Parasomnias are chilling disorders to either witness or experience, which I know personally by both suffering from and watching family suffer from them. Defined as "a group of sleep-wake disorders that involve unusual behaviors or abnormal physiological events during sleep" (Burke 411), they come in several different types. However, having one type of parasomnia doesn't preclude that someone cannot suffer another— or, perhaps, a strange mixture of the two. This is because "Sleepwalking and night terrors are considered to be manifestations of the same nosologic continuum" (Waldemar 1). This paper will focus on the parallels, contrasts, and even the combination of sleepwalking, or somnambulism, and sleep terrors, or night terrors. While such a parasomnia is only considered necessary to diagnose if it causes "clinically significant distress or impairment do clinicians" (ibid), the existence of any of the strange symptoms of either somnambulism or night terrors can cause a certain level of alarm in anyone dealing with it or has a loved one dealing with it; or, especially, when dealing with both. Thus, this paper will consider not only the definitions and symptoms of these specific types of parasomnias, but also the potential causes and cures with the hope that it can educate the readers who may be dealing with either disorder or, quite possibly, both of them. By understanding how much these disorders parallel each other and even intersect more than previously understood, the individual parasomnias themselves may become clearer.
Starting with night terrors, they are defined as: "partial arousals from slow-wave sleep "often accompanied by a cry or piercing scream, accompanied by auto-nomic nervous system and behavioral manifestations of in-tense fear... Sometimes there is prolonged inconsolability associated with a sleep terror" (Dominque 1). They occur during slow-wave or REM sleep, usually- but not necessarily always- during the first wave of the night (Szelenberger), or within the first two hours after an individual falls asleep. When it comes to night terrors, "Episodes can last 5-10 minutes, but have been known to last for up to 30 minutes" (Gardner), and they can happen more than once in the night. Night terrors are far more common in infants and children than in adolescence and adulthood, with "As many as 37% of 18-month-olds and nearly 20% of 30-month-olds experiencing sleep terrors, compared to 2% of the adult population.... [because] Most childhood cases spontaneously disappear in adolescence" (Burke).
(Szelenberger)
Next, somnambulism is defined as: "complex behaviors that are usually initiated during partial arousals from slow-wave sleep... The sleepwalking individual is disoriented in time and space, with slow speech, with severely diminished mentation, and blunted response to questions or requests. There is often prominent anterograde and retrograde memory impairment... but not always" (Dominique 1). Sleepwalking is a slight misnomer, since somnambulism covers a wide range of unwanted physical activites that occur during sleep, including "talking, walking, and sitting up in bed, and even violent acts with open eyes and blank looks occur unknowingly during sleep while sufferer believed to be in sleep" (Wajiha). Like night terrors, somnambulism also occurs during slow-wave or non-REM sleep. Violence is a potential symptom of somnambulism, either self-inflicted or against others, and is more frequent in CO-SW (childhood-onset sleepwalking) in general and in males with AO-SW (adult-onset sleepwalking) (Bargiotas). During one test "Among 63 sleepwalkers, 45% had ≥1 episodes/month, 54% had partial recall of the episodes" (Bargiotas). Sleepwalking is more common in adulthood than sleep terrors are, but sleepwalking in childhood is more common than sleepwalking in adulthood since "10-30% of children have had an episode of sleepwalking" (Burke).
(Szelenberger)
Somnambulism and night terrors share many symptoms as well. This includes, "relative unresponsiveness to external stimuli as well as mental confusion" (Petit). Physically, scientists observing individuals who suffer from either somnambulism of night terrors note that the patients "have excessive twitching during rapid eye movement sleep, which may result either from a higher dreaming activity in rapid eye movement sleep or from a more generalised non-rapid eye movement/rapid eye movement motor dyscontrol during sleep" (Hariri). Even when it comes to the age groups and causes of night terrors and somnambulism, these two parasomnias intersect, "because slow-wave sleep decreases with age, events become less common in older school-age children and adolescents" (Meltzer). This explains why younger children are the most likely to suffer from either or both parasomnias; of course, there are still instances of these disorders persisting and adult-onset conditions. Another less common aspect of either parasomnias that is still possible is "NREM parasomnias can also occur during daytime naps for younger children (thus the term sleep terrors rather than night terrors)" (Meltzer).
When it comes to night terrors, it has been shown that many children (and adults) who suffer from them also had at least one parent who suffered from them (Petit). This is especially true when it comes to discerning whether a child suffers from transient night terrors- "having sleep terrors before age 4 years and none thereafter" (Petit) or having permanent night terrors- "sleep terrors be-fore age 4 years and still had them after the age of 5 years" (ibid). There are also many potential triggers for both night terrors including, "sleep deprivation, noise, fever (temperature, >38.3°C), medication, and sleep-related respiratory events" (Petit). Also, a study at Smedje et al has discovered that "children with emotional problems are more likely to experience night terrors" (Gardner) than children who are emotionally healthy. This reasoning extends to adults, since there is a strong connection between veterans and sleep disturbances that include night terrors, as well as depression, PTSD, and alcohol use (Richardson). However, well it has been shown that night terrors affect people more given their age, there "no relationship between sex and either sleep terrors or sleepwalking was found" (Petit).
Further consideration of night terrors has led to some to consider that "Psychological conflict was hypothesized to precede the intense panic and screaming that characterizes night terrors" (Ahluwalia). This hypothesis is based on interviews with the minority of adults who do have vague or good recall of their episodes of night terrors. From these interviews, the night terrors revealed to have been suffered included, "experiences of being crushed, trapped, abandoned, fear, falling and dying" (Ahluwalia). Others see shadowy forms manifested into their fears including spiders, strange men, and demons. There is also an "association between anxious and depressive disorders and sleep terrors" (Ahluwalia). When it comes to adolescents, children who suffered from night terrors "scored higher on neuroticism and had more psychiatric diagnoses than the control group" (Ahluwalia) as well as those who have been associated with histories of enuresis (ibid). Another potential cause is being exposed to violent material, especially right before bed time (Ahluwalia).
There is a strong genetic connection for somnambulism with "22.5% for children without parental history ,47.4% for children with 1 parent with a history of sleepwalking, and 61.5% for children with both parents with a history of sleepwalking" (Petit). Somnambulism can also share similar triggers to night terrors including, ""sleep deprivation, noise, fever (temperature, >38.3°C), medication, and sleep-related respiratory events" (Petit). Other potential triggers for somnambulism include, "diseases like thyrotoxicosis, herpessimplex encephalitis, migraine, respiratory problems, and alsoTourette's syndrome may contribute to somnambulism" (Wajiha). Especially chilling, is the fact that pregnancy- and the related hormones- can trigger somnambulism as well (Wajiha).When it comes to sleepwalking in adults, some of it is, in fact, a carry-over from childhood where somnambulism disappears "in about 75% of the affected during the adolescence" (Bargiotas). But it can also "appear de novoin adulthood... approximately 13% develop this sleep disturbance during adulthood" (Bargiotas). Whether somnambulism is a carry-over from childhood or new for adulthood, "The overall prevalence of SW in adulthood is about 4%" (Bargiotas). Among adult sleepwalkers, approximately 13% develop this sleep disturbance during adulthood [5]. The overall prevalence of SW in adulthood is about 4% (Bargiotas). During the aforementioned test of 62 sleepwalkers, "36% reported trig-ger factors for SW" (Bargiotas).
When it comes to treating, or at least alleviating the symptoms of, night terrors in adolescents, many parents are often just assured that their children will simply grow out of the parasomnia, usually by age eight (Richarde). Generally, sleep terrors "can continue for 3-4 months, and the mean duration of untreated night terrors is reportedly 3.9 years" (Gardner). For more violent night terrors, a potential tactic to take in alleviating them are "scheduled awaken-ings" (Petit). This helps to break the flow of sleep and limit the amount of REM sleep that a child has, reducing their vulnerability window to night terrors. Basic behavior modification can be useful as well, and some have found it helpful to avoid "violent material even in cartoons with children... especially before bed-time" (Ahluwalia). Projective therapy may also be useful, with puppets and drawing pictures useful to younger children, and journaling the incident helpful for older children (Gardner). However, if those tactics don't work, hypnosis can be considered. Only in instances where the child is in danger to themselves or others should a more medicinal intervention be considered (Richarde). One herbal consideration that is generally safe for children and can help calm the nervous system is, "Avena sativa (milky oat) seed" (Richarde). There are also preventive methods that apply to sight terrors and somnambulism alike and both children and adults, which are, "avoiding sleep deprivation, irregular sleep schedules, and noisy sleeping environments" (Petit).
When it comes to night terrors in adults, there is no longer that hope that they will just 'grow out of it.' The amount of danger an adult can accidentally cause those around them also increases with adulthood, so more immediate intervention is usually recommended. Many of the childhood intervention techniques are the same, including sleep modification and hypnosis. Potential medicinal routes to be taken include "benzodiazepines, tricyclic antidepressants, or selective serotonin re-uptake inhibitors (SSRIs)" (Richarde). However, there are also more herbal ways to alleviate the causes of non-REM sleep, namely: "Withania somnifera (ashwagandha), Centella asiatica (gotu kola), Bacopa monnieri (brahmi), and Eleutheroccocus senticosus (eleuthero). Adrenal tonics and blood sugar balancers:Eleutheroccocus senticosus (eleuthero), Withania somnifera (ashwagandha), and Ocimum sanctum (holy basil). Nervous system tonics: Avena sativa (milky oat) seed... Piper methisticum (kava)... Mild relaxants: Melissa officinalis (lemon balm) and Matricaria chamomilla (chamomile)" (Richarde).
Similarity to night terrors, it is recommended to not take any medical action to stop somnambulism, since children generally grow out of it- though, for sleep walking, it's around the age twelve or thirteen instead of eight (Richarde). Also, like night terrors, when parents face a more dangerous rash of sleep walking, the recommended approach for dealing with somnambulism in children is "scheduled awaken-ings" (Petit) for the same reason, and then hypnosis, and finally medicinal or herbal intervention if the somnambulism is threatening to the child or others (Richarde). For an added level of safety, it may be recommended that "house alarms may be needed to prevent children from leaving the house in their sleep" (Petit). Some individuals who suffer from somnambulism prefer to seek more spiritual treatment plans (Wajiha).
Again, the main difference between attempting to sleep walking in adults versus trying to treat it in adolescents is the loss of the belief that one will 'grow out of it.' However, the treatments are otherwise the same for adolescent sleep walking as well as adult night terrors: altering sleep patterns, hypnotic therapy, and the same variety of medicine.
There are strong parallels between both night terrors and somnambulism, but the connections between those two parasomnias do not end there. They both occur during non-REM sleep. Many of the causes and almost all of the potential cures are the same for both ailments. However, the two parasomnias are more bound together than just that. For one thing, "As many as one-third of children who had early childhood sleep terrors developed sleepwalking later in childhood" (Petit). Once again revisiting the results of the study of 63 sleepwalkers, "Almost all subjects reported co-occurring parasomnias" (Bargiotas). In fact, "Almost all sleepwalkers (98%) reported co-occurring parasomnias. Sleep talking (91%), night terrors (69%), bruxismus (54%) and nocturnal eating behaviour (50%) were the most frequently occurring events. In addition, hallucinations (45%), sleep paralysis (35%) and enuresis (7%) were frequently reported" (Petit). That means that almost three-fourths of the individuals who suffer sleepwalking in the study have night terrors as well as somnambulism.
What does it look like to suffer both sleep terrors and sleepwalking? While specific experiences differ for everyone, there are certain attributes that each parasomnia brings in the comorbidity. The night terror dynamic of the event involves the individual seeing frightening images that are not story-length or as easily remembered as a mere nightmare, and causes physical, observable distress like "a terrified scream or panicky cry" (Burke). The somnambulism aspect brings with it the ability to do gross motor skills including, but not limited to, "leaving the bed and moving about; simply sitting up in bed, talking, or gesturing" (Burke). So, to put those two aspects of a joined parasomnia together, the picture would be such. An individual who suffers from both sleep disorders might not merely scream when they see their frightening image, but also sit up in reaction to it. More dangerously, they might jump out of bed in attempt to flee that image, or throw themselves over a roommate in an attempt to protect them. Some have been known to go fleeing from their room and the frightening image and accidentally put themselves into danger by running down the stairs or even going outside without being fully awake. To clarify, night terrors bring with them the frightening imagery that inspires motor skills that are attributed to somnambulism, giving individuals who suffer from both a greater range of fear and potential injury.
To conclude, night terrors and somnambulism are closely related parasomnias. While there are distinct differences in those two disorders, they both occur during the same stage of sleep, non-REM. The potential causes of both night terrors and sleepwalking are the same: genetics, trauma, stress, etc. The cures are also very similar, whether it is purposely disrupting sleep patterns, avoiding caffeine, or even taking some of the same types of medication. Finally, these two disorders are often co-morbid with each other. As mysterious as both these conditions can seem, and as bizarre as they seem to be to those who suffer them or who have loved ones who suffer them, research is revealing new aspects of understanding that becomes even more complete when night sleep terrors and somnambulism are viewed together, expanding on vulnerable age groups, triggers, and comorbidity.
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