The couple were very worried. Their adolescent son had started walking while sleeping. For the first few times, they thought it to be a childish prank and scolded him. But later on they realized that he was doing it involuntarily and needed medical attention. Somnambulism or sleep walking is the act of walking or doing any activity associated with wakefulness, in the sleeping state. The activities may be benign like simply walking around or dressing up or even sitting on the bed. At times a sleep walker may commit a crime or indulge in sexual activity during sleep walking. While, “awake”, during sleeping the person is like in a trance and is totally oblivious to his surroundings. Afterwards, he or she has no memory of what has been done in that state. Somnambulism usually occurs in mid childhood and early adolescence. But 15% of cases may develop this problem while in their teens. The duration of sleep walking may be from 3 minutes to 20-40 minutes.A genetic predisposition for somnambulism has been postulated as it is known to occur in first degree relatives and identical twins.Sleep deprivation, bizarre sleep schedules can induce somnambulism. Alcohol intoxication is also known to cause it in some persons.Somnambulism is known to occur as side effect of some medicines like sedatives, tranquilizers, anti -allergy drugs, e.t.c. It is also part of the manifestations of diseases like epilepsy, night time severe asthma, psychosis, P.T.S.D., e.t.c.Irrespective of the cause of somnambulism, it is worrying for both the patient and his family members. It also poses a high risk of injury for the victim as unknowingly he can fall or trip over objects and injure himself. Usually no tests are needed for diagnosing somnambulism. Tests if done are to exclude other treatable medical conditions which may be the cause or may be associated with somnambulism.Sleep studies are helpful to confirm somnambulism. Electroencephephalography, psychiatric evaluation, help in confirming or excluding night time epilepsy or psychiatric disorders. Cases of sleep walking which occur due to drugs, high fever, e.t.c., usually resolve after the condition is treated, hence no other treatment is required. In most of the children, it stops spontaneously, once they grow up. But some unfortunate persons continue to sleep walk even after growing up. These individuals need special care and attention. Measures like taking a light meal in evening, avoiding mental stimulants like tea, coffee, television, e.t.c, before bed time, wearing comfortable lose bed clothes, ensure a good sleep and also help to reduce chances of somnambulism.Even after adopting these measures, if one tends to sleep walk, adequate precautions should be taken to keep him out of harm; s way. If possible, the person should be made to sleep on the ground to avoid falling down. The floor should be clear of objects which can make him trip over. A bell put near the pillow can warn family members that now the person is moving out of bed and he can be supervised to see that he is safe. Windows need to be kept closed so that the child or adult suffering from somnambulism does not fall down. Whether a person who is walking in his sleep should be interrupted or not is controversial. Some workers say that he or she should not be disturbed in that state and only watched closely for sake of safety. While some claim that in a state of somnambulism, if the person is lead to his bed and made to lie again, the episode can be aborted. Mental relaxation helps to avoid episodes of somnambulism in those who develop it due to stress or anxiety.Arousing a person few minutes before the anticipated time of somnambulism and keeping him awake for about an hour can ward off the episode and is beneficial in long term prevention of somnambulism. People should be aware of somnambulism that it is a disease like any other sickness needing care and treatment. It is not a witchcraft or madness and should never be ignored.Specialist internal medicine-Ruhengeri Hospital
