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Last night I had a lot of trouble sleeping, I would fall asleep and then jerk awake what seemed like everytime I would fall asleep. I also had a pretty bad headache last night too. I remember waking up from what I thought was a dream of me in my car trying to back it out of my parking spot. I remember thinking in this "dream" that I was going to hit the other car next to me if I moved any farther, but then I remember consciously thinking but I was dreaming so it doesnt matter if I hit the other car. I remember looking behind the car to see if there was anyone there but I could barely see (because it was dark) The next thing I remember is waking up in my bed and very groggy thinking that was a weird dream. The rest of the night (I dont know a time line at all) I was still falling a sleep and jerking awake, I was very restless.
When I woke up in the morning I stayed in bed till about 11am because I was so tired from ack of sleep last night, and I didnt think anything of my weird "dream" until I went to my car to leave for work, my car was backed out about 4 feet from the curb and the tires were over the line into the other parking spot. I would never park my car this way and I know I did not leave it this way. I have no recolection of walking to or from my car last night just the weird "dream" and then my car being parked the way it was... I am a little scared and I am going to ask my roommate to hide my keys before we go to bed and see if anything happens sometime soon.
This arises in the well known but still mysterious disorder of sleep walking. Sleep walking occurs during arousals from deep sleep. It is most common in young children who get far more deep sleep (stage N3) than adults. In fact, sleep walking may be induced in young children by just trying to get them up during the night. If they begin to sleep walk, they can be directed back to bed without ever coming to full consciousness and will not remember the event the next day. Children are often in such a deep state of sleep that they may not be awakened even by very loud noises. Small children rely on the protection of adults during deep sleep. Adults get much less deep sleep and so are usually easier to arouse during the night if an emergency arises.
Typically sleep walking involves the person getting out of bed and beginning to move about. The eyes are usually open and appear glassy and vacant. Very complex motor movements can occur during sleep walking. Most often this is walking from one place to another. The sleep walker may return to bed. The next day there is usually no memory for the event and the person may be puzzled to find objects moved around in the bed room or house. Even more complex movements may occur. Violence can occur, especially if an attempt is made to awaken a sleep walker. Urination in an inappropriate location is fairly common. Eating may also occur while asleep, as may some efforts at cooking. Generally the individual has no memory of these behavioirs.
It is also possible for sleep walkers to experience dream imagery and even vivid hallucinations. Diagnostically, it may be difficult to differentiate sleep walking with hallucinations from REM sleep behavior disorder (RBD). A common difference between the two is that sleep walking usually is an eyes open behavior while people with RBD usually are acting out dreams in an eyes closed condition.
Sleep walking is sometimes observed during nocturnal polysomnography. At these times an EEG pattern of deep sleep with an arousal is noted with EMG and video activity of major body movement. As the movements progress an EEG consistent with deep sleep continues. What occurs is a sleep state dissociation in which the frontal cortex, responsible for higher judgment and planning, is asleep, while at the same time, motor centers responsible for behavior are active. Thus a person may unknowingly execute complex behaviors.
Some sleep walkers have actually driven, sometimes for significant distances. This is a frightening possibility as sleep walkers can be injured while sleepwalking and most certainly can injure themselves or others while sleep driving. Amazingly sleep drivers have been able to get from one location to another without ever waking up. We do not know how many driving fatalities may have resulted from sleep driving.
The most important aspect of treating sleep walking is preventing injury to the sleep walker or to others who may be present. In my next post I will discuss treatment approaches and safety measures for sleep walking.
