Sleepwalking, Sexsomnia, Sleep Eating and other Parasomnias (A Better Night’s Sleep Podcast)

Sleepwalking, Sexsomnia, Sleep Eating and other Parasomnias (A Better Night’s Sleep Podcast)


[music]
[Dr. Julie Kinn] This is “A Better Night’s Sleep,” a podcast about sleep, sleep disorders,
and evidence-based treatment from military sleep experts. I’m Dr. Julie Kinn with the Defense Health
Agency and today we are joined again by Col. Brian Robertson at Walter Reed National Military
Medical Center. [Col. Brian Robertson] Hi. How are you doing? [Kinn] [Robertson]
[Kinn] I’m great. Thank you again for joining us. Today we are talking about children and their
sleep issues. Right. And one thing I’m interested in is sleepwalking. Is this a rare condition or something that
you see often? [Robertson] It’s not rare at all. This is the first thing parents should know. Children sleepwalk much more than adults. [Kinn] Really? [Robertson] Yes. So, it’s a problem that almost always if someone’s
sleepwalking is they slept walk as a child. And what you’ll see is that it tends to go
away, usually the beginning of adolescence so around age 13, 14. For children, very common to sleep–
[Kinn] I’m assuming as soon as they’re out of a crib, this is something that we need
to be aware of. How do you know if your child is likely to
be a sleepwalker? [Robertson] Usually, the parents find out
when they hear some noise in the night and they go investigate and they see their child
who is sort of stumbling around. They’re walking but they’re not doing it very
well and then they don’t respond when you call their name. And that’s how you know you have a sleepwalker. [Kinn] Maybe this says more about me as a
parent but if I saw my child out of bed I would just assume they’re trying to sneak
around the house and watch TV. [Robertson] So, it’s not sneaking, first of
all. You should always think about sleepwalking
as sort of an automatic behavior. So, when we sleep, there’s a particular part
of your sleep called “really deep sleep” or sometimes sleep doctors will call it the
“non-REM sleep stage 3 or stage 4,” so it’s really deep sleep. This usually happens in the first third of
the night. And children tend to have a lot more of this
“in-3 sleep” or this “stage 3 sleep” than adults do. So that may be one of the reasons why we see
more sleepwalking is that there’s just more time spent in that deep sleep when sleepwalking
happens. During this time, people do not remember what
happened. So if you wake these patients up and they’ve
been sleepwalking, they’ll be confused, they won’t know where they are, and they certainly
won’t know they’ve been sleepwalking. [Kinn] The safety issues have got to be incredible,
especially for kids in bunk beds and loft beds. [Robertson] Right. So first of all, bunk beds are obviously a
hazard, so a child that sleepwalks should not be in a bunk bed. The second thing is that we might consider
— what we want to do is make it difficult for them to hurt themselves, alright? So, there are various strategies parents have
used from guard rails on the bed that sort of keep the child corralled, which might actually
be enough for some, to some parents will put little child locks on the door of the bedroom. These are the plastic ones, so in an emergency,
any adult can just break it by pushing really hard, but it’s enough to make it hard to open
the door. Baby gates are a really common strategy, probably
more popular than anything else. Usually, parents have a couple of them in
the attic they can pull out again. So they put baby gates up, especially at the
top of stairs. That’s where we really worry about people
getting hurt is that they’ll start sleepwalking downstairs and then stumble and fall. Leaving the house is another issue. [Kinn] Oh my. [Robertson] Yeah, right? So if we have someone that’s sleepwalking,
you obviously don’t want them to leave the house. In fact, we do see children from time to time
in the clinic where the sleepwalking…the parents discover the sleepwalking because
the child’s found outside — asleep or they wake up when they go outside when they’re
asleep. Or they just wake up in the morning because
they decided to lay down in the yard and then they find that they wake up there. Again, these children are moving around and
they’re not under conscious control, so you have to keep that in mind when you approach
a child that’s sleepwalking. [Kinn] That’s my next question for you because
maybe this is a cultural thing but I think in some groups there’s — possibly it’s a
myth — that never wake a sleepwalker, just turn them around and head them back to bed. [Robertson] So, it’s actually more of a danger
for the person doing the waking. And it’s a good rule. It’s a good rule. But the reason it’s a good rule is you can
get hurt. So, remember these people do not know what
they’re doing. The children don’t know what they’re doing
and they can actually flail around. There could be a long period of confusion. The best advice we usually tell parents is
if you see your child sleepwalking in the hallway is to verbally tell them to go back
to bed. Sometimes this works. Sometimes this works. The child knows where the bedroom is. They tend to go back there. Gently guiding them, physically guiding them,
and turning them around and heading them back to bed is generally what we recommend. [Kinn] So if you just say verbally somewhere
in their subconscious that’s kind of like sinking in and they’re understanding that
direction? [Robertson] It’s in there. It’s in there. Parents bring me videos all the time of their
children sleepwalking. You can hear the parents say, “Hey Johnny,
go back to bed.” And the child will sort of stumble, and clumsily
turn around and sort of head back down the hall, the parents will follow them and then
they get back in bed. [Kinn] So if it’s an adult, can you tell them
to go do the dishes? [Robertson] [Laughs] We wish. Unfortunately, we’re not that coordinated,
right? [Kinn] Too bad. [Robertson] So these are basic automatic behaviors,
right? What do humans do, right? These are automatic things. We walk. The other sleep things which I know we’re
going to talk about later, we talk, we eat — that’s another automatic thing that we
do — and even have sex — is another automatic thing. So these are really fundamental, reptile-level
things that humans can do and we can do them without being awake. [Kinn] So we really are talking about just
the basic functions. So sleep talking, is that caused by the same
part of our sleep that causes us to sleepwalk? [Robertson] Right. So, it happens in that ”stage 3 sleep”
or “in-3 sleep” as we call it. It happens in that deep sleep and people sleep
talk. They don’t remember what they said. No recollection of this conversation, sometimes
they can even have quasi-intelligent conversation with the person. They may even answer questions but they don’t
make any sense. They’re not dreaming. It’s not the same thing. We remember our dreams, we don’t remember
these episodes of sleep talking, so not the same thing. I always put it like this: if you have someone
that is having one of these parasomnias like sleep talking or sleepwalking, and they don’t
get out of bed, they’re probably just talking. If they get out of bed, they’re sleepwalking. But there’s not really a functional difference
between the two other than what the patient’s behavior is. [Kinn] And it sounds like there’s probably
not a treatment for the sleepwalking except for just making a safe environment. [Robertson] Exactly. That’s the treatment for it. Sometimes medications can be used but they
are not very effective. You really just need to keep the patient in
their bed. Keep the patient safe if we can. [Kinn] Now what about sleep eating? It strikes me that’s not quite as dangerous
but still not good. [Robertson] It depends. So I’ve had patients try to eat and drink
various substances. So, one patient that kind of alarmed me just
happened recently. It was a 12- or 13-year-old who came in and
had tried to drink nail polish remover from his mother’s nightstand, so they can get themselves
in trouble with sleep eating. Because, you’re not, again, you’re not awake,
you’re just going through the motions of it and you’ll pick up things and try to eat or
drink them. I had one memorable patient who tried to drink
paper. That was the story that she gave us. I had another patient who woke up in the kitchen,
had put some Cheerios on a plate and was pushing them around with a fork. So he wasn’t actually eating them but he was
kind of going through the motions of eating, and the natural things that people do when
they eat. [Kinn] And I had not heard of sexsomnia until
you mentioned that, but I’m guessing that’s, again, part of the same sleep cycle? [Robertson] Right. So this is the same problem. Functionally, the sleep doctors, we think
of it as the same issue as sleepwalking, sleep talking, and eating in your sleep. But sexsomnia or having sex in your sleep
is its own special thing. It can be really embarrassing for patients
to talk about. We often have to ask them. No one really volunteers it very much. But we ask them. When we find a patient that tells us they’ve
been sleepwalking or something like that, we’ll ask about sexsomnia too. [Kinn] That’s got to be something where there
has to be a lot of frank discussion with you and your bed partner. [Robertson] Yes. So the big issue — so married people tend
to do OK with this, especially if they’re happily married. They get it that their spouse is sort of moving
around and pawing at them or something like that. Again, this is just like the sleep eating. They’re not eating well and they’re not having
sex well. There’s thrusting movements but they’re not
taking off their clothes necessarily or sometimes they are. So it’s that kind of thing. It’s clumsy. [Kinn] A partner would understand, “Ok, this
isn’t their normal pattern. I can tell this isn’t them trying to have
sex with me.” [Robertson] The one worry I have about sexsomnia
is that you don’t want to be in bed with someone you don’t want to have sex with when you have
this problem. And this is a big issue with parents and grandparents
in particular. Obviously, you could think that like if something
like this happened with a child in the bed, that family would never get over it. Even if everyone understood that it was sexsomnia,
there’s no coming back from that. [Kinn] Absolutely. And co-sleeping is common. [Robertson] It is. And you have to be careful. If there’s a history of sexsomnia, we warn
our patients very sternly that you shouldn’t get involved with that. The other thing I think I should mention too
is sleepovers with teenagers. So after puberty, this becomes more of an
issue. They have their friends there. And they may get themselves in situations,
especially in group sleepovers, that they really don’t want to be in. [Kinn] Sure. So it sounds like if you are a sleepwalker
or if your adolescent kid is a sleepwalker, then this is an area to start discussing post-puberty,
to be aware that it’s a possibility. If your child is a sleepwalker and they’re
sleeping in the same room as another kid — a lot of our kids share rooms — then it’s
something to have some frank discussions about and possibly consider a different sleeping
arrangement. And maybe passing up on those sleepovers. [Robertson] Maybe so. [Kinn] So what makes these parasomnias more
likely? Are there any predictors? [Robertson] Yes. So there is one important one and it’s a really
common thing: insufficient sleep. So, people that do not get enough sleep tend
to have more of these episodes. Another piece of advice that we give to our
patients with parasomnias is to make sure they get adequate sleep. For adults, that’s 7 to 8 hours a night. For teenagers, it’s about 9 hours a night. And for children that are younger, it goes
up from about 9 to 12 hours depending on their age. [Kinn] Interesting. I guess it’s not easy but that’s another controllable
thing we can do in addition to making a safer environment in prevention is just making sure
they’re getting enough good, high-quality sleep. [Robertson] Absolutely. That’s correct. [Kinn] It also strikes me that in our previous
episode when we talked about allergies and sleep apnea that, again, those kinds of issues
are also going to affect quality of sleep, which can lead to sleep deprivation and more
fatigue. [Robertson] Right. So all these things play into each other. So, sleep medicine is pretty interesting because
it’s very narrow in that it’s focused on sleep, but also very broad in that there’s lots of
factors that can come into play here. So, if you have a patient with parasomnias
and they have untreated allergic diseases, for instance, they may have more parasomnias
when their allergies are bad and less when they’re better. If you take a teenager doing all-nighters
to study for finals, more likely to have parasomnias. So, that insufficient sleep’s important. [Kinn] Well, thank you so much for helping
us understand more about it. Again, it’s always a pleasure to have you
on the show. [music]
[Robertson] All right. Thank you. [Kinn] “A Better Night’s Sleep” is produced
by the Defense Health Agency. Please get in touch with us on Facebook and
Twitter @MilitaryHealth. Thank you so much for subscribing and rating
us on iTunes or whatever it is you listen to podcasts. Please consider sharing us with your friends,
your network. We would love to be able to share this information. And send us your questions. And we hope you have a better night’s sleep. [music]

Leave a Reply

Your email address will not be published. Required fields are marked *