Somnambulism

SOMNAMBULISM (from the Latin somnus—sleep and ambulo—I walk, I stroll), or sleepwalking, is a peculiar disorder of consciousness in which automatism in behavior comes to the fore. In this state, the behavior of the somnambulist outwardly bears individual signs of purposeful actions. Somnambulists, or sleepwalkers, usually perform a whole series of complex acts (climbing on roofs, walking on ledges, climbing trees, etc.), while remembering absolutely nothing about it. Consciousness of these actions is absent in these individuals; they perform all the described acts in a state of a peculiar continuation of sleep. Usually, such individuals, as if suddenly awakening, begin to move automatically, attempt to climb out of a window, descend via drainpipes, etc. Upon waking, they cannot say anything about what happened to them and are surprised by accounts of how deftly and cunningly they acted in the described state. It is generally accepted that somnambulism is one of the specific signs of epilepsy, which until recently bore the name of the "night disease." Indeed, in the majority of cases, an analysis of somnambulism reveals a lesion of an epileptic nature. In this regard, somnambulism is usually considered on the same plane as phenomena of trance and ambulatory automatism (see Epilepsy). However, it should be pointed out that somnambulism as a phenomenon is not inherent only to epilepsy alone. Cases of somnambulism frequently encountered in childhood have a different, non-epileptic nature. Observations have been registered indicating that attacks of somnambulism began after the patient suffered psychological trauma that had the character of shock experiences. In such cases, the child loses sleep and is affectively tense and fearful. To this are added episodic attacks of automatic rising at night and wandering in a sleepy state, with the presence of complete amnesia. In other cases, somnambulism in children manifests as a "neurotic" stigma, as an indicator of hereditary instability of the nervous system, an instability of the mobility type. To this are added additional signs in the form of crying out at night, and occasionally nocturnal enuresis, etc. These "neurotic" stigmata, if epilepsy is excluded, usually fade and may disappear by the period of puberty. The mechanism of somnambulism can be understood from the nature of the disorder of consciousness characteristic of it: the switching off of cortical apparatuses and systems in the presence of the action of subcortical systems and coordination—this is apparently the basis upon which, under the influence of causes still unknown to us, the above-described short-term automatic activity begins to manifest, having no ultimate goal or meaning. Therapy for somnambulism consists first of all in choosing therapeutic agents that act upon the causes of the condition. Since somnambulism is a manifestation of a number of diseases, and primarily epilepsy, the therapy for somnambulism in each individual case follows the corresponding line. In cases where somnambulism is a manifestation of epilepsy, luminal, a starvation diet, bromides with iodine, etc., are indicated (see Epilepsy). In other cases, the use of warm baths, half-baths, etc., before sleep is indicated. This is especially recommended in relation to childhood. It is extremely important in this regard to monitor the state of the intestines and the urinary bladder. In cases associated with general nervousness and lability of the vegetative-vascular system, strict adherence to sleep hygiene is persistently recommended, and above all, the hygiene of the period before sleep (do not eat 3–4 hours before it, air out the room, take a light walk 1 hour before sleep, etc.).

V. Vnukov.