Nocturnal Wandering is Associated With Conditions Other Than Sleepwalking
Mark R.Pressman, Director, Sleep Medicine Services, Lankenau Medical Center[email protected]
Submitted August 06, 2012
As noted by the Ohayon et al. [1], nocturnal wandering (NW) is not synonymous with sleepwalking. NW may also refer to wandering during the night due to epilepsy. Alcohol intoxication is well known to result in drunken behavior while awake but this type of cognitive impairment may be undistinguishable from other forms of NW. Dementia and CNS drug effects can also result in NW.
Alternate explanations of the data are available. The highest OR for NW reported was for obsessive compulsive disorder (OCD). OCD has no known relationship to sleepwalking, nor are there any published reports.
However, SSRI medications used to treat OCD are well known to increase tonic EMG levels during REM sleep and are thus most likely associated with REM behavior disorder, not sleepwalking. [2] Sleepwalking is typically associated with amnesia and has a familial pattern, but this is also true of alcoholism.
Ohayon et al.'s study does not provide any direct evidence to support the claim that alcohol causes sleepwalking. Rather there is an association of NW with individuals who report alcohol abuse in their past. Causation for
individual subjects cannot be determined from these data. There has never been an empirical, laboratory-based study of alcohol use in clinically diagnosed sleepwalkers. [3]
1. Ohayon, MM, Mahowald MW, Duavilliers Y, Krystal AD, Leger D. Prevelence and comorbitity of nocturnal wandering the US adult general population. Neurology 2012:78;1583-1589.
2. Schenck CH, Mahowald MW, Kim SW, O'Connor KA, Hurwitz TD. Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep 1992;15:226-235.
3. Pressman MR, Mahowald MW, Schenck CH, Cramer Borneman MA. Alcohol- Induced Sleepwalking or Confusional Arousals as a Defense to Criminal Behavior: Review of Scientific Evidence, Methods and Forensic Considerations, Journal of Sleep Research 2007;6:198-212.
As noted by the Ohayon et al. [1], nocturnal wandering (NW) is not synonymous with sleepwalking. NW may also refer to wandering during the night due to epilepsy. Alcohol intoxication is well known to result in drunken behavior while awake but this type of cognitive impairment may be undistinguishable from other forms of NW. Dementia and CNS drug effects can also result in NW.
Alternate explanations of the data are available. The highest OR for NW reported was for obsessive compulsive disorder (OCD). OCD has no known relationship to sleepwalking, nor are there any published reports. However, SSRI medications used to treat OCD are well known to increase tonic EMG levels during REM sleep and are thus most likely associated with REM behavior disorder, not sleepwalking. [2] Sleepwalking is typically associated with amnesia and has a familial pattern, but this is also true of alcoholism.
Ohayon et al.'s study does not provide any direct evidence to support the claim that alcohol causes sleepwalking. Rather there is an association of NW with individuals who report alcohol abuse in their past. Causation for individual subjects cannot be determined from these data. There has never been an empirical, laboratory-based study of alcohol use in clinically diagnosed sleepwalkers. [3]
1. Ohayon, MM, Mahowald MW, Duavilliers Y, Krystal AD, Leger D. Prevelence and comorbitity of nocturnal wandering the US adult general population. Neurology 2012:78;1583-1589.
2. Schenck CH, Mahowald MW, Kim SW, O'Connor KA, Hurwitz TD. Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep 1992;15:226-235.
3. Pressman MR, Mahowald MW, Schenck CH, Cramer Borneman MA. Alcohol- Induced Sleepwalking or Confusional Arousals as a Defense to Criminal Behavior: Review of Scientific Evidence, Methods and Forensic Considerations, Journal of Sleep Research 2007;6:198-212.
For disclosures, contact the editorial office at [email protected]