What other conditions will my doctor consider before diagnosing sleepwalking?
Sleepwalking, night terrors, and confusional arousals are all related, common non-REM sleep disorders that tend to overlap in some of their symptoms. Approximately 15%-20% of young children through mid adolescence will experience some or all of these behaviors. Moreover, seizures occurring during sleep (nocturnal seizures) can cause movement disorder during sleeping.
Night terrors: Like sleepwalking night terrors tend to occur during the first half of a night's sleep - often within 30 to 90 minutes from falling asleep. Also like sleepwalking, they occur during stage 3 of sleep. However, unlike sleepwalking, an individual with night terrors will portray a sudden and often agitated arousal that may appear to parents as violent and terrified behaviors.
Night terrors often start during the toddler years with peak incidence between five and seven years of age. During these times evidence of a surge in autonomic nervous system activity is evident. Accelerated heart and respiratory rates, dilated pupils, and sweating are characteristic.
Triggers for night terrors may include sleep deprivation, stress, medications (stimulants, sedatives, antihistamines, etc). Unlike sleepwalking, episodes of night terrors may recur for several weeks in a row, abate completely, and later return.
Confusional arousals: Similar to night terrors, confusional arousals are characterized by a sudden and violent arousal from sleep with behaviors described as agitated and semi-purposeful in pattern. Speech is generally coherent (unlike sleepwalking). A distinguishing point between night terrors and confusional arousals is the lack of autonomic nervous system (accelerated heart/respiratory rates, dilated pupils, sweating) phenomena in the latter. Confusional arousals tend to occur during the first half of a night's sleep (during stage 3). They are characteristically short-lived, lasting 5 to 15 minutes but can last up to 30 minutes in duration. Amnesia for the event is characteristic.
Nocturnal seizures: Several important differential points help delineate the above three sleep behaviors from seizure activity. Seizures by their nature are very brief, often lasting only a few minutes. In addition, seizure events are likely to be confused with the above; and are characterized by a series of repeated, stereotypical, and frequent behaviors occurring in clusters. Moreover, seizures more commonly occur in the second half of the night's sleep. Patients often will have postictal (symptoms after the seizure) complications such as headache, extreme grogginess, hard to arouse, as well as incontinence of urine and stool. To assist in establishing a correct diagnosis a neurologist may perform a video-EEG study to help clarify the issue.