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Sleepwalking and depression

by SirGan

Sleep walking or somnambulism is one specific sleep disorder characterized by walking or other activity while the person is still asleep. It represent a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep. Sleep disorders such as sleepwalking, insomnia and many others are very common and sometimes could be triggered by specific conditions such as stress, physical illnesses that cause pain or frequent urination, working shifts… Depression is also considered the important factor for developing these disorders! Disturbed sleep can cause a great deal of distress for people, whether it is caused by depression or not. Sleepwalking is a serious disorder for some and a mild annoyance for others.

Depression and sleep disorders

There is doubt that all people with depression can have many types of sleep problems. Generally, these involve getting less sleep than usual and include:

Difficulty getting off to sleep - often because of lying in bed with thoughts going round in your head.
Frequently waking up during the night.
Waking early in the morning and not being able to get back to sleep.
In rare cases- somnambulism

Most people think that just having enough sleep will solve all the problems. Of course, this isn't true! Even if people with depression do get a reasonable number of hours' sleep, they often wake in the morning feeling un-refreshed and feel tired through the day. Probably more than 80% of people suffering from depression have problems with their sleep, usually not getting enough.

Symptoms of sleepwalking

There are several symptoms which are related to somnambulism and some of the most common are:

Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in pre-pubertal children.
difficulty in arousing the patient during an episode
eyes open during sleep
may have blank facial expression
may sit up and appear awake during sleep
amnesia following an episode
confusion, disorientation on awakening
episodes typically occur in the first third of the sleep episode
other medical and psychiatric disorders can be present but do not account for the symptom
Fatigue
stress and
anxiety

Statistic data

It is proven that somewhere between 1% and 17% of U.

S. children sleepwalk. Some 18% of Americans are prone to the act, roughly 2 in 11 of the US population. Several studies done in the past have showed that the highest prevalence of sleepwalking was 16.7% for children of 11 to 12 years of age. Boys are seen to be more likely to sleepwalk than girls.

Cause of sleepwalking - stress

Several researches done in the past have showed that sleep problems frequently occur around periods of stress. It is not uncommon for a person's sleep to be disrupted following the death of a loved one or around the time of a major medical problem. This is why many sleep problems resolve once the stress is resolved or the medical condition subsides. However, some sleep disorders can begin with an acute problem and become a chronic sleep problem.

Normal sleep patterns

Sleep can be assessed by measuring the electrical activity that occurs in the brain. It is a known and well studied method. We normally undergo several cycles during the night moving through the various stages of sleep. Sleep can be divided into a number of different stages. People tend to go through stages 1 to 4 when we fall asleep and the reverse when we wake up. Stages 1 and 2 are regarded as light sleep. Stages 3 and 4 are deep sleep. There is also a fifth stage and it is called a rapid eye movement sleep (REM) because although our eyes remain shut, they move around a lot during this stage. REM sleep is the time that we dream when we are asleep.

REM (Rapid Eye Movement) Sleep

Non-REM Sleep

REM begins typically after about 90 minutes into sleep.
It occurs throughout the night on a 90-100 minute cycle
Polygraph measurements during REM sleep appear very similar to those taken of the person in the waking state
Vital signs such as pulse rate, ventilation rate and blood pressure are all comparatively high during REM sleep
Brain oxygen demand increases above that of supply
Body temperature regulation is altered
Depressed people demonstrate changes in REM sleep. REM occurs earlier and mostly occurs to the latter half of the period of sleep.
Someone waking from REM sleep will usually do so rapidly and report that they were experiencing dreaming.
As a person gets older the percentage of time spent in REM sleep decreases.

The pulse rate typically slows by 5-10 beats per minute; ventilation and blood pressure also drop and unlike in REM sleep is stable and regular.
Episodic, involuntary movements occur - similar to the jumping/falling movements some people will be familiar with.
Someone waking rapidly from deep non-REM half to one hour into sleep will be disorientated and possess disorganized thinking and will be slow in returning to baseline consciousness/cognition.
Thus it is suggested (Kaplan) that awaking from deep non-REM sleep will result in specific disorders resulting from the disorientation experienced, such as bedwetting, somnambulism and nightmares.
Cerebral blood flow in non-REM sleep is reduced, as it is too almost all body tissues.
In the healthy adult, non-REM sleep accounts for 75 percent of sleep time

Sleep patterns in depression

The sleep patterns of person with depression is very different from normal sleep pattern:

It takes much longer to get off to sleep.
The total sleep time is reduced.
There is little or no deep sleep.
REM sleep occurs earlier in the night.
There are more frequent wakening during the night
The person wakes up earlier in the morning.

Pathophysiology of somnambulism

Experts are saying that sleepwalking most often occurs at a certain point in the sleep architecture. Several researches done in the past have proven that this happens in the point where the sleeper's brain waves become larger during the passing into deeper sleep. Most people misunderstand this because -this is not REM sleep, but deep non-REM sleep. The patient can also have other REM disorders or psychiatric and medical disorders which do not account for the sleepwalking.

What happens during the sleepwalking in the brain of the patient? While sleepwalking, the patients' brainwaves show a mixture of types of brainwave patterns, including ones similar to those observed in waking patients, as well as those found in deep sleep.

How serious is sleep walking?

It could be very difficult to answer on this question! This is because for some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. But problem is that some experience episodes more than once per month, the episodes occur almost nightly or are associated with physical injury. There are evidenced cases in which sleepwalkers exit the house, walk the streets and even drive a car! It is proven that sleepwalking that starts at an early age, generally disappears as the child gets older. If the child begins to sleepwalk at the age of 9 or older, it often lasts into adulthood.

Differential Diagnosis of sleepwalking

Some disorders have similar or even the same symptoms. The doctor has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Partial Complex Seizures Occurring during sleep
REM Behavior Disorder
Night Terrors
Malingering
Dissociative Phenomena
Medication Effects

Signs and tests for the proper diagnosis

Usually, no examination and testing is necessary for the diagnosis of sleep walking.

If sleep walking is frequent or persistent, examination to rule out other disorders (such as partial complex seizures) may be appropriate. Some experts believe that it may be appropriate to undergo a psychological evaluation to determine causes such as excessive anxiety or stress, or medical evaluation to rule out other causes.

Treatment

Medications

Benzodiazepines are the medicines that help sleeping. They are effective and they have few side effects. However, your body becomes used to them very quickly, so their effect starts to vanish for many people. Which means- they are addictive! This is particularly the case in depression, since it may take several weeks for the illness itself to respond to treatment.

Antidepressants

Some of the older antidepressants like Amitriptyline and Dothiepin are sedative. As a result, they were used a great deal to help depressed patients who had marked sleep problems.

Other medications

Occasionally other sedative medicines are used along with an antidepressant such as sedative antipsychotics. These medications can help anxiety, agitation, and sleep and, under certain situations, may help somebody to respond to an antidepressant when they did not previously.

Some tips for better sleep

Get into a routine with your sleep times.
Take some physical exercise during the day.
Avoid exercise two hours before bedtime.
Avoid watching disturbing or violent films prior to bedtime.
Avoid drinking caffeine in the evening after 6pm.
Drink herbal teas or milky drinks such as Horlicks in the evening.
Avoid heavy meals two hours before bedtime.
Avoid alcohol in the evening. While alcohol is sedative, it is not a good idea to try to use it to sort out a sleep problem. This is because alcohol does not lead to normal restful sleep.
Your bedroom should be warm and familiar with a comfortable bed and quilt, etc.