Sleepwalking motor events are associated with arousal-related activation of cingulate motor area. These results support the notion of blurred boundaries between wakefulness and NREM sleep in sleepwalking. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Nocturnal enuresis in a longitudinal perspective. A primary problem of maturity and/or a secondary environmental reaction?

PubMed

Klackenberg, G

1981-07-01

The study is part of a prospective longitudinal investigation, involving annual somatic, psychological and social check-ups in a random sample of 212 children. Data are presented on the gradual achievement of bladder control, with relapses into wetting. Information is provided on relationships with training, with behavioural variables, with emotional maturity (Rorschach) and with sleep. It seems probable that primary enuresis usually ceases by the age of 8 at the latest and that enuresis in older children is a secondary emotional disorder which may, however, have started at an earlier age. The 6-year-old enuretic shows signs of delayed emotional maturity. The relation with somnambulism is ambiguous. Enuresis is not significantly related to training. None of the data obtained in this study conflict with the theory that primary enuresis is chiefly a maturity problem, the nature of which can be emotional. The neurophysiological aspect has not been investigated.

Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis.

PubMed

Stallman, Helen M; Kohler, Mark

2016-01-01

Sleepwalking is thought to be a common arousal disorder; however, the epidemiology of this disorder has not yet been systematically examined. A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted for 'sleepwalking' OR 'somnambulism' in any field, to identify studies that reported the epidemiology of sleepwalking or sleepwalking disorders. Fifty-one studies assessed the prevalence rates of sleepwalking in a total sample of 100 490. The meta-analysis showed the estimated lifetime prevalence of sleepwalking was 6.9% (95% CI 4.6%-10.3%). The current prevalence rate of sleepwalking-within the last 12 months-was significantly higher in children 5.0% (95% CI 3.8%-6.5%) than adults 1.5% (95% CI 1.0%-2.3%). There was no evidence of developmental trends in sleepwalking across childhood. The significant risk of bias across all studies suggests these results should be used cautiously. Further epidemiological research that addresses methodological problems found in studies of sleepwalking to date is needed.

Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors.

PubMed

Mysliwiec, Vincent; O'Reilly, Brian; Polchinski, Jason; Kwon, Herbert P; Germain, Anne; Roth, Bernard J

2014-10-15

To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences. A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors. DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients. We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma.

Preaching What We Practice: Teaching Ethical Decision-Making to Computer Security Professionals

NASA Astrophysics Data System (ADS)

Fleischmann, Kenneth R.

The biggest challenge facing computer security researchers and professionals is not learning how to make ethical decisions; rather it is learning how to recognize ethical decisions. All too often, technology development suffers from what Langdon Winner terms technological somnambulism - we sleepwalk through our technology design, following past precedents without a second thought, and fail to consider the perspectives of other stakeholders [1]. Computer security research and practice involves a number of opportunities for ethical decisions. For example, decisions about whether or not to automatically provide security updates involve tradeoffs related to caring versus user autonomy. Decisions about online voting include tradeoffs between convenience and security. Finally, decisions about routinely screening e-mails for spam involve tradeoffs of efficiency and privacy. It is critical that these and other decisions facing computer security researchers and professionals are confronted head on as value-laden design decisions, and that computer security researchers and professionals consider the perspectives of various stakeholders in making these decisions.

Zolpidem-induced sleepwalking, sleep related eating disorder, and sleep-driving: fluorine-18-flourodeoxyglucose positron emission tomography analysis, and a literature review of other unexpected clinical effects of zolpidem.

PubMed

Hoque, Romy; Chesson, Andrew L

2009-10-15

Zolpidem is a hypnotic which acts at the GABAA receptor and is indicated for short-term insomnia. Sleep related disorders including somnambulism, sleep related eating and sleep-driving have been reported with zolpidem. A 51-year-old insomniac who used zolpidem 10 mg nightly starting at 44 years of age is described. A few weeks after starting zolpidem she began walking, eating, and had one episode of driving while asleep. Episodes of sleep related eating, sleepwalking, and sleeptalking occurred 3 nights per week, 1 to 2 h after sleep onset. After her evaluation, the patient's zolpidem was gradually discontinued, and all sleep related activities immediately ceased. An 18F-FDG-PET was obtained 2 months after discontinuation of zolpidem. The following day, FDG was administered 1 h after oral administration of 10 mg zolpidem, and then a second PET was performed. We report the results and a review of the literature regarding other unintended effects seen with zolpidem use.

Biperiden for treatment of somnambulism in adolescents and adults with or without epilepsy: clinical observations.

PubMed

Hodoba, Danilo; Schmidt, Dieter

2012-12-01

Sleepwalking in adolescents and adults may lead to serious injuries and require treatment. Anecdotal treatment recommendations include benzodiazepines (which also work in focal seizures of the frontal lobe that are an important differential diagnosis), imipramine and amitriptyline. We assessed in a follow-up study of 4 years (medium, range: 2-7 years) the usefulness of the antiparkinsonian drug biperiden (Akineton©), an acetylcholine antagonist with high affinity for muscarinic M1-type receptors, in four consecutive cases of arousal disorder with sleepwalking and confusional behavior in adolescents and adults with or without epilepsy who did not respond to diazepam, clonazepam or amitriptyline. The adjunctive use of biperiden was associated with reduction or remission of sleepwalking episodes in four consecutive treatment-refractory cases of arousal disorder with sleepwalking and confusional behavior. In contrast, biperiden showed no effect in a patient with REM behavioral disorder. Although our observations do not and cannot establish the efficacy or safety of biperiden, it may be useful to consider biperiden for treatment of sleepwalking, if needed. A putative cholinergic mechanism of arousal disorders, including sleepwalking, provides a reasonable hypothesis why the anticholinergic agent biperiden might work. Evidence for efficacy and safety from randomized controlled trials is needed to confirm our preliminary observations. Copyright © 2012 Elsevier Inc. All rights reserved.

Relationships between non-pathological dream-enactment and mirror behaviors.

PubMed

Nielsen, Tore; Kuiken, Don

2013-09-01

Dream-enacting behaviors (DEBs) are behavioral expressions of forceful dream images often occurring during sleep-to-wakefulness transitions. We propose that DEBs reflect brain activity underlying social cognition, in particular, motor-affective resonance generated by the mirror neuron system. We developed a Mirror Behavior Questionnaire (MBQ) to assess some dimensions of mirror behaviors and investigated relationships between MBQ scores and DEBs in a large of university undergraduate cohort. MBQ scores were normally distributed and described by a four-factor structure (Empathy/Emotional Contagion, Behavioral Imitation, Sleepiness/Anger Contagion, Motor Skill Imitation). DEB scores correlated positively with MBQ total and factor scores even with social desirability, somnambulism and somniloquy controlled. Emotion-specific DEB items correlated with corresponding emotion-specific MBQ items, especially crying and smiling. Results provide preliminary evidence for cross-state relationships between propensities for dream-enacting and mirror behaviors--especially behaviors involving motor-affective resonance--and our suggestion that motor-affective resonance mediates dream-enactment imagery during sleep and emotional empathy during waking. Copyright © 2013 Elsevier Inc. All rights reserved.

From catalepsy to psychical research: The itinerary of Timothée Puel (1812-1890).

PubMed

Evrard, Renaud; Pratte, Erika Annabelle

2017-02-01

The physician and botanist Timothée Puel (1812-1890) lived through a pivotal period of psychology (1848-1878), between the academic prohibition of the study of animal magnetism to its disjointed recovery in hypnotism and psychical research. One of his cases of "catalepsy complicated with somnambulism" triggered a lively debate on "extraordinary neuroses" within the young Société médico-psychologique [Medico-psychological Society]. In 1874, Puel founded the Revue de psychologie expérimentale [Journal of Experimental Psychology], the first of its kind in French, which he intended as the vehicle of international interest in psychical research, the scholarly and institutionalized study of "psychism" that prepared the way for the recognition of academic psychology. Puel circulated between these different currents by taking advantage of the polysemy of concepts like "sleep," "experimental psychology," and "psychism." This article discusses his role in the context of emerging French psychology in the mid- to late 19th century. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A comparison of complex sleep behaviors with two short-acting Z-hypnosedative drugs in nonpsychotic patients

PubMed Central

Chen, Li-Fen; Lin, Ching-En; Chou, Yu-Ching; Mao, Wei-Chung; Chen, Yi-Chyan; Tzeng, Nian-Sheng

2013-01-01

Objective Complex sleep behaviors (CSBs) are classified as “parasomnias” in the International Classifcation of Sleep Disorders, Second Edition (ICSD-2). To realize the potential danger after taking two short-acting Z-hypnosedative drugs, we estimated the incidence of CSBs in nonpsychotic patients in Taiwan. Methods Subjects (N = 1,220) using zolpidem or zopiclone were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan over a 16-month period in 2006–2007. Subjects with zolpidem (N = 1,132) and subjects with zopiclone (N = 88) were analyzed. All subjects completed a questionnaire that included demographic data and complex sleep behaviors after taking hypnotics. Results Among zolpidem and zopiclone users, 3.28% of patients reported incidents of somnambulism or amnesic sleep-related behavior problems. The incidence of CSBs with zolpidem and zopiclone were 3.27%, and 3.41%, respectively, which was signifcantly lower than other studies in Taiwan. Conclusion These results serve as a reminder for clinicians to make inquiries regarding any unusual performance of parasomnic activities when prescribing zolpidem or zopiclone. PMID:23976857

Technology Leadership or Technology Somnambulism? Exploring the Discourse of Integration amongst Information and Communication Technology Coordinators

ERIC Educational Resources Information Center

McDonagh, Adrian; McGarr, Oliver

2015-01-01

This research aimed to explore information and communication technology (ICT) coordinators' discourse in relation to ICT integration in a sample of Irish post-primary schools. As ICT leaders in their schools, how they conceptualise ICT significantly influences school-based policy and use. The research involved semi-structured interviews with a…

[Unusual behaviors in sleep as "compensatory" reactions, aimed at normalizing sleep-alertness cycles].

PubMed

Gol'bin, A Ts; Guzeva, V I; Shepoval'nikov, A N

2013-01-01

The present article is an attempt to perform a conceptual clinical and physiological analysis of a large spec- trum of sleep-related phenomena called parasomnias in children, based on data from three independent in- stitutions. Parasonmias appear in the process of falling asleep, at the time of sleep stage changes, and upon awakening. They are common for both healthy children and those with neurological and psychiatric disorders. Brief descriptions of clinical pictures of several groups of parasomnias and their polysomnographic characteristics are presented. Instances of stereotyped rhythmic movements (e.g. head rocking), paroxysmal somatic and behavioral episodes (night terrors and nightmares), "static" phenomena (sleep with open eyes, strange body positions), as well as somnambulism are specifically described. Common features of parasomnias as a group have been identified (the "Parasomnia syndrome"). It was found that sleep architecture frequently normalizes after a parasomnia episode, whereas parasomnias are self-liquidated after sleep matures (self-cure). The significance of gender differences in parasomnias have been reviewed. Possible compensatory physiological functions of parasomnias acting as "switches" or "stabilizers" of sleep stages to "off-set" deviated or immature sleep-wake mechanisms were discussed.

Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors

PubMed Central

Mysliwiec, Vincent; O'Reilly, Brian; Polchinski, Jason; Kwon, Herbert P.; Germain, Anne; Roth, Bernard J.

2014-01-01

Study Objectives: To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences. Methods: A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors. Results: DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients. Conclusions: We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma. Citation: Mysliwiec V, O'Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJ. Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. J Clin Sleep Med 2014;10(10):1143-1148. PMID:25317096

Zolpidem-Induced Sleepwalking, Sleep Related Eating Disorder, and Sleep-Driving: Fluorine-18-Flourodeoxyglucose Positron Emission Tomography Analysis, and a Literature Review of Other Unexpected Clinical Effects of Zolpidem

PubMed Central

Hoque, Romy; Chesson, Andrew L.

2009-01-01

Zolpidem is a hypnotic which acts at the GABAA receptor and is indicated for short-term insomnia. Sleep related disorders including somnambulism, sleep related eating and sleep-driving have been reported with zolpidem. A 51-year-old insomniac who used zolpidem 10 mg nightly starting at 44 years of age is described. A few weeks after starting zolpidem she began walking, eating, and had one episode of driving while asleep. Episodes of sleep related eating, sleepwalking, and sleeptalking occurred 3 nights per week, 1 to 2 h after sleep onset. After her evaluation, the patient's zolpidem was gradually discontinued, and all sleep related activities immediately ceased. An 18F-FDG-PET was obtained 2 months after discontinuation of zolpidem. The following day, FDG was administered 1 h after oral administration of 10 mg zolpidem, and then a second PET was performed. We report the results and a review of the literature regarding other unintended effects seen with zolpidem use. Citation: Hoque R; Chesson AL. Zolpidem-induced sleepwalking, sleep related eating disorder, and sleep-driving: fluorine-18-flourodeoxyglucose positron emission tomography analysis, and a literature review of other unexpected clinical effects of zolpidem. J Clin Sleep Med 2009;5(5):471-476 PMID:19961034

EEG Functional Connectivity Prior to Sleepwalking: Evidence of Interplay Between Sleep and Wakefulness

PubMed Central

Desjardins, Marie-Ève; Carrier, Julie; Lina, Jean-Marc; Fortin, Maxime; Gosselin, Nadia; Montplaisir, Jacques

2017-01-01

Abstract Study Objectives: Although sleepwalking (somnambulism) affects up to 4% of adults, its pathophysiology remains poorly understood. Sleepwalking can be preceded by fluctuations in slow-wave sleep EEG signals, but the significance of these pre-episode changes remains unknown and methods based on EEG functional connectivity have yet to be used to better comprehend the disorder. Methods: We investigated the sleep EEG of 27 adult sleepwalkers (mean age: 29 ± 7.6 years) who experienced a somnambulistic episode during slow-wave sleep. The 20-second segment of sleep EEG immediately preceding each patient’s episode was compared with the 20-second segment occurring 2 minutes prior to episode onset. Results: Results from spectral analyses revealed increased delta and theta spectral power in the 20 seconds preceding the episodes’ onset as compared to the 20 seconds occurring 2 minutes before the episodes. The imaginary part of the coherence immediately prior to episode onset revealed (1) decreased delta EEG functional connectivity in parietal and occipital regions, (2) increased alpha connectivity over a fronto-parietal network, and (3) increased beta connectivity involving symmetric inter-hemispheric networks implicating frontotemporal, parietal and occipital areas. Conclusions: Taken together, these modifications in EEG functional connectivity suggest that somnambulistic episodes are preceded by brain processes characterized by the co-existence of arousal and deep sleep. PMID:28204773

EEG Functional Connectivity Prior to Sleepwalking: Evidence of Interplay Between Sleep and Wakefulness.

PubMed

Desjardins, Marie-Ève; Carrier, Julie; Lina, Jean-Marc; Fortin, Maxime; Gosselin, Nadia; Montplaisir, Jacques; Zadra, Antonio

2017-04-01

Although sleepwalking (somnambulism) affects up to 4% of adults, its pathophysiology remains poorly understood. Sleepwalking can be preceded by fluctuations in slow-wave sleep EEG signals, but the significance of these pre-episode changes remains unknown and methods based on EEG functional connectivity have yet to be used to better comprehend the disorder. We investigated the sleep EEG of 27 adult sleepwalkers (mean age: 29 ± 7.6 years) who experienced a somnambulistic episode during slow-wave sleep. The 20-second segment of sleep EEG immediately preceding each patient's episode was compared with the 20-second segment occurring 2 minutes prior to episode onset. Results from spectral analyses revealed increased delta and theta spectral power in the 20 seconds preceding the episodes' onset as compared to the 20 seconds occurring 2 minutes before the episodes. The imaginary part of the coherence immediately prior to episode onset revealed (1) decreased delta EEG functional connectivity in parietal and occipital regions, (2) increased alpha connectivity over a fronto-parietal network, and (3) increased beta connectivity involving symmetric inter-hemispheric networks implicating frontotemporal, parietal and occipital areas. Taken together, these modifications in EEG functional connectivity suggest that somnambulistic episodes are preceded by brain processes characterized by the co-existence of arousal and deep sleep. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep disturbances in Angelman syndrome: a questionnaire study.

PubMed

Bruni, Oliviero; Ferri, Raffaele; D'Agostino, Gaetana; Miano, Silvia; Roccella, Michele; Elia, Maurizio

2004-06-01

Only few studies are available on sleep disorders in Angelman syndrome (AS), a neurodevelopmental disorder with several behavior disturbances. The aim of this study was to determine the prevalence of sleep disorders in a relatively large group of AS subjects, compared to that of age-matched controls. Forty-nine consecutive parents of patients with AS (26 males and 23 females aged 2.3-26.2 years) were interviewed and filled out a comprehensive sleep questionnaire. Based on their genetic etiology, four groups were defined: deletion of chromosome 15q11-13 (25 subjects); methylation imprinting mutation (six subjects), UBE3A mutations (seven subjects) and paternal uniparental disomy (five subjects). In the remaining cases genetic testings were negative. A significantly high frequency of disorders of initiating and maintaining sleep, prolonged sleep latency, prolonged wakefulness after sleep onset, high number of night awakenings and reduced total sleep time were found in our AS patients, as compared to age-matched controls. We also found other types of sleep disorders, never reported before, such as enuresis, bruxism, sleep terrors, somnambulism, nocturnal hyperkinesia, and snoring. No differences were found between the four genetic aetiology groups. Moreover, we did not find important improvement of sleep disturbances from pre-pubertal to post-pubertal ages. Our data confirm the significant presence of sleep/wake rhythms fragmentation, peculiar of AS, and also demonstrate the presence of several other types of sleep disturbances in this syndrome.

Intrinsic Brain Activity in Altered States of Consciousness

PubMed Central

Boly, M.; Phillips, C.; Tshibanda, L.; Vanhaudenhuyse, A.; Schabus, M.; Dang-Vu, T.T.; Moonen, G.; Hustinx, R.; Maquet, P.; Laureys, S.

2010-01-01

Spontaneous brain activity has recently received increasing interest in the neuroimaging community. However, the value of resting-state studies to a better understanding of brain–behavior relationships has been challenged. That altered states of consciousness are a privileged way to study the relationships between spontaneous brain activity and behavior is proposed, and common resting-state brain activity features observed in various states of altered consciousness are reviewed. Early positron emission tomography studies showed that states of extremely low or high brain activity are often associated with unconsciousness. However, this relationship is not absolute, and the precise link between global brain metabolism and awareness remains yet difficult to assert. In contrast, voxel-based analyses identified a systematic impairment of associative frontoparieto–cingulate areas in altered states of consciousness, such as sleep, anesthesia, coma, vegetative state, epileptic loss of consciousness, and somnambulism. In parallel, recent functional magnetic resonance imaging studies have identified structured patterns of slow neuronal oscillations in the resting human brain. Similar coherent blood oxygen level–dependent (BOLD) systemwide patterns can also be found, in particular in the default-mode network, in several states of unconsciousness, such as coma, anesthesia, and slow-wave sleep. The latter results suggest that slow coherent spontaneous BOLD fluctuations cannot be exclusively a reflection of conscious mental activity, but may reflect default brain connectivity shaping brain areas of most likely interactions in a way that transcends levels of consciousness, and whose functional significance remains largely in the dark. PMID:18591474

Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series.

PubMed

Poceta, J Steven

2011-12-15

To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleep-related parasomnias. A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the influence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered. Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case. Sleep driving and other complex behaviors can occur after zolpidem ingestion. Physicians should assess patients for potential risk factors and inquire about parasomnias. Serious legal and medical complications can occur as a result of these forms of automatic complex behaviors.

Gray matter abnormalities of the dorsal posterior cingulate in sleep walking.

PubMed

Heidbreder, Anna; Stefani, Ambra; Brandauer, Elisabeth; Steiger, Ruth; Kremser, Christian; Gizewski, Elke R; Young, Peter; Poewe, Werner; Högl, Birgit; Scherfler, Christoph

2017-08-01

This study aimed to determine whether voxel-based analysis of T1 weighted magnetic resonance imaging (MRI) and diffusion tensor imaging is able to detect alterations of gray and white matter morphometry as well as measures of mean diffusivity and fractional anisotropy in patients with non-rapid eye movement parasomnia. 3 Tesla MRI was performed in 14 drug-free, polysomnography-confirmed adult patients with non-rapid eye movement parasomnia (age: 29 ± 4.2 years; disease duration 19.2 ± 7.7 years) and 14 healthy subjects, matched for age and gender. Statistical parametric mapping was applied to objectively identify focal changes of MRI parameters throughout the entire brain volume. Statistical parametric mapping localized significant decreases of gray matter volume in the left dorsal posterior cingulate cortex (BA23) and posterior midcingulate cortex (BA24) in patients with non-rapid eye movement parasomnias compared to the control group (p < 0.001, corrected for multiple comparisons). No significant differences of mean diffusivity and fractional anisotropy measures were found between the non-rapid eye movement parasomnia group and the healthy control group. Recently, the simultaneous co-existence of arousal or wakefulness originating from the motor and cingulate cortices and persistent sleep in associative cortical regions was suggested as a functional framework of somnambulism. Gray matter volume decline in the dorsal posterior and posterior midcingulate cortex reported in this study might represent the neuroanatomical substrate for this condition. Copyright © 2017 Elsevier B.V. All rights reserved.

Final chapter, From India to the Planet Mars: A Study of a Case of Somnambulism with Glossolalia, by Théodore Flournoy (1900).

PubMed

de Oliveira Maraldi, Everton; Alvarado, Carlos S

2018-03-01

Among the many attempts to explain mediumship psychologically at the turn of the century were the efforts of Swiss psychologist Théodore Flournoy (1854-1920). In his well-known book Des Indes à la Planète Mars (1900), translated as From India to the Planet Mars (1900), Flournoy analysed the mediumistic productions of medium Hélène Smith (1861-1929), consisting of accounts of previous lives in France and in India, and material about planet Mars. Flournoy explained the phenomena as a function of cryptomnesia, suggestive influences, and subconscious creativity, analyses that influenced both psychology and psychical research. The purpose of this Classic Text is to reprint the conclusion of Flournoy's study, whose ideas were developed in the context of psychological attention to mediumship and secondary personalities.

Pain in Sleepwalking: A Clinical Enigma.

PubMed

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2015-11-01

Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Cross-sectional case-control study. Data were collected at the Sleep Disorders Center, Montpellier, France. One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive

Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series

PubMed Central

Poceta, J. Steven

2011-01-01

Study Objectives: To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleep-related parasomnias. Methods: A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the influence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered. Results: Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case. Conclusions: Sleep driving and other complex behaviors can occur after zolpidem ingestion. Physicians should assess patients for potential risk factors and inquire about parasomnias. Serious legal and medical complications can occur as a result of these forms of automatic complex behaviors. Citation: Poceta JS. Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series. J Clin Sleep Med 2011;7(6):632-638. PMID:22171202

NREM Arousal Parasomnias and Their Distinction from Nocturnal Frontal Lobe Epilepsy: A Video EEG Analysis

PubMed Central

Derry, Christopher P.; Harvey, A. Simon; Walker, Matthew C.; Duncan, John S.; Berkovic, Samuel F.

2009-01-01

Study Objectives. To describe the semiological features of NREM arousal parasomnias in detail and identify features that can be used to reliably distinguish parasomnias from nocturnal frontal lobe epilepsy (NFLE). Design. Systematic semiologial evaluation of parasomnias and NFLE seizures recorded on video-EEG monitoring. Patients. 120 events (57 parasomnias, 63 NFLE seizures) from 44 subjects (14 males). Interventions. The presence or absence of 68 elemental clinical features was determined in parasomnias and NFLE seizures. Qualitative analysis of behavior patterns and ictal EEG was undertaken. Statistical analysis was undertaken using established techniques. Results. Elemental clinical features strongly favoring parasomnias included: interactive behavior, failure to wake after event, and indistinct offset (all P < 0.001). Cluster analysis confirmed differences in both the frequency and combination of elemental features in parasomnias and NFLE. A diagnostic decision tree generated from these data correctly classified 94% of events. While sleep stage at onset was discriminatory (82% of seizures occurred during stage 1 or 2 sleep, with 100% of parasomnias occurring from stage 3 or 4 sleep), ictal EEG features were less useful. Video analysis of parasomnias identified three principal behavioral patterns: arousal behavior (92% of events); non-agitated motor behavior (72%); distressed emotional behavior (51%). Conclusions Our results broadly support the concept of confusion arousals, somnambulism and night terrors as prototypical behavior patterns of NREM parasomnias, but as a hierarchical continuum rather than distinct entities. Our observations provide an evidence base to assist in the clinical diagnosis of NREM parasomnias, and their distinction from NFLE seizures, on semiological grounds. Citation: Derry CP; Harvey AS; Walker MC; Duncan JS; Berkovic SF. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis. SLEEP

Adverse Reactions to Zolpidem: Case Reports and a Review of the Literature

PubMed Central

Miyaoka, Tsuyoshi; Tsuji, Seiichi; Inami, Yasushi; Nishida, Akira; Horiguchi, Jun

2010-01-01

Objective: Zolpidem, a nonbenzodiazepine hypnotic, is very effective and widely prescribed in clinical practice for the treatment of insomnia and is thought to have few adverse effects. However, zolpidem-induced adverse effects have begun to be reported in the literature, but few systemic descriptions of the adverse effects (especially for psychotic reactions) of zolpidem have been undertaken. In light of the accumulating reports of adverse reactions to zolpidem, we present 2 case reports of zolpidem-induced adverse effects and review the literature on this subject. Data Sources: Articles were selected by the authors on the basis of our experience and by a PubMed search using the terms zolpidem or side effects or adverse effects or adverse reactions. Study Selection and Data Extraction: Publications relevant to the objective of this article were obtained (1992–2010), and some adverse neuropsychiatric reactions were summarized. Data Synthesis: Zolpidem has been associated with the development of adverse neuropsychiatric reactions, such as hallucinations/sensory distortion, amnesia, sleepwalking/somnambulism, and nocturnal eating. The following 4 variables should be considered when prescribing zolpidem: (1) gender: women have been found to have a significantly higher serum zolpidem concentration than men; (2) zolpidem dose: the adverse reactions that develop are dose dependent; (3) protein binding affinity: a high proportion of zolpidem is protein bound; therefore, low serum albumin results in a higher level of free zolpidem leading to adverse psychiatric reactions; and (4) cytochrome P450 (CYP) isoenzyme inhibition: concomitant administration of zolpidem and other drugs may cause interactions that lead to increased concentrations of zolpidem. Conclusions: Zolpidem is clinically very effective in treating insomnia. However, while rare, zolpidem-induced unusual complex behavior may develop. Primary care physicians should be alert to the possible unusual complex

Pain in Sleepwalking: A Clinical Enigma

PubMed Central

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2015-01-01

Study Objectives: Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Design: Cross-sectional case-control study. Setting: Data were collected at the Sleep Disorders Center, Montpellier, France. Participants: One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Measurements and Results: Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Conclusion: Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia

Sleepwalking associated with hyperthyroidism.

PubMed

Ajlouni, Kamel M; Ahmad, Azmi T; El-Zaheri, Mohamed M; Al-Zahiri, Mohammad M; Ammari, Fawwaz L; Jarrah, Nadim S; AbuJbara, Mousa A; Ajlouni, Heitham K; Daradkeh, Tewfik K

2005-01-01

To report several cases of hyperthyroidism in patients presenting with the unusual symptom of sleepwalking and to discuss the possible pathophysiologic basis for this novel association. After encountering and reporting the first case of new-onset somnambulism in a patient presenting with thyrotoxicosis at our institution, we routinely inquired about the sleep history of patients with thyrotoxicosis, questioning both the patients and family members when applicable. Those patients who actually had sleepwalking episodes coinciding with the onset of thyrotoxicosis underwent close follow-up, and the relationship between the sleepwalking and the results of thyroid function tests was analyzed. In addition, we reviewed the literature on psychiatric disorders and sleep problems, and the pathophysiologic rationale for a cause-and-effect relationship is discussed. We collected 8 cases of patients with new-onset sleepwalking episodes that coincided with the start of thyrotoxicosis. The disappearance of the sleepwalking with successful achievement of euthyroidism supports a cause-and-effect relationship. This hypothesis is further supported by the absence of a family history, the adult onset, and the relapse of sleepwalking in 2 of the patients when their thyrotoxicosis became poorly controlled as a result of noncompliance with medications and its subsequent disappearance with reachievement of euthyroidism. Of note, such a presentation was seen only in patients with thyrotoxicosis caused by diffuse toxic goiter or Graves' disease and never in patients with other causes of thyrotoxicosis. New-onset sleepwalking could be caused by thyrotoxicosis or, more specifically, by thyrotoxicosis resulting from diffuse toxic goiter. The mechanism is hypothesized to be related to the combination of prolongation of non-rapid eye movement sleep and the associated fatigue. Specific inquiry about this unusual presentation of thyrotoxicosis is encouraged, and more studies are needed to confirm

Dream-Enacting Behaviors in a Normal Population

PubMed Central

Nielsen, Tore; Svob, Connie; Kuiken, Don

2009-01-01

Study Objectives: Determine the prevalence and gender distributions of behaviors enacted during dreaming (“dream-enacting [DE] behaviors”) in a normal population; the independence of such behaviors from other parasomnias; and the influence of different question wordings, socially desirable responding and personality on prevalence. Design: 3-group questionnaire study Setting: University classrooms Participants: Three undergraduate samples (Ns = 443, 201, 496; mean ages = 19.9 ± 3.2 y; 20.1 ± 3.4 y; 19.1 ± 1.6 y) Interventions: N/A Measurements and Results: Subjects completed questionnaires about DE behaviors and Social Desirability. Study 1 employed a nonspecific question about the behaviors, Study 2 employed the same question with examples, and Study 3 employed 7 questions describing specific behavior subtypes (speaking, crying, smiling/laughing, fear, anger, movement, sexual arousal). Somnambulism, somniloquy, nightmares, dream recall, alexithymia, and absorption were also assessed. Factor analyses were conducted to determine relationships among DE behaviors and their independence from other parasomnias. Prevalence increased with increasing question specificity (35.9%, 76.7%, and 98.2% for the 3 samples). No gender difference obtained for the nonspecific question, but robust differences occurred for more specific questions. Females reported more speaking, crying, fear and smiling/laughing than did males; males reported more sexual arousal. When controlling other parasomnias and dream recall frequency, these differences persisted. Factor solutions revealed that DE behaviors were independent of other parasomnias and of dream recall frequency, except for an association between dream-talking and somniloquy. Sexual arousal was related only to age. Behaviors were independent of alexithymia but moderately related to absorption. Conclusions: Dream-enacting behaviors are prevalent in healthy subjects and sensitive to question wording but not social desirability

Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation.

PubMed

Petit, Dominique; Pennestri, Marie-Hélène; Paquet, Jean; Desautels, Alex; Zadra, Antonio; Vitaro, Frank; Tremblay, Richard E; Boivin, Michel; Montplaisir, Jacques

2015-07-01

Childhood sleepwalking and sleep terrors are 2 parasomnias with a risk of serious injury for which familial aggregation has been shown. To assess the prevalence of sleepwalking and sleep terrors during childhood; to investigate the link between early sleep terrors and sleepwalking later in childhood; and to evaluate the degree of association between parental history of sleepwalking and presence of somnambulism and sleep terrors in children. Sleep data from a large prospective longitudinal cohort (the Quebec Longitudinal Study of Child Development) of 1940 children born in 1997 and 1998 in the province were studied from March 1999 to March 2011. Prevalence of sleep terrors and sleepwalking was assessed yearly from ages 1 1/2 and 2 1/2 years, respectively, to age 13 years through a questionnaire completed by the mother. Parental history of sleepwalking was also queried. The peak of prevalence was observed at 1 1/2 years for sleep terrors (34.4% of children; 95% CI, 32.3%-36.5%) and at age 10 years for sleepwalking (13.4%; 95% CI, 11.3%-15.5%). As many as one-third of the children who had early childhood sleep terrors developed sleepwalking later in childhood. The prevalence of childhood sleepwalking increases with the degree of parental history of sleepwalking: 22.5% (95% CI, 19.2%-25.8%) for children without a parental history of sleepwalking, 47.4% (95% CI, 38.9%-55.9%) for children who had 1 parent with a history of sleepwalking, and 61.5% (95% CI, 42.8%-80.2%) for children whose mother and father had a history of sleepwalking. Moreover, parental history of sleepwalking predicted the incidence of sleep terrors in children as well as the persistent nature of sleep terrors. These findings substantiate the strong familial aggregation for the 2 parasomnias and lend support to the notion that sleepwalking and sleep terrors represent 2 manifestations of the same underlying pathophysiological entity.

Increasing trends of sleep complaints in the city of Sao Paulo, Brazil.

PubMed

Santos-Silva, Rogerio; Bittencourt, Lia Rita Azeredo; Pires, Maria Laura Nogueira; de Mello, Marco Tulio; Taddei, Jose Augusto; Benedito-Silva, Ana Amelia; Pompeia, Celine; Tufik, Sergio

2010-06-01

The aim of this study was to compare the prevalence of sleep habits and complaints and to estimate the secular trends through three population-based surveys carried out in 1987, 1995, and 2007 in the general adult population of the city of Sao Paulo, Brazil. Surveys were performed using the same three-stage cluster-sampling technique in three consecutive decades to obtain representative samples of the inhabitants of Sao Paulo with respect to gender, age (20-80 years), and socio-economic status. Sample sizes were 1000 volunteers in 1987 and 1995 surveys and 1101 in a 2007 survey. In each survey, the UNIFESP Sleep Questionnaire was administered face-to-face in each household selected. For 1987, 1995, and 2007, respectively, difficulty initiating sleep (weighted frequency %; 95% CI) [(13.9; 11.9-16.2), (19.15; 16.8-21.6), and (25.0; 22.5-27.8)], difficulty maintaining sleep [(15.8; 13.7-18.2), (27.6; 24.9-30.4), and (36.5; 33.5-39.5)], and early morning awakening [(10.6; 8.8-12.7), (14.2; 12.2-16.5), and (26.7; 24-29.6)] increased in the general population over time, mostly in women. Habitual snoring was the most commonly reported complaint across decades and was more prevalent in men. There was no statistically significant difference in snoring complaints between 1987 (21.5; 19.1-24.2) and 1995 (19.0; 16.7-21.6), but a significant increase was noted in 2007 (41.7; 38.6-44.8). Nightmares, bruxism, leg cramps, and somnambulism complaints were significantly higher in 2007 compared to 1987 and 1995. All were more frequent in women. This is the first study comparing sleep complaints in probabilistic population-based samples from the same metropolitan area, using the same methodology across three consecutive decades. Clear trends of increasing sleep complaints were observed, which increased faster between 1995 and 2007 than from 1987 to 1995. These secular trends should be considered a relevant public health issue and support the need for development of health care and

Hysteria after Charcot: back to the future.

PubMed

Bogousslavsky, Julien

2011-01-01

The studies on hysteria and hypnotism probably constitute the most important long-term work of Jean-Martin Charcot and his school, starting around 1870 until Charcot's death in 1893. Désiré Bourneville, Charcot's sixth interne at La Salpêtrière, was probably instrumental in stimulating his mentor's interest in hysteria, while Charles Richet's 1875 article on somnambulism was the trigger for Charcot to introduce hypnotism into the management of hysterics. Albert Pitres, Paul Richer, Georges Gilles de la Tourette, Paul Sollier, Joseph Babinski, Sigmund Freud and Pierre Janet became the most famous of Charcot's collaborators on hysteria, either as 'guardians of the temple' (Richer, Gilles de la Tourette, who defended their mentor's concepts against Hippolyte Bernheim and the Nancy school in the dispute during the 1880-1890s), or in renewing the field in psychology (Janet and Freud, in the 1890s) or clinical neurology (Babinski in the 1900s). In 1908, a 'quarrel of hysteria' led several of Charcot's pupils into opposition with each other, from which Babinski was considered victorious against Charcot's successor Fulgence Raymond, despite the weaknesses of his theory on 'pithiatism'. During World War I, there was a new surge of interest in hysteria associated with war psycho-neuroses, and several students of Charcot became actively involved in medical military care (Sollier, Babinski, Gilbert Ballet, Achille Souques). Babinski's pupil Clovis Vincent developed a treatment called torpillage (torpedoing) against war hysteria, associating painful galvanic current discharges with 'persuasion', but this was dismissed after the soldiers, considering it as torture, rebelled. After World War I, the neurological and psychiatric interest in hysteria again faded away, and this condition largely went back to the no-man's land, where it had been before Charcot initiated his studies. A comprehensive look at the evolution of ideas on hysteria in the followers of Charcot shows that

[Dissociative disorders: from Janet to DSM-IV].

PubMed

Nakatani, Y

2000-01-01

I reviewed the literature on dissociation and dissociative disorders from Pierre Janet to DSM-IV, and examined the current trends in research. Janet's theory on hysteria is multifaceted, and is based on three psychological models. Based on a hierarchical model, Janet related hysteric symptoms to the activities within the lower strata of mental hierarchy (automatisms psychologiques), which were demonstrably shown in somnambulism. A second model was based on the concept of a psychological system, which was hypothetically composed of ideas, images, feelings, sensations, and movements. According to this model, dissociation of psychological functions was fundamental to the mechanism of hysteria: loss of integration was thought to engender fixed ideas (ideas fixes) and to lead to the development of a system totally isolated from the whole personality system. Janet also attempted to explain various mental disorders using an economic model. He referred to a loss of equilibration between psychological force and psychological tension. Thus, an unexpected emotional experience was conceived to cause a consumption of reserved psychological force, which was in turn followed by exhaustion associated with hysteric symptoms. Whereas most current researchers regard Janet as the first to study psychological trauma as a principal cause of dissociation, I feel it is important to note that he also emphasized the role of stigmata, i.e., permanent traits of hysteric patients, which were represented as a suggestibility and a tendency toward a narrowing of the consciousness field. Discussion about dissociation and its relation to trauma all but disappeared after Janet. However, during the Second World War and post-war period, some psychiatrists began to pay attention to two emerging phenomena: a high incidence of dissociative symptoms such as fugue and amnesia among combatants, and traumatic neurosis frequently observed among ex-inmates of concentration camps. In the 1970s, interest in