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At least 19 recordsLinked to original sources
PubMed2003

Somnambulism due to probable interaction of valproic acid and zolpidem.

OBJECTIVE: To report a case of somnambulism due to a probable interaction between valproic acid and zolpidem in a patient with no prior personal or family history of somnambulism. CASE SUMMARY: A 47-year-old white man with a history of bipolar disorder was being maintained on citalopram 40 mg once daily and zolpidem 5 mg at bedtime. During treatment, he developed manic symptoms and was started on adjunctive valproic acid therapy. Soon after this, he developed episodes of somnambulism, which stopped when valproic acid was discontinued. On rechallenge with valproic acid, somnambulism returned. DISCUSSION: To our knowledge, this is the first report in the literature describing a probable interaction between valproic acid and zolpidem leading to somnambulism. Even though valproic acid has been associated with sleep changes, there are no published reports of somnambulism with this agent. Zolpidem has been associated with somnambulism, but our patient did not experience this when he was on zolpidem monotherapy. However, within 2 days of starting adjunctive valproic acid, sleepwalking occurred. It stopped after valproic acid was withdrawn. On rechallenge with valproic acid, sleepwalking recurred. However, when zolpidem was discontinued and valproic acid was continued, somnambulism did not occur. An assessment on the Naranjo probability scale suggests probable pharmacokinetic or pharmacodynamic interactions between the 2 medications. CONCLUSIONS: Valproic acid and zolpidem are generally safe medications that are commonly prescribed and often used together. No interactions have been previously reported with combined use of valproic acid and zolpidem. This case suggests a probable interaction between these 2 agents that can have a serious consequence, somnambulism. This could be frightening to patients and put them in danger. Recognition of such interactions that place patients at risk for potentially serious adverse events is imperative for appropriate care.

Bipolar Disorder↗
PubMed2005

[Somnambulism: clinical and eletrophysiological aspects].

The authors review the literature on the epidemiology, the clinical and electrophysiological symptoms of somnambulism. The disorder specified as "nREM parasomnia with awakening disorder" belongs to the nREM sleep (awakening) parasomnias. In most of the cases its occurence is familial with the highest prevalence at age 12 year. Above age 12 year most cases recover whereas 6% of prevalence is reported in adults. It is probable that most patients seek medical help only in severe cases associated with injuries, accidents or violence. Its etiology is unknown; in essence it is a sleep regulation disorder characterised by a dissociated state of partial awakening from nREM sleep: the motor system becomes awake while consciousness remains clouded. There are several medicines inducing somnambulism in patients otherwise free from this disorder. In somnambule patients the most important provoking factors are sleep deprivation as well as pathological states and circumstances evoking sleep loss. Somnambulism should be differentiated from complex partial epileptic seizures and REM behaviour disorder. As there is no specific treatment at the moment it is important to assure safe sleeping circumstances - ground flour, closed windows, and no fragile furniture. Clonazepam and selective serotonin reuptake inhibitors prove sometimes effective, but the most effective methods in decreasing the frequency of somnambule episodes are the regular sleep-wakefulness schedule and the avoidance of sleep deprivation.

Diagnosis, Differential↗
PubMed1987

[Somnambulism and migraine in children. A non-fortuitous association].

Looking for frequency of somnambulism in 3 homogeneous groups of children, a first group of migrainous children, a second group of epileptic children and a third group of normal children, the authors have observed that an antecedent of somnambulism existed in 28% of migrainous children, when it was found in only 6% of epileptic children, and in 5% of normal children. This significant difference demonstrates that the association of migraine and somnambulism is real. The possibility that migraine and somnambulism appearing in the same patient at different ages might be the expression of a same neurochemical disorder is discussed. The practical interest to know this association is that somnambulism may be a real clinical marker of migrainous background that should be searched for in every patient presenting with chronic cephalalgia.

Adolescent↗
PubMed1986

[Migraine and somnambulism. A survey of 122 migraine patients].

A retrospective study looking for an history of somnambulism in childhood, in a population of 122 patients with migraine, and 110 patients with non-migraine headache has been performed. A very high frequency of somnambulism in patients with migraine was found whereas frequency of somnambulism in patients with non-migraine headache was similar to that of the general population. The probability that a sleepwalking child acquires a migraine is greater when she is a girl. Migraine is then often of the ophthalmic type. Somnambulism and migraine appear at different ages, the former in the late infancy, the latter in childhood and both could be due to a disorder of serotonin metabolism. The authors suggest that somnambulism be considered as an accessory criterion for the diagnosis of migrainous disease.

Adolescent↗
PubMed1980

[Forms of hypnotic somnambulism according to their clinical basis].

Three forms of hypnotic somnambulism were distinguished clinically: classical somnambulism in patients with hysterical neurosis on a juvenile-unstable basis (42 cases); sensual-lucid somnambulism in patients with hysterical neurosis on a primitive personality basis (46 cases) and sensual-split somnambulism in patients with pseudoneurotic schizophrenia with a hysteroid clinical picture (58 cases). The differential diagnostic importance of such forms of somnambulism is stressed.

Adult↗
PubMedDate not supplied

Is somnambulism a distinct disorder of humans and not seen in non-human primates?

Though somnambulism (sleepwalking) is a well-recognized sleep disorder in humans, a biomedical literature search in Medline and Primate Literature bibliographic databases showed no publications on sleepwalking in non-human primates. From this finding, two inferences can be made. First is that somnambulism may be present in non-human primates; but due to limitations in expertise and methodological resources as well as narrow focus of research interest, until now researchers have not detected it in wild and/or captive conditions. Second, somnambulism does not exist in non-human primates including apes (chimpanzee, gorilla, orang-utan and gibbon); and thus, it is a unique behavioral disorder present only in humans. It is premature to conclude which of these two inferences is correct. In Jane Goodall's view, sleepwalking behavior is absent in chimpanzees. If further field observations can confirm Goodall's assertion that somnambulism is indeed absent in chimpanzees, it will be of evolutionary and medical interest to know why this parasomnic behavior became established in humans during the past 5.5 million years or so.

Animals↗
PubMed1995

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

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.

Adult↗
PubMed1982

Somnambulism in childhood--prevalence, course and behavioral correlations. A prospective longitudinal study (6-16 years).

The occurrence and course of somnambulism and its correlations with behavioral variables have been investigated annually from 6 to 16 years of age in a sample recruited by random means. The prevalence was highest at 11-12 year. No sex difference was found. Apart from sporadic occurrences, the longitudinal data reveal a group of children for whom somnambulism is rather persistent. But even in this group the somnambulism is usually unrelated to other sleep disturbances (apart from "bad" dreams), deviant behavior or known environmental factors. These children have more inhibited aggression and a more developed mental defence against anxiety as determined by Rorschach tests. At school they appear to be more popular than other children.

Adolescent↗
PubMed1983

Childhood migraine and somnambulism.

Based on a sample of 222 children from four diagnostic groups, a high frequency of somnambulism in children suffering from migraine headache is reported. The strength of the association between somnambulism and childhood migraine raises the possibility that somnambulism might be considered as a minor diagnostic criterion in the clinical diagnosis of childhood migraine. This association may further clarify the nature of the serotonin abnormality underlying migraine.

Adolescent↗
PubMed1990

[The significance of EEG findings in somnambulism].

In the EEG of 26 patients with somnambulism of an one time transversal examination sharp waves were more frequent than in patients with other diseases, 12 records of 13 children exhibited sharp waves, 5 records of 13 adults, 16 cases exhibited subcortical dysfunctions. There were no relations between epilepsy and somnambulism. Somnambulism was be found preponderantly in episodes of peculiar psychic charge of pupils and young adults. For effective therapy psychological examination is more useful than electrocephalographical examination. The treatment with transquilizer and psychotherapy is rich in meaning.

Adolescent↗
PubMed1994

Homicidal somnambulism: a case report.

A case of a homicide and an attempted homicide during presumed sleepwalking is reported in which somnambulism was the legal defense and led to an acquittal. Other possible explanations including complex partial seizures, dissociative state, rapid eye movement sleep behavior disorder and volitional waking behavior are discussed. The evidence supporting the probability that this act occurred during an episode of somnambulism and sleep-related confusional arousal is reviewed and weighed. This evidence includes personal and family history of somnambulism and related disorders; neurological, psychiatric and psychological assessments; presence of possible precipitating factors; and polysomnographic data.

Adult↗
PubMed1998

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

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.

Adult↗
PubMed1991

Polysomnographic characteristics of healthy elderly subjects with somnambulism-like behaviors.

We compared the sleep characteristics of seven healthy elderly people complaining of nocturnal somnambulism-like behaviors with those of 14 age-matched healthy elderly people who had never shown such behavior. Polysomnographic data revealed the appearance of "Stage 1-REM with tonic electromyographic (EMG) activity" sometimes accompanied by abnormal behavior in the first group, but the sleep architecture and parameters showed no significant difference between the two groups except for higher REM density in the first group. "Stage 1-REM with tonic EMG," observed in the first group was considered equivalent to REM sleep without muscle atonia. It is suggested that both reduced activity of tonic phenomena (muscle atonia) and increased activity of phasic phenomena (higher REM density) of REM sleep are essential for the induction of somnambulism-like behaviors during sleep in healthy elderly subjects.

Aged↗
PubMed2003

Bupropion-induced somnambulism.

Whereas there are some case reports of bupropion-induced vivid dreaming and nightmares, until now it has not been associated with somnambulism. A case is reported of a patient treated with bupropion as a smoking cessation medication, who developed somnambulism during nicotine withdrawal. Furthermore, the sleepwalking episodes were associated with eating behaviour. Amnesia was reported for all episodes. As, on one hand,bupropion is a noradrenergic and dopaminergic drug and nicotine withdrawal, on the other hand, is associated with alterations in monoaminergic functions, an interaction at the level of these neurotransmitters is suggested as the underlying mechanism.

Adult↗
PubMed2004

Somnambulism (sleepwalking).

Somnambulism is an arousal parasomnia consisting of a series of complex behaviours that result in large movements in bed or walking during sleep. It occurs in 2-14% of children and 1.6-2.4% of adults. Occasional benign episodes are managed conservatively. However, recurrent sleepwalking with a risk of injury to self or others mandates immediate treatment with pharmacotherapy while awaiting work-up. The most commonly used medications are benzodiazepines, particularly clonazepam, with tricyclic antidepressants and serotonin selective re-uptake inhibitors also administered. Treatment of underlying causes such as obstructive sleep apnoea, upper airway resistance syndrome, restless legs syndrome and periodic limb movements, is currently the best approach and usually eliminates somnambulism in children and adults.

Adult↗
PubMed1976

[Etiology and pathogenesis of somnambulism].

The problem of somnambulism is discussed in this paper by reference to the present state of research in this field. A complex of conditions is assumed to underly sleep-walking and be triggered by various factors. Psychic or organic moments may trigger somnambulance if there exists a readiness for this form of reaction. The corpus striatum is assumed to control the overall coordination of stereotypic motor movements, which is made an independently functioning subsystem by certain states of tension in the central nervous system.

Adult↗
PubMed1954

Paternal domination as a cause of somnambulism.

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.

Family↗
PubMed1991

[Non-epileptic sleep disorders (somnambulism) in epilepsy. Diagnostic and therapeutic possibilities].

The case history of a 15 1/2-year-old boy is presented who suffers from screaming fits during the night and epilepsia. The problem has existed since he was eight. He lives alone with his mother in a "partner-like" relationship. The previous diagnosis, namely epilepsy, has masked any possible psychodynamic element. Our diagnostic instruments were: 1. Standardized diagnostics with DSM III-R; 2. psychoanalytically oriented psychodiagnostics; 3. long term EEG-video-monitoring, which eventually succeeded in differentiating his multiple symptoms. Using these methods we were able to differentiate a sleep disorder (somnambulism) from his grandmal epilepsy. We changed his anticonvulsive pharmacological therapy and introduced an individual psychotherapy ("Katathymes Bilderleben"). This kind of psychotherapy is applied for the first time as a therapy for somnambulism. By using this therapeutic concept we cured our patient from his symptoms.

Adolescent↗