somnambulism

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Classification according to ICD-10
F51.3 Sleepwalking (somnambulism)
ICD-10 online (WHO version 2019)

The somnambulism (more rarely the somnambulism ; of Latin somnus , "sleep" and ambulare , "walking around, walk"), even sleepwalking or somnambulism ( Noktambulismus ), historical Mondsucht ( somnambulism ), known, is a phenomenon in which a sleeping without waking leaves bed, walks around and sometimes does some work. The incident usually only lasts a few minutes. It is a strange twilight state . Despite their sleeping state, the person perceives their surroundings.

The somnambulistic state can occur spontaneously or provoked by external suggestive influence. The latter is a hypnotic influence. The first documented artificial induction took place in the 1780s by the Marquis de Puységur , a student of Franz Anton Mesmer , who had propagated animal magnetism . Puységur's research influenced the French neurologist Jean-Martin Charcot (1825–1893) and the French neuropsychiatrist Hippolyte Bernheim (1837–1919), who were also familiar with the correspondence of spontaneous and provoked somnambulism, as demonstrated by Puységur in 1784.

Conditions and triggers

Conditions that contribute to sleepwalking are genetic predisposition and a prior period of sleep loss, often due to emotional distress. There is also another triggering factor, for example excessive caffeine or alcohol consumption, the use of sleeping pills, antidepressants and antipsychotics as well as periodic breathing disorders caused by sleep apnea syndrome. The trigger prevents non-REM sleep after the sleep loss period. The actions during sleepwalking ultimately depend on the perceptions and feelings before falling asleep.

Frequency and causes

The frequency of the phenomenon is only estimated. One to two percent chronic sleepwalkers are assumed in adults, whereas between 10 and 30 percent are affected in children (this corresponds to around 15 percent of five to twelve year olds). However, only 3 to 4 percent of children walk around in their sleep more often. In about 70 to 80 percent of cases, the tendency disappears by puberty . In adults, too, it is not always a permanent phenomenon, sometimes it only occurs once or a few times.

In earlier times, it was assumed that the full moon or another light source used to trigger the sleepwalking, which is why the phenomenon also Mondsucht was called (somnambulism). This has been scientifically refuted. Physical stimuli such as a filled bladder or external stimuli such as loud noises can promote the phenomenon. Since childhood sleepwalking usually disappears with puberty, the main cause is a not yet fully developed central nervous system .

A genetic disposition for somnambulia is considered to be proven , because the phenomenon occurs more frequently in certain families. If both parents are sleepwalkers, the probability that the children are also affected is statistically 60 percent. Close relatives are also somnambulistic in 80 percent of the sleepwalkers surveyed.

classification

Somnambulism is a sleep disorder and belongs to the subgroup of parasomnias . The current state of research, which takes into account studies in sleep laboratories , assumes that sleepwalking is a disruption of the waking mechanism that, unlike the behavior of most sleepers, leads to unconscious psychomotor activities and to getting up. For other people, waking up briefly while sleeping only causes the person to turn or move around in bed and then go back to sleep. Somnambulism only occurs in deep sleep phases, not in dream phases ( REM sleep ). The phenomenon of night walking usually has nothing to do with seizure-like epileptic twilight attacks. However, cases have been observed in which occasional nocturnal psychomotor seizures or postparoxysmal twilight states according to Grand mal in the form of somnambulistic states.

The altered state of consciousness associated with night walking is not necessarily only to be assessed as a sleep disorder, which was used not only by means of hypnosis, but also as twilight sleep for healing purposes. Often the unusual abilities of the night walkers also cause astonishment. These achievements are made possible by the elimination of fears and inhibitions that determine everyday consciousness. The proverbial sleepwalking security starts from there. Certain functions, such as the processes controlled by the extrapyramidal and vegetative nervous system, can even be disturbed by attention, as one can visualize this for oneself. So is z. For example, descending stairs is largely directed by the extrapyramidal nervous system and can be impaired by focused attention, such as by consciously counting the stairs and steps.

Classification according to Uroš J. Jovanović :

  • So-called subclinical manifestations with only appropriate information in the electroencephalogram (EEG), electrooculogram (EOG), electrocardiogram (EKG) or electromyogram (EMG).
  • The abortive (imperfect) form of sleepwalking is limited to the bed. People often sit up, look around and usually speak incomprehensibly.
  • The clinically fully developed, but not serious form of sleepwalking shows the usual symptoms, including possible consequences of injury for the person concerned.
  • The rare, aggressive form of sleepwalking, on the other hand, can take on unpredictable proportions. Sleepwalkers can become violent towards people who want to help or who are just unsuspecting in their way.

Symptoms

Sleepwalking involves very complex actions. A wide variety of activities can be carried out, the variance between the individual sleepwalkers is very large. However, there are some typical symptoms of sleepwalking:

  • Change in the state of consciousness (decreased consciousness), especially in the first third of night sleep
  • decreased reactivity
  • decreased dexterity
  • no memory of sleepwalking after waking up
  • expressionless, rigid face, the eyes are fixed straight ahead, the gaze seems to go into space
  • Developing hunger during sleepwalking
  • very rarely aggressive behavior
  • targeted and directed, sometimes complex actions

In a sleepwalking episode, the person concerned first straightens up in bed and repeatedly performs motor movements, for example nibbling on the duvet. In some cases, the episode ends after this without the person getting up. In other cases the sleepwalkers get out of bed, walk around, open closets or doors, leave the room and sometimes the house; even complex activities such as driving a car can be performed. Some sleepwalkers eat during an episode.

During sleepwalking, the eyes are always rigidly open, the face is expressionless, the coordination of movements is poor, and orientation is restricted. Obstacles are often not noticed; You can fall down stairs, but also fall from the balcony or from the window. Therefore sleepwalkers are in principle at risk of accidents. They are approachable and also answer questions, but with indistinct articulation .

Most sleepwalkers return to bed on their own and continue to sleep. After waking up, in most cases they cannot remember anything; In some cases the memory corresponds to that of fragments of a dream . Doctors speak of amnesia .

Aggressive acting out

The theory that people become violent or even kill during a somnambulistic phase is controversial. Such behaviors are possible with REM sleep behavior disorder and are often confused with sleepwalking. The case of the Canadian Kenneth Parks gained particular prominence : he drove 23 kilometers in his car at night and then killed his mother-in-law. When he was clear again, he could not remember anything and was acquitted on the basis of a sleep medicine report .

Treatment and intervention

In the event of an acute episode of somnambulia, the affected person should not be woken up forcefully, as they are very drowsy and drowsy. If a person does not return to bed alone, he should be brought there carefully; Light touching and steering in the right direction can be enough. There is no specific therapy with a reliable prognosis . Most experts advise against medication.

On the history of the study of somnambulism

Armand de Chastenet de Puységur published observations in 1784 on a sleep-like condition that often appeared in the course of mesmeric treatment. He called this artificial state "provoked somnambulism". The real story of hypnosis begins with him . The expressions hypnosis and suggestion were not coined by him, but only in 1843 by the surgeon James Braid (1795-1860) from Manchester. This may seem a curiosity, but the Puységur method was mainly used by surgeons who allegedly achieved freedom from pain in some operations. This method had spread to India. Although Puységur repeatedly referred to his experiences, most recently with a paper on somnambulism that appeared in 1811, his view remained largely ineffective in broader circles. Based on similar concepts of animal magnetic fluid as Mesmer, Tardy de Montravel published an Essau sur la théorie du somnambulisme magnétique in 1785 . With a sixth sense (between the outer five senses and the soul) he explains, among other things, the "magnetic rapport".

Sleepwalking in film, literature and opera

Johann Heinrich Füssli : The sleepwalking Lady Macbeth

Sleepwalking has always been an issue - often in a humorous sense. Bourvil poses in the successful French comedy Drei Bruchpiloten in Paris , also: “The Big Sause” (La grande vadrouille) (1966) sleepwalking to explain his affection to a girl. In Tanz der Vampire (1967), the figure of Prof. Abronsius even constructs an extensive theory of sleeping bats that he was pursuing as an excuse. In the silent film Das Cabinet des Dr. Caligari (1920) uses a sleepwalker as an experimental experimental medium, and in the film Sleepwalker by the Swedish director Johannes Runeborg an architect plagued by sleep disorders finds himself in a nightmarish world in which his family suddenly disappears.

Figure of a sleepwalker as a roof ornament

The sleepwalker motif also appears again and again in literature. In the children 's book Heidi's Lehr- und Wanderjahre by Johanna Spyri , Heidi, plagued by homesickness and loneliness, becomes a sleepwalker. In Sebastian Fitzek's psychological thriller Der Nachtwandler , the wife of the protagonist Leon disappears under inexplicable circumstances, and in the novel Not in a Dream by the writer Robert Kleindienst , the protagonist Simon Selander only gradually becomes aware of his sleepwalking phases, which bring him into threatening situations.

From the year 1843 there is a detailed report about the sleepwalking sister-in-law of the author in the reports from the magnetic sleep life of the somnambula Auguste K. in Dresden .

The phenomenon is also described in Kleist's drama Prince Friedrich von Homburg . The prince sleepwalked through the night and couldn't remember anything afterwards.

Vincenzo Bellini processed the theme in his opera La sonnambula (1831).

See also

Web links

Commons : Sleepwalking  - collection of pictures, videos and audio files
Wiktionary: somnambulism  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ A b Armand Marie Jacques de Chastenet de Puységur : Mémoires pour servir à l'histoire et à l'établissement du magnétisme animal. 1784.
  2. ↑ a b Somnambulism . In: Hermann Samuel Glass pane: The labyrinth of medicine. The wrong ways and triumphs of medicine . 1st edition. Rowohlt, Reinbek near Hamburg 1961; P. 179 ff.
  3. ↑ a b Night walking . In: Wilhelm Karl Arnold et al. (Ed.): Lexicon of Psychology . Bechtermünz, Augsburg 1996, ISBN 3-86047-508-8 ; Sp. 1445 f.
  4. ↑ a b Marquis de Puységur . In: Erwin Heinz Ackerknecht : Brief history of psychiatry . 3. Edition. Enke, Stuttgart 1985, ISBN 3-432-80043-6 ; P. 84.
  5. ↑ NHL: Sleepwalking. Retrieved September 17, 2019 .
  6. ↑ Rosanlind D. Cartwright: The TWENTY-FOUR HOUR MIND . Ed .: OXFORD University Press.
  7. ↑ Sleepwalking from AG Traum of the German Society for Sleep Research and Sleep Medicine (DGSM), glos-berlin.de  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 421 kB)@1@ 2Template: Toter Link / glos-berlin.de  
  8. ↑ Somnambulism and Epilepsy . In: Walter Christian: Clinical electroencephalography. Textbook and old glass . 2nd Edition. Georg Thieme, Stuttgart 1977, ISBN 3-13-440202-5 ; P. 165.
  9. ↑ Philipp Bamberger a . Ansgar Matthes : Seizures in Childhood . Karger, Basel 1959
  10. ↑ Hans Walter Gruhle : Understanding Psychology. Experiential theory . 2nd Edition. Georg Thieme, Stuttgart 1956; P. 304 - on Stw. "Unusual abilities of night walkers"; P. 311 - on tax. "Hypnosis" and "doubling of personality ".
  11. ↑ a b Entry on somnambulism in Flexikon , a Wiki of the DocCheck company , accessed on November 25, 2015.
  12. ^ Uroš J. Jovanović: Somnambulistic psychomotor epilepsy. In: German journal for neurology. Volume 197, Issue 2, pp. 181–191, doi: 10.1007 / BF00242304 .
  13. ↑ Inorganic sleep disorders ICD-10, icd-code.de
  14. ↑ Help, our child sleepwalking, experto.de
  15. ↑ M. Saletu, GM Saletu-Zyhlarz: Sleepwalking, sleep drunkenness and night terrors : the classic NREM parasomnias and their differential diagnosis in adulthood In: Somnologie-Schlafforschung und Schlafmedizin 19 (4) , 2015, pp. 226–232.
  16. ↑ P. Young, G. Möddel: Sleepwalking and other Non-REM Parasomnias . In: Current Neurology 41.04, 2014, pp. 225–236.
  17. ↑ James Braid : Neurypnology; or the rational of nervous sleep, considered in relation with animal magnetism. Illustrated by numerous cases of its successful applications in the relief and cure of disease. John Churchill, London 1843.
  18. ↑ Armand Marie Jacques de Chastenet de Puységur : Recherches, expériences et observations physiologiques sur l'homme dans l'état du somnambulisme naturel, et dans le somnambulisme provoqué par l'acte magnétique. Paris 1811.
  19. ↑ Sabine Kleine: The rapport between animal magnetism and hypnotism. In: Würzburg medical history reports. Volume 13, 1995, pp. 299-330; here: p. 303 f.
  20. ↑ Communications from the magnetic sleep life of the Auguste K. somnambula in Dresden. Dresden 1843, urn : nbn: de: bvb: 12-bsb10287713-0 .