Pathophysiology and treatment of adult somnambulism

Despite almost 5 decades of clinical and laboratory investigations of sleep disorders, relatively little is known about the mechanisms which give rise to sleepwalking (somnambulism) and even less about how to effectively treat the disorder. Sleepwalking occurs in 4% to 17% of children and is far more common in adults (approximately 4%) than commonly acknowledged. Patients suffering from this sleep disorder often consult due to a history of aggressive and/or injurious behaviour during sleep. In a significant number of cases, patients report having suffered serious injuries (e.g., contusions, fractures to limbs, rib cage, multiple lacerations) and/or having attacked a bed partner during an episode. Establishing a correct diagnosis and adequately treating sleepwalking is vital for the patient’s health as well as in light of the growing number of medico-legal cases of sleep-related violence. In most centers, the benzodiazepinic drug clonazepam is used for treatment. A significant proportion of clinicians, however, are reluctant to prescribe daily doses of benzodiazepines over long periods of time due to concerns about drug habituation and potentially harmful consequences of long-term usage. Moreover, many sleepwalkers do not respond to this medication or present side effects. Numerous descriptive studies suggest that hypnosis can be effective in the long-term management of sleepwalking. The first aim of the proposed research is to evaluate the treatment effects of hypnosis on sleepwalking frequency and intensity. A second aim of the proposed research is to elucidate our understanding of sleepwalking by recording sleepwalkers’ brain activity during sleep both before and after a period sleep deprivation. Taken together, these studies should a) lead us to a better understanding of why some people suffer from sleepwalking, b) help identify neurobiological markers of the disorder, and c) guide future clinical treatments.