“What is the best way to treat sleepwalking?”
My daughter has started to walk in her sleep, and it worries both me and my husband. Is there any treatment options?
2 Answers
I presume that her daughter is still fairly young. This is actually normal behavior in children up to roughly teenage years. In general no treatment is needed and other than providing an environment free of injury hazards for tripping or falling in the dark the best option is usually to not intervene with medicine. Seeing a pediatric sleep specialist might be useful for peace of mind and to be sure this is simply benign sleep walking.
Yes, there are treatment options. It would be helpful to know the age of your daughter. Most childhood sleepwalkers grow out of the condition well before adulthood. A few questions which would orient the best way treat your daughter.
First, there are very few dangers in childhood. Just reassure yourself about this and also tell your daughter so she does not worry unnecessarily.
Sleepwalking arises typically in the first third of the night's sleep during an arousal in the deepest stages of what is often called slow wave sleep (SWS - the brain waves are of high amplitude and slow). It may be triggered by ambient noises such as a door slamming shut. So make sure her bedroom is quiet and dark. It is very important that she is not chronically sleep deprived for whatever reason, because sleep deprivation causes an increase in the amount and intensity of SWS and in sleep depth in general (it is harder to awaken persons in this situation).
If your daughter is of an anxious personality, stress-reduction programs by a psychologist may be effective, as in certain instances is hypnosis. In a few cases, there is a very high frequency of sleepwalking in the extended family indicating a strong genetic predisposition. In these persons, chemotherapy is almost always needed.
Finally, and only as a last resort in young children, medication can be useful. If all else has failed, you should ask your family doctor to do a trial for 3 or 4 weeks on one of the benzodiazepines, which decrease SWS and have a half life in the blood which is about that of the nightly sleep need of your daughter. This depends mainly on her age and is probably around 9 hours. The drugs which have proven most effective are either clonazepam and lorazepam, taken about 20 min before the time of habitual sleep onset. In a good proportion of instances, a few weeks of such treatment stops the sleepwalking episodes completely. If these drugs do not help, then one would try so-called tricyclic medication which diminishes the intensity and amount of Rapid Eye Movement sleep and the arousals at the end of each period of sustained SWS are mainly due to the onset of a REM sleep period. Tricyclic medication, when effective, appears to be due to reducing the intensity of arousals due to the onset of REM sleep.
In very rare cases, sleepwalking must be differentiated from what is called REM sleep behavior disorder and/or frontal lobe epilepsy. Sorting this out requires referring your daughter to a Sleep Disorder Center, preferably one in a pediatric hospital. Make sure that the center is university-affiliated and accredited by the American Association of Sleep Medicine or, in Canada, the Canadian Sleep Society.
Good luck and best wishes,
Roger Broughton, MD, PhD, FRCP(C), FAASM
First, there are very few dangers in childhood. Just reassure yourself about this and also tell your daughter so she does not worry unnecessarily.
Sleepwalking arises typically in the first third of the night's sleep during an arousal in the deepest stages of what is often called slow wave sleep (SWS - the brain waves are of high amplitude and slow). It may be triggered by ambient noises such as a door slamming shut. So make sure her bedroom is quiet and dark. It is very important that she is not chronically sleep deprived for whatever reason, because sleep deprivation causes an increase in the amount and intensity of SWS and in sleep depth in general (it is harder to awaken persons in this situation).
If your daughter is of an anxious personality, stress-reduction programs by a psychologist may be effective, as in certain instances is hypnosis. In a few cases, there is a very high frequency of sleepwalking in the extended family indicating a strong genetic predisposition. In these persons, chemotherapy is almost always needed.
Finally, and only as a last resort in young children, medication can be useful. If all else has failed, you should ask your family doctor to do a trial for 3 or 4 weeks on one of the benzodiazepines, which decrease SWS and have a half life in the blood which is about that of the nightly sleep need of your daughter. This depends mainly on her age and is probably around 9 hours. The drugs which have proven most effective are either clonazepam and lorazepam, taken about 20 min before the time of habitual sleep onset. In a good proportion of instances, a few weeks of such treatment stops the sleepwalking episodes completely. If these drugs do not help, then one would try so-called tricyclic medication which diminishes the intensity and amount of Rapid Eye Movement sleep and the arousals at the end of each period of sustained SWS are mainly due to the onset of a REM sleep period. Tricyclic medication, when effective, appears to be due to reducing the intensity of arousals due to the onset of REM sleep.
In very rare cases, sleepwalking must be differentiated from what is called REM sleep behavior disorder and/or frontal lobe epilepsy. Sorting this out requires referring your daughter to a Sleep Disorder Center, preferably one in a pediatric hospital. Make sure that the center is university-affiliated and accredited by the American Association of Sleep Medicine or, in Canada, the Canadian Sleep Society.
Good luck and best wishes,
Roger Broughton, MD, PhD, FRCP(C), FAASM
