Sleepwalking

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Sleepwalking
John Everett Millais, The Somnambulist.jpg
John Everett Millais, The Somnambulist, 1871
Specialty Clinical psychology, Psychiatry, sleep medicine

Sleepwalking, also known as somnambulism or noctambulism, is a phenomenon of combined sleep and wakefulness. [1] It is classified as a sleep disorder belonging to the parasomnia family. [2] It occurs during slow wave stage of sleep, in a state of low consciousness, with performance of activities that are usually performed during a state of full consciousness. These activities can be as benign as talking, sitting up in bed, walking to a bathroom, consuming food, and cleaning, or as hazardous as cooking, driving a motor vehicle, [3] [4] [5] violent gestures and grabbing at hallucinated objects. [6]

Contents

Although sleepwalking cases generally consist of simple, repeated behaviors, there are occasionally reports of people performing complex behaviors while asleep, although their legitimacy is often disputed. [7] Sleepwalkers often have little or no memory of the incident, as their consciousness has altered into a state in which memories are difficult to recall. Although their eyes are open, their expression is dim and glazed over. [8] This may last from 30 seconds to 30 minutes. [6]

Sleepwalking occurs during slow-wave sleep (N3) of non-rapid eye movement sleep (NREM sleep) cycles. It typically occurs within the first third of the night when slow-wave sleep is most prominent. [8] Usually, it will occur once in a night, if at all. [6]

Signs and symptoms

Sleepwalking is characterized by: [9]

Despite how it is portrayed in many cultures (eyes closed and walking with arms outstretched), the sleepwalker's eyes are open but may appear as a glassy-eyed stare or blank expression and pupils are dilated. They are often disoriented, consequent to awakening: the sleepwalker may be confused and perplexed, and might not know why or how they got out of bed; however, the disorientation will fade within minutes. They may talk while sleepwalking, but the talk typically does not make sense to the observer. There are varying degrees of amnesia associated with sleepwalking, ranging from no memory at all, vague memories or a narrative. [11]

Associated disorders

Most studies look at sleep disorders in adults but children can also be affected. In the ten percent of the population that experience sleep-related disorders, children are mainly affected due to their youthful brains. [12] A study conducted in Australia, [13] looked at sleepwalking and its association with sleep behaviors in children. It was found that sleepwalking could be associated with children's bedtime routines. Those who have behavioral problems are more likely to develop a sleep disorder and should be assessed. The relationship between sleepwalking and the behavioral and emotional problems are more associated than their bedtime routines. This may very well be because sleep related disorders and sleepwalking happen simultaneously; one cannot exist without the other. [13]

In the study "Sleepwalking and Sleep Terrors in Prepubertal Children" [14] it was found that, if a child had another sleep disorder –such as restless leg syndrome (RLS) or sleep-disorder breathing (SDB) –there was a greater chance of sleepwalking. The study found that children with chronic parasomnias may often also present SDB or, to a lesser extent, RLS. Furthermore, the disappearance of the parasomnias after the treatment of the SDB or RLS periodic limb movement syndrome suggests that the latter may trigger the former. The high frequency of SDB in family members of children with parasomnia provided additional evidence that SDB may manifest as parasomnias in children. Children with parasomnias are not systematically monitored during sleep, although past studies have suggested that patients with sleep terrors or sleepwalking have an elevated level of brief EEG arousals. When children receive polysomnographies, discrete patterns (e.g., nasal flow limitation, abnormal respiratory effort, bursts of high or slow EEG frequencies) should be sought; apneas are rarely found in children. Children's respiration during sleep should be monitored with nasal cannula or pressure transducer system or esophageal manometry, which are more sensitive than the thermistors or thermocouples currently used in many laboratories. The clear, prompt improvement of severe parasomnia in children who are treated for SDB, as defined here, provides important evidence that subtle SDB can have substantial health-related significance. Also noteworthy is the report of familial presence of parasomnia. Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias. RLS and SDB have been shown to have familial recurrence. RLS has been shown to have genetic involvement.

Sleepwalking may also accompany the related phenomenon of night terrors, especially in children. In the midst of a night terror, the affected person may wander in a distressed state while still asleep, and examples of sufferers attempting to run or aggressively defend themselves during these incidents have been reported in medical literature. [15]

In some cases, sleepwalking in adults may be a symptom of a psychological disorder. One study suggests higher levels of dissociation in adult sleepwalkers, since test subjects scored unusually high on the hysteria portion of the "Crown-Crisp Experiential Index". [16] Another suggested that "A higher incidence [of sleepwalking events] has been reported in patients with schizophrenia, hysteria and anxiety neuroses". [17] Also, patients with migraine headaches or Tourette syndrome are 4–6 times more likely to sleepwalk.

Consequences

During the amnesic state sleepwalkers are in, many things can happen without their recollection. One thing that can happen is a sleep disorder called sexomnia, where an individual can engage in sexual behaviors with oneself or others. [18] Its occurrence is rare, but can happen during sleepwalking. [19] Sleep-related eating disorder, in which sleepwalkers eat involuntarily, can also happen. The events can include eating/drinking regular foods or odd combinations of food. [20] Insomnia and daytime sleepiness can also occur. [21] Most sleepwalkers get injuries at some point during sleepwalking, often minor injuries such as cuts or bruises. [22] [23] In rare occasions, however, sleepwalkers have fractured bones and died as the result of a fall. [24] [25] Sleepwalkers may also face embarrassment of being found naked in public. [26] [27]

Causes

The cause of sleepwalking is unknown. A number of, as yet unproven, hypotheses are suggested for why it might occur, including: delay in the maturity of the central nervous system, [6] increased slow wave sleep, [28] sleep deprivation, fever, and excessive tiredness. There may be a genetic component to sleepwalking. One study found that sleepwalking occurred in 45% of children who have one parent who sleepwalked, and in 60% of children if both parents sleepwalked. [8] Thus, heritable factors may predispose an individual to sleepwalking, but expression of the behavior may also be influenced by environmental factors. [29] [10] Genetic studies using common fruit flies as experimental models reveal a link between night sleep and brain development mediated by evolutionary conserved transcription factors such as AP-2 [30] Sleepwalking may be inherited as an autosomal dominant disorder with reduced penetrance. Genome-wide multipoint parametric linkage analysis for sleepwalking revealed a maximum logarithm of the odds score of 3.14 at chromosome 20q12-q13.12 between 55.6 and 61.4 cM. [31]

Sleepwalking has been hypothesized to be linked to the neurotransmitter serotonin, which also appears to be metabolized differently in migraine patients and people with Tourette syndrome, both populations being four to nine times more likely to experience an episode of sleepwalking. [32] Hormonal fluctuations have been found to contribute to sleepwalking episodes in women, with the likeliness to sleepwalk being higher before the onset of menstruation. [33] It also appears that hormonal changes during pregnancy decrease the likelihood of engaging in sleepwalking. [34]

Medications, primarily in four classes—benzodiazepine receptor agonists and other GABA modulators, antidepressants and other serotonergic agents, antipsychotics, and β-blockers—have been associated with sleepwalking. [35] The best evidence of medications causing sleepwalking is for Zolpidem and sodium oxybate; all other reports are based on associations noted in case reports. [35]

A number of conditions, such as Parkinson's disease, are thought to trigger sleepwalking in people without a previous history of sleepwalking. [36] [ needs update ]

Diagnosis

Polysomnography is the only accurate assessment of a sleepwalking episode. Because this is costly and sleepwalking episodes are usually infrequent, other measures commonly used include self-, parent-, or partner-report. Three common diagnostic systems that are generally used for sleepwalking disorders are International Classification of Diseases (ICD-10), [1] the International Classification of Sleep Disorders (ICSD-3), [37] and the Diagnostic and Statistical Manual. [2]

The Diagnostic and Statistical Manual defines two subcategories of sleepwalking, although sleepwalking does not need to involve either behaviours:

Sleep eating involves consuming food while asleep. These sleep eating disorders are more often than not induced for stress related reasons. Another major cause of this sleep eating subtype of sleepwalking is sleep medication, such as Ambien for example (Mayo Clinic). There are a few others, but Ambien is a more widely used sleep aid. [38] Because many sleep eaters prepare the food they consume, there are risks involving burns and such with ovens and other appliances. As expected, weight gain is also a common outcome of this disorder, because food that is frequently consumed contains high carbohydrates. As with sleepwalking, there are ways that sleep eating disorders can be maintained. There are some medications that calm the sleeper so they can get longer and better-quality rest, but activities such as yoga can also be introduced to reduce the stress and anxiety causing the action. [39]

Differential diagnoses

Sleepwalking should not be confused with alcohol- or drug-induced blackouts, which can result in amnesia for events similar to sleepwalking. During an alcohol-induced blackout (drug-related amnesia), a person is able to actively engage and respond to their environment (e.g. having conversations or driving a vehicle), however the brain does not create memories for the events. [40] Alcohol-induced blackouts can occur with blood alcohol levels higher than 0.06 g/dl. [41] A systematic review of the literature found that approximately 50% of drinkers have experienced memory loss during a drinking episode and have had associated negative consequences similar to sleepwalkers, including injury and death. [40]

Other differential diagnoses include rapid eye movement sleep behavior disorder, confusional arousals, and night terrors.

Assessment

An assessment of sleepwalking via polysomnography poses the problem that sleepwalking is less likely to occur in the sleep laboratory, and if an episode occurs, it is usually less complex than what the patient experiences at home. [42] [43] [44] Therefore, the diagnosis can often be made by assessment of sleep history, time-course and content of the sleep related behaviors. [45] Sometimes, home videos can provide additional information and should be considered in the diagnostic process. [46]

Some features that should always be assessed include: [47]

The assessment should rule out differential diagnoses.

Treatment

There have been no clinical trials to show that any psychological or pharmacological intervention is effective in preventing sleepwalking episodes. [9] Despite this, a wide range of treatments have been used with sleepwalkers. Psychological interventions have included psychoanalysis, hypnosis, scheduled or anticipatory waking, assertion training, relaxation training, managing aggressive feelings, sleep hygiene, classical conditioning (including electric shock), and play therapy. Pharmacological treatments have included tricyclic antidepressants (imipramine), an anticholinergic (biperiden), antiepileptics (carbamazepine, valproate), an antipsychotic (quetiapine), benzodiazepines (clonazepam, diazepam, flurazepam and triazolam), melatonin, a selective serotonin reuptake inhibitor (paroxetine), a barbiturate (sodium amytal) and herbs. [9]

There is no evidence to show that waking sleepwalkers is harmful or not, though the sleepwalker is likely to be disoriented if awakened as sleepwalking occurs during the deepest stage of sleep.[ citation needed ]

Unlike other sleep disorders, sleepwalking is not associated with daytime behavioral or emotional problems. This may be because the sleepwalker's sleep is not disturbed—unless they are woken, they are still in a sleep state while sleepwalking.[ citation needed ]

Maintaining the safety of the sleepwalker and others and seeking treatment for other sleep problems is recommended. [9] Reassurance is recommended if sleepwalking is not causing any problems. [9] However, if it causes distress or there is risk of harm, hypnosis and scheduled waking are recommended as treatments. [9]

Safety planning

For those whose sleepwalking episodes are hazardous, a door alarm may offer a measure of protection. There are various kinds of door alarms that can attach to a bedroom door and when the door is opened, the alarm sounds. [48] The intention is that the sound will fully awaken the person and interrupt the sleepwalking episode, or if the sleepwalker lives with others, the sound will prompt them to check on the person.

Sleepwalkers should aim to have their bedrooms on the ground floor of a home, apartment, dorm, hotel, etc.

Sleepwalkers should not have easily accessible weapons (loaded guns, knives) in the bedroom or any room of the house for that matter. If there are weapons, they should be locked away with keys secluded from the sleepwalker. [11]

For partners of sleepwalkers who are violent or disturb their sleep, sleeping in another room may lead to better sleep quality and quantity.

Epidemiology

The lifetime prevalence of sleepwalking is estimated to be 4.6–10.3%. A meta-analysis of 51 studies, that included more than 100,000 children and adults, found that sleepwalking is more common in children with an estimated 5%, compared with 1.5% of adults, sleepwalking at least once in the previous 12 months. The rate of sleepwalking has not been found to vary across ages during childhood. [49]

History

Sleepwalking has attracted a sense of mystery, but was not seriously investigated and diagnosed until the 19th century. The German chemist and parapsychologist Baron Karl Ludwig von Reichenbach (1788–1869) made extensive studies of sleepwalkers and used his discoveries to formulate his theory of the Odic force. [50]

Sleepwalking was initially thought to be a dreamer acting out a dream. [6] For example, in one study published by the Society for Science & the Public in 1954, this was the conclusion: "Repression of hostile feelings against the father caused the patients to react by acting out in a dream world with sleepwalking, the distorted fantasies they had about all authoritarian figures, such as fathers, officers and stern superiors." [51] This same group published an article twelve years later with a new conclusion: "Sleepwalking, contrary to most belief, apparently has little to do with dreaming. In fact, it occurs when the sleeper is enjoying his most oblivious, deepest sleep—a stage in which dreams are not usually reported." [52] More recent research has discovered that sleepwalking is actually a disorder of NREM (non-rapid eye movement) arousal. [6] Acting out a dream is the basis for a REM (rapid eye movement) sleep disorder called REM Behavior Disorder (or REM Sleep Behavior Disorder). [6] More accurate data about sleep is due to the invention of technologies, such as the electroencephalogram (EEG) by Hans Berger in 1924 [53] and BEAM by Frank Duffy in the early 1980s. [54]

In 1907, Sigmund Freud spoke about sleepwalking to the Vienna Psychoanalytic Society (Nunberg and Federn). He believed that sleepwalking was connected to fulfilling sexual wishes and was surprised that a person could move without interrupting their dream. At that time, Freud suggested that the essence of this phenomenon was the desire to go to sleep in the same area as the individual had slept in childhood. Ten years later, he speculated about somnambulism in the article "A Metapsychological Supplement to the Theory of Dreams" (1916–17 [1915]). In this essay, he clarified and expanded his hypothetical ideas on dreams. He described the dream as a fragile equilibrium that is destabilized by the repressed unconscious impulses of the unconscious system, which does not obey the wishes of the ego. Certain preconscious daytime thoughts can be resistant and these can retain a part of their cathexis as well. Unconscious impulses and day residues can come together and result in a conflict. Freud then wondered about the outcome of this wishful impulse: an unconscious instinctual demand that becomes a dream wish in the preconscious. Freud stated that this unconscious impulse could be expressed as mobility during sleep. This would be what is observed in somnambulism, though what actually makes it possible remains unknown. [55]

As of 2002, sleepwalking has not been detected in non-human primates. It is unclear whether it simply has not been observed yet, or whether sleepwalking is a uniquely human phenomenon. [56]

Culture

Opera

Amina, the somnabuliste, at the mill Sonnambula atto 3.jpg
Amina, the somnabuliste, at the mill

Vincenzo Bellini's 1831 Italian opera semiseria, La sonnambula, the plot of which is centered on the question of the innocence of the betrothed and soon-to-be married Amina, who, upon having been discovered in the bedchamber of a stranger, and despite the assurances of that stranger that Amina was entirely innocent, has been rejected by her enraged fiancé, Elvino—who, then, decides to marry another. In fact, when stressed, Amina was susceptible to somnambulism; and had come to be in the stranger's bedchamber by sleep-walking along a high parapet (in full view of the opera's audience). Elvino, who later observes the (exhausted by all the fuss) Amina, sleep-walking across a very high, very unstable, and very rickety bridge at the local mill, realizes his mistake, abandons his plans of marriage to the other woman, and re-unites with Amina.

Jenny Lind and James Braid

In August 1847, the famous soprano Jenny Lind visited Manchester, and gave two performances as Amina. The outstanding difference between Lind and her contemporaries was that, "whilst the beauty of her voice was far greater than any other in living memory (thus, the Swedish Nightingale), what really set her apart was her outstanding ability to act"; and, moreover, in performing as Amina, rather than walking along a wide and well-protected walkway (as the others did), she routinely acrobatically balanced her way along narrow planks. [57]

While she was in Manchester—on the basis that, at the time, many characterized "hypnotism" as "artificial somnambulism", [58] [59] and that, from a rather different perspective, her stage performance could also be described as one of "artificial" (rather than spontaneous) somnambulism—her friends arranged for her to visit the local surgeon James Braid, who had discovered hypnotism in 1841: [60] [61] [62]

Mr. Braid, surgeon, whose discoveries in hypnotism are well known, having invited the fair impersonator of a somnambulist to witness some of the abnormal feats of a real somnambulist, artificially thrown into that state, it was arranged that a private séance should take place [on Friday, 3 September 1847].

— Manchester Guardian, 8 September 1847

Drama

Mary Hoare's painting Lady Macbeth, Sleepwalking Mary Hoare - Lady Macbeth, Sleepwalking - B1975.4.1972 - Yale Center for British Art.jpg
Mary Hoare's painting Lady Macbeth, Sleepwalking

Literature

As sleepwalking behaviours occur without volition, sleepwalking can be used as a legal defense, as a form of legal automatism. [64] An individual can be accused of non-insane or insane automatism.[ where? ] The first is used as a defense for temporary insanity or involuntary conduct, resulting in acquittal. The latter results in a "special verdict of not guilty by reason of insanity." [65] This verdict of insanity can result in a court order to attend a mental institution. [66]

In the 1963 case Bratty v A-G for Northern Ireland , Lord Morris stated, "Each set of facts must require a careful examination of its own circumstances, but if by way of taking an illustration it were considered possible for a person to walk in his sleep and to commit a violent crime while genuinely unconscious, then such a person would not be criminally liable for that act." [67] While the veracity of the cases are disputed,[ by whom? ] there have been acts of homicide where the prime suspect may have committed the act while sleepwalking.

Alternative explanations to homicidal or violent sleepwalking include malingering, drug-induced amnesia, and other disorders in which sleep-related violence may occur, such as REM Sleep Behavior Disorder, fugue states, and episodic wandering. [68]

Historical cases

Albert Tirrell was acquitted of the murder of Maria Bickford in 1846, under a defense that he was sleepwalking. (National Police Gazette, 1846) 1846 Tirrell Bickford BostonTragedy NationalPoliceGazette.jpg
Albert Tirrell was acquitted of the murder of Maria Bickford in 1846, under a defense that he was sleepwalking. (National Police Gazette, 1846)

See also

Related Research Articles

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<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

<span class="mw-page-title-main">Sleep paralysis</span> Sleeping disorder

Sleep paralysis is a state, during waking up or falling asleep, in which one is conscious but in a complete state of full-body paralysis. During an episode, one may hallucinate, which often results in fear. Episodes generally last no more than a few minutes. It can recur multiple times or occur as a single episode.

<span class="mw-page-title-main">Rapid eye movement sleep behavior disorder</span> Medical condition

Rapid eye movement sleep behavior disorder or REM behavior disorder (RBD) is a sleep disorder in which people act out their dreams. It involves abnormal behavior during the sleep phase with rapid eye movement (REM) sleep. The major feature of RBD is loss of muscle atonia during otherwise intact REM sleep. The loss of motor inhibition leads to sleep behaviors ranging from simple limb twitches to more complex integrated movements that can be violent or result in injury to either the individual or their bedmates.

<span class="mw-page-title-main">Night terror</span> Sleep disorder causing feelings of panic or dread

Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last longer, especially in children. Sleep terror is classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experiences that occur during entry into sleep, during sleep, or during arousal from sleep.

<span class="mw-page-title-main">Delta wave</span> High amplitude low frequency brain wave

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<span class="mw-page-title-main">Nightmare disorder</span> Medical condition

Nightmare disorder is a sleep disorder characterized by repeated intense nightmares that most often center on threats to physical safety and security. The nightmares usually occur during the REM stage of sleep, and the person who experiences the nightmares typically remembers them well upon waking. More specifically, nightmare disorder is a type of parasomnia, a subset of sleep disorders categorized by abnormal movement or behavior or verbal actions during sleep or shortly before or after. Other parasomnias include sleepwalking, sleep terrors, bedwetting, and sleep paralysis.

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<span class="mw-page-title-main">Catathrenia</span> Sleep-related breathing disorder

Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea and expiratory groaning during sleep. It describes a rare condition characterized by monotonous, irregular groans while sleeping. Catathrenia begins with a deep inspiration. The person with catathrenia holds her or his breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. It appears more often during expiration REM sleep than in NREM sleep.

<span class="mw-page-title-main">Sleep study</span> Sleep Medicine

A sleep study is a test that records the activity of the body during sleep. There are five main types of sleep studies that use different methods to test for different sleep characteristics and disorders. These include simple sleep studies, polysomnography, multiple sleep latency tests (MSLTs), maintenance of wakefulness tests (MWTs), and home sleep tests (HSTs). In medicine, sleep studies have been useful in identifying and ruling out various sleep disorders. Sleep studies have also been valuable to psychology, in which they have provided insight into brain activity and the other physiological factors of both sleep disorders and normal sleep. This has allowed further research to be done on the relationship between sleep and behavioral and psychological factors.

Nocturnal sleep-related eating disorder (NSRED) is a combination of a parasomnia and an eating disorder. It is a non-rapid eye movement sleep (NREM) parasomnia. It is described as being in a specific category within somnambulism or a state of sleepwalking that includes behaviors connected to a person's conscious wishes or wants. Thus many times NSRED is a person's fulfilling of their conscious wants that they suppress; however, this disorder is difficult to distinguish from other similar types of disorders.

Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.

<span class="mw-page-title-main">Witching hour</span> Time of night associated with supernatural events

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Confusional arousals are classified as “partial awakenings in which the state of consciousness remains impaired for several minutes without any accompanying major behavioural disorders or severe autonomic responses”. Complete or partial amnesia of the episodes may be present.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

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References

  1. 1 2 Zivetz, Laurie (1992). The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Organization. hdl:10665/37958. ISBN   9789241544221. OCLC   26553093. Archived from the original on 18 February 2022.
  2. 1 2 3 "Diagnostic and Statistical Manual of Mental Disorders (DSM–5)". www.psychiatry.org. Archived from the original on 18 February 2022. Retrieved 2022-02-18.
  3. ↑ "I went driving and motorbiking in my sleep". BBC News. 2017-12-11. Archived from the original on 18 February 2022. Retrieved 2020-02-27.
  4. ↑ "SLEEP: Sex While Sleeping Is Real, and May Be No Joke", Michael Smith (June 19, 2006), MedPage Today, access date 18 February 2022
  5. ↑ "SLEEP: Sex While Sleeping Is Real, and May Be No Joke". www.medpagetoday.com. 19 June 2006. Archived from the original on 18 February 2022. Retrieved 2022-02-18.
  6. 1 2 3 4 5 6 7 Swanson, Jenifer, ed. "Sleepwalking". Sleep Disorders Sourcebook. MI: Omnigraphics, 1999. 249–254, 351–352.
  7. ↑ Rachel Nowak (15 October 2004). "Sleepwalking woman had sex with strangers". New Scientist . Archived from the original on 2007-05-09. Retrieved 2007-04-30.
  8. 1 2 3 Lavie, Peretz, Atul Malhotra, and Giora Pillar. Sleep disorders: diagnosis, management and treatment: a handbook for clinicians. London: Martin Dunitz, 2002. 146–147.
  9. 1 2 3 4 5 6 Stallman, Helen M. (2017). "Assessment and treatment of sleepwalking in clinical practice". Australian Family Physician. 46 (8): 590–593. PMID   28787563. Archived from the original on 16 February 2022.
  10. 1 2 "Sleepwalking - Symptoms and causes". Mayo Clinic. Archived from the original on 18 February 2022. Retrieved 2022-02-18.
  11. 1 2 Schenck, Carlos H. (March 2007). Sleep: The Mysteries, the Problems, and the Solutions. Avery Publishing. pp. 105–109. ISBN   978-1-58333-270-2. OCLC   1265420054.
  12. ↑ Willock, Brent (April 2022). "On dreaming, parasomnia, dream enactment, and murder". Psychoanalytic Psychology. 39 (2): 97–110. doi:10.1037/pap0000382. ISSN   1939-1331. S2CID   244209446.
  13. 1 2 Stallman, Helen M; Kohler, Mark J; Biggs, Sarah N; Lushington, Kurt; Kennedy, Declan (2017-09-25). "Childhood Sleepwalking and Its Relationship to Daytime and Sleep Related Behaviors". Sleep and Hypnosis - International Journal: 61–69. doi: 10.5350/Sleep.Hypn.2016.18.0122 .
  14. ↑ Guilleminault, Christian; Palombini, Luciana; Pelayo, Rafael; Chervin, Ronald D. (1 January 2003). "Sleepwalking and Sleep Terrors in Prepubertal Children: What Triggers Them?". Pediatrics. 111 (1): e17–e25. doi: 10.1542/peds.111.1.e17 . PMID   12509590 – via pediatrics.aappublications.org.
  15. ↑ "Sleep terrors (night terrors) - Symptoms and causes". Mayo Clinic. Retrieved 2019-03-25.
  16. ↑ Crisp, A.H.; Matthews, BM; Oakey, M; Crutchfield, M; et al. (1990). "Sleepwalking, night terrors, and consciousness". British Medical Journal. 300 (6721): 360–362. doi:10.1136/bmj.300.6721.360. PMC   1662124 . PMID   2106985.
  17. ↑ Orme, J.E. (1967), "The Incidence of Sleepwalking in Various Groups", Acta Psychiatrica Scandinavica, Vol 43, Iss 3, pp 279–28.
  18. ↑ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4): e13596. doi:10.1111/jsr.13596. ISSN   0962-1105. PMID   35388549. S2CID   248000922.
  19. ↑ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4): e13596. doi:10.1111/jsr.13596. ISSN   0962-1105. PMID   35388549. S2CID   248000922.
  20. ↑ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4): e13596. doi:10.1111/jsr.13596. ISSN   0962-1105. PMID   35388549. S2CID   248000922.
  21. ↑ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4): e13596. doi:10.1111/jsr.13596. ISSN   0962-1105. PMID   35388549. S2CID   248000922.
  22. ↑ Milliet N, Ummenhofer W. Somnambulism and trauma: case report and short review of the literature. J Trauma. 1999;47(2):420–2
  23. ↑ Sillesen NH, Nielsen LT, Bonde C. Complex injuries associated with somnambulism. Ugeskr Laeger. 2010;172(50):3489–90
  24. ↑ "Sleepwalker dies after falling from hotel window following night out with work colleagues". Daily Mirror . 2014-01-03.
  25. ↑ "Tragedy as sleepwalker plunges to death from hotel window" . 2014-01-02. Archived from the original on 2022-01-12.
  26. ↑ "Naked sleepwalker stumbles out of city hotel then makes an odd request to police". Daily Mirror . 2016-05-22.
  27. ↑ "Sleep walker mows lawn naked". 2005-03-21.
  28. ↑ Pressman. "Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications." Sleep Med Rev 11.1 (2007):5–30.
  29. ↑ Kales, A.; Soldatos, C. R.; Bixler, E. O.; Ladda, R. L.; Charney, D. S.; Weber, G.; Schweitzer, P. K. (1 August 1980). "Hereditary factors in sleepwalking and night terrors". The British Journal of Psychiatry. 137 (2): 111–118. doi:10.1192/bjp.137.2.111. PMID   7426840. S2CID   13186645.
  30. ↑ Kucherenko, Mariya M.; Ilangovan, Vinodh; Herzig, Bettina; Shcherbata, Halyna R.; Bringmann, Henrik (2016-01-01). "TfAP-2 is required for night sleep in Drosophila". BMC Neuroscience. 17 (1): 72. doi: 10.1186/s12868-016-0306-3 . ISSN   1471-2202. PMC   5103423 . PMID   27829368.
  31. ↑ Dogu, Okan; Pressman, Mark R. (4 January 2011). "Identification of sleepwalking gene(s): Not yet, but soon?". Neurology. American Academy of Neurology. 76 (1): 12–13. doi:10.1212/WNL.0b013e318203e9c0. ISSN   0028-3878. PMID   21205687. S2CID   207118557. Archived from the original on 18 February 2022.
  32. ↑ Barabas, Gabor; Matthews, Wendy S.; Ferrari, Michael (2008). "Somnambulism in Children with Tourette Syndrome". Developmental Medicine & Child Neurology. 26 (4): 457–460. doi:10.1111/j.1469-8749.1984.tb04471.x. PMID   6148287. S2CID   1759571.
  33. ↑ Schenck, C. H., & Mahowald, M. W. (1995b). Two cases of premenstrual sleep terrors and injurious sleep-walking. Journal of Psychosomatic Obstetrics & Gynecology, 16, 79–84.
  34. ↑ Hedman, C., Pohjasvaara, T., Tolonen, U., Salmivaara, A., & Myllyla, V. (2002). Parasomnias decline during pregnancy. Acta Neurologica Scandinavica, 105, 209–214.
  35. 1 2 Stallman, HM; Kohler, M; White, J (February 2018). "Medication induced sleepwalking: A systematic review". Sleep Medicine Reviews. 37: 105–113. doi:10.1016/j.smrv.2017.01.005. PMID   28363449. S2CID   10381396.
  36. ↑ Poryazova, R; Waldvogel, D; Bassetti, CL (October 2007). "Sleepwalking in patients with Parkinson disease". Archives of Neurology. 64 (10): 1524–7. doi: 10.1001/archneur.64.10.1524 . PMID   17923637.
  37. ↑ Sateia, Michael J. (1 November 2014). "International classification of sleep disorders-third edition: highlights and modifications". Chest. 146 (5): 1387–1394. doi:10.1378/chest.14-0970. ISSN   1931-3543. OCLC   986580999. PMID   25367475. Archived from the original on 28 January 2022.
  38. ↑ Staff, Mayo Clinic. "Sleep-related Eating Disorders". Mayo Clinic. Retrieved 5 May 2014.
  39. ↑ Clinic, Cleveland. "Sleep-Related Eating Disorders". Cleveland Clinic. Retrieved 5 May 2014.
  40. 1 2 Wetherill, Reagan R.; Fromme, Kim (2016). "Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies". Alcoholism: Clinical and Experimental Research. 40 (5): 922–935. doi:10.1111/acer.13051. PMC   4844761 . PMID   27060868.
  41. ↑ Hartzler, Bryan; Fromme, Kim (2003). "Fragmentary and en bloc blackouts: Similarity and distinction among episodes of alcohol-induced memory loss". Journal of Studies on Alcohol. 64 (4): 547–550. doi:10.15288/jsa.2003.64.547. PMID   12921196.
  42. ↑ Blatt, I., Peled, R., Gadoth, N., & Lavie, P. (1991). The value of sleep recording in evaluating somnambulism in young adults. Electroencephalography & Clinical Neurophysiology, 78, 407–412.
  43. ↑ Joncas, S., Zadra, A., Paquet, J., & Montplaisir, J. (2002). The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology, 58, 936–940.
  44. ↑ Kales, A., Soldatos, C. R., Caldwell, A. B., Kales, J. D., Humphrey, F. J., 2nd, Charney, D. S., & Schweitzer, P. K. (1980). Somnambulism. Clinical characteristics and personality patterns. Archives of General Psychiatry, 37, 1406–1410.
  45. ↑ Hublin, C., Kaprio, J., Partinen, M., Heikkila, K., & Koskenvuo, M. (1997). Prevalence and genetics of sleepwalking: A population-based twin study. Neurology, 48, 177–181.
  46. ↑ Kavey, N. B., Whyte, J., Resor, S. R., Jr., & Gidro-Frank, S. (1990). Somnambulism in adults. Neurology, 40, 749–752.
  47. ↑ Zadra, Antonio; Pilon, Mathieu (2012-03-01). Parasomnias II. Oxford University Press. doi:10.1093/oxfordhb/9780195376203.013.0028.
  48. ↑ "Wandering & Movement Alarms & Monitors / Page 1 - Independent Living Centres Australia". ilcaustralia.org.au. Archived from the original on 18 February 2022. Retrieved 2018-09-09.
  49. ↑ Stallman, HM; Kohler, M (2016). "Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis". PLOS ONE. 11 (11): e0164769. Bibcode:2016PLoSO..1164769S. doi: 10.1371/journal.pone.0164769 . PMC   5104520 . PMID   27832078.
  50. ↑ Kushida, Clete A. (30 December 2012). Encyclopedia of Sleep. Academic Press. pp. 154–155. ISBN   9780123786111. OCLC   1033861556.
  51. ↑ Society for Science & the Public. "Sleepwalking Cause." The Science News-Letter. 27 February 1954: 132.
  52. ↑ Society for Science & the Public. "Sleepwalker Not Dreaming." The Science News-Letter, 25 June 1966: 508
  53. ↑ Magiorkinis, Emmanouil; Diamantis, Aristidis; Sidiropoulou, Kalliopi; Panteliadis, Christos (24 August 2014). "Highights in the History of Epilepsy: The Last 200 Years". Epilepsy Research and Treatment. 2014: e582039. doi: 10.1155/2014/582039 . ISSN   2090-1348. PMC   4158257 . PMID   25210626.
  54. ↑ "History of the Scientific Standards of QEEG Normative Databases" (PDF). Archived (PDF) from the original on 18 February 2022.
  55. ↑ "Somnambulism". International Dictionary of Psychoanalysis. 2005. Archived from the original on 22 September 2020.
  56. ↑ Kantha, S. S. (28 November 2003). "Is somnambulism a distinct disorder of humans and not seen in non-human primates?". Medical Hypotheses. 61 (5–6): 517–518. doi:10.1016/s0306-9877(03)00206-8. ISSN   0306-9877. PMID   14592779. Archived from the original on 18 February 2022.
  57. ↑ Yeates, L.B., James Braid: Surgeon, Gentleman Scientist, and Hypnotist, Ph.D. Dissertation, School of History and Philosophy of Science, Faculty of Arts & Social Sciences, University of New South Wales, January 2013. Yeates (2013), p.788.
  58. ↑ For example, Pritchard J.C., A Treatise on Insanity and Other Disorders Affecting the Mind, Sherwood, Gilbert and Piper, (London), 1835, p.p.410.
  59. ↑ Prichard, James C. (1835). A treatise on insanity and other disorders affecting the mind. London: Sherwood, Gilbert and Piper – via Archive.org.
  60. ↑ "Jenny Lind at the Manufacturing Establishments", Manchester Guardian, No.1947, (Saturday, 4 September 1847), p.7, col.C; "Jenny Lind and the Hypnotic Somnambulist", Manchester Guardian, No.1948, (Wednesday, 8 September 1847), p.5, col.F; "Jenny Lind and the Manchester Somnambulists", Newcastle Courant, No.9015, (Saturday, 17 September 1847), p.2, col.E; "Jenny Lind and Hypnotism", The Medical Times, Vol.16, No.416, (18 September 1847), p.602; and "Jenny Lind and Mesmerism", The Lady's Newspaper, No.39, (Saturday, 25 September 1847) p.294, col.A.
  61. ↑ Jenny Lind and the Mesmerist, The Maitland Mercury and Hunter River General Advertiser, (Wednesday, 26 January 1848), p.1.
  62. ↑ Storer, H., "Jenny Lind and the Somnambulist", The Critic: A Journal for Readers, Authors, and Publishers, Vol.6, No.145, (9 October 1847), p.238; Braid, J., "(Letter to Dr. Storer, written on 28 September 1847)", The Critic: A Journal for Readers, Authors, and Publishers, Vol.6, No.145, (9 October 1847), p.238.
  63. ↑ Oulton, Walley Chamberlain (16 March 1812). "The Sleep-Walker; or, Which is the Lady? A Farce, in Two Acts". OCLC   1061924365 – via Google Books.
  64. ↑ Popat, S; Winslade, W (2015). "While You Were Sleepwalking: Science and Neurobiology of Sleep Disorders & the Enigma of Legal Responsibility of Violence During Parasomnia". Neuroethics. 8 (2): 203–214. doi:10.1007/s12152-015-9229-4. PMC   4506454 . PMID   26203309.
  65. ↑ Lederman, Eliezer. "Non-Insane and Insane Automatism: Reducing the Significance of a Problematic Distinction." The International and Comparative Law Quarterly 34.4 (1985): 819.
  66. ↑ Mackay, Irene (1992). "The Sleepwalker is Not Insane". The Modern Law Review. 55 (5): 715–716. doi:10.1111/j.1468-2230.1992.tb02845.x.
  67. ↑ Culebras, A. (1996). Clinical Handbook of Sleep Disorders. Massachusetts, MA, USA: Butterworth-Heinemann. pp. 317–319. ISBN   978-0-7506-9644-9. OCLC   34932724.
  68. ↑ Shearer, Lloyd (October 14, 1961). "He killed in his sleep". Ottawa Citizen.
  69. ↑ Donnelley, Paul (2000). Essex Murders. Wharncliffe Books.
  70. ↑ Heaton-Armstrong A, Shepherd E, Wolchover D, eds. (2002). Analysing Witness Testimony: Psychological, Investigative and Evidential Perspectives: A Guide for Legal Practitioners and Other Professionals. Blackstone Press. ISBN   978-1-85431-731-5.
  71. ↑ Broughton et al. Homicidal Somnambulism: A Case Report. Sleep (1994); 17(3):253-64
  72. 1 2 Lyon, Lindsey (8 May 2009). "7 Criminal Cases That Invoked the 'Sleepwalking Defense'". US News & World Report .
  73. ↑ "Acuerdan internar 10 años al hombre que mató a su mujer y su suegra creyéndolas avestruces" [They agreed to intern the man who killed his wife and mother-in-law for 10 years, believing them to be ostriches]. Diario Sur (in European Spanish). 2007-02-21. Retrieved 2023-05-29.
  74. ↑ "'Sleepwalker' accused of murder". BBC News Online. 10 March 2005.
  75. ↑ de Bruxelles, Simon (18 November 2009). "Sleepwalker Brian Thomas admits killing wife while fighting intruders in nightmare". The Times . London. Retrieved 2009-12-26.
  76. ↑ "Camper van 'dream killer' Brian Thomas freed by judge". BBC News Online . 2009-11-20. Retrieved 2016-05-30.
  77. ↑ "Man who killed his wife while sleeping goes free". The Independent. 2009-11-21. Retrieved 2016-05-30.

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