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Sleepwalking During Pregnancy – Causes and Risks

Sleep is a dynamic process as our brains are active even during sleep. For normal functioning of all the systems of our body, sleep is very important. Sleep affects our physical and mental health. Our immune system has the ability to fight disease and endure sickness all due to the impact of good sleep that affects our immune system.

If you are deprived of sleep, you will see a decrease in your body temperature, in the release of growth hormones and a decrease in the functioning of your immune system function as measured by white blood cell count (the soldiers of the body).

What is Sleepwalking?

Sleepwalking is a complex yet interesting sleep disorderknown as ‘Somnambulism’ or ‘Noctambulism’, and belongs to the parasomnia family.

9 Causes of Sleepwalking:

Studies show that, in humans, the metabolic activity of the brain decreases significantly after 24 hours of sustained wakefulness. Lack of sleep makes a person drowsy and unable to concentrate on anything the next day leading to disorientation and impairment of memory and physical performance. Hallucinations and mood swings may develop if you continue to have episodes of wakefulness.

Therefore, over exertion, fatigue, lack of sleep and insomnia can trigger sleepwalking episodes. In addition, stress and anxiety, sleep apnea, restless legs syndrome, snoring, need to pee frequently in the night, acid reflux, nausea, shortness of breath and physical discomfort, all contribute to sleep disturbances that result in sleepwalking. 

8 Stages of Sleep:

There are 5 stages of sleep. Stages I, II, III and IV are characterized as non-rapid eye movement (non-REM) sleep. Stage 5 is REM (rapid eye movement) sleep cycle associated with dreaming. These stages progress cyclically from stage I through to stage REM and then back with stage I.

Each sleep cycle (stages I-IV, and REM) lasts about 90-100 minutes and repeats throughout the night.All through the night, we tend to go through different stages of sleep in approximately 90 minute cycles. Usually we fall into deep sleep/delta sleep (non-REM sleep) soon after the onset of sleep and into REM sleep towards dawn.

The first sleep cycle each night has a relatively short REM sleep and long periods of deep/delta sleep; but later in the night REM sleep lengthens and deep/delta sleep time decreases. 

The average person experiences four to five complete sleep cycles per night.

Stage I is a light sleep where you drift in and out of sleep and can be awakened easily. In this stage, the eyes move slowly and many people experience sudden feeling of falling down the heights followed by twitching of muscles.

In stage II, the eye movement stops and the brain waves slow down.

Stage III sleep is known for surges of important hormones essential for proper growth and metabolism.

In stage IV, the brain exclusively produces delta waves.

Stages III and IV are referred to as deep or delta sleep, and it is very difficult to wake someone who is in this stage of sleep. This is when some adults and children and especially pregnant women experience sleepwalking.

Due to the short time frame involved, sleepwalking does not tend to occur during naps.

During our non-REM sleep (delta sleep – stage III and IV), abnormal events like non-REM parasomnias occur during sleep. Non-REM parasomnias often run in families and it causes: confused arousals, night terrors, sleep talking, sleep walking, sleep eating and drinking.

Non-REM parasomnias often take place in the first third of the night, and maybe triggered by lack of sleep, stress, fever, etc. In such episodes, on being woken, you may remember a nightmare where you are being chased or attacked.

In the REM stage of sleep, breathing becomes more rapid and irregular, heart rate increases, blood pressure also rises and this is the stage where most of our dreams occur. If awakened during REM sleep, you can remember the dreams. You may experience 3 to 5 intervals of REM sleep each night.

There are parasomnias that occur during every phase of sleep. Those which take place during the deepest stages of sleep will often involve some type of behavior that may be harmful or even violent. Some of these disorders seem to run in families. Some seem to be brought on by certain anti-depressants and others by neurological disorders.

7 Factors that Trigger Sleepwalking:

Factors that seem to be associated with sleepwalking, factors that trigger sleepwalking are genetic, environmental, physiological and medical.

Genetic Factor: Sleepwalking occurs more frequently in identical twins, and is 10 times more likely to occur if you have a history of sleepwalking.

Environmental Factors: Chaotic sleep schedules, lack of sleep, fever, stress, anxiety, magnesium deficiency and intake of alcohol can trigger sleepwalking.

Intake of particular drugs like: sedatives/hypnotics (to promote sleep), neuroleptics (for treating psychosis), minor tranquilizers (to have a calming effect), stimulants (to increase activity), and anti-histamines (to treat symptoms of allergies) can cause sleepwalking.

Physiological Factors: The physiological factors that trigger sleepwalking are:

Conditions such as pregnancy and hormonal changes are known to increase the frequency of sleepwalking;

Associated medical conditions;

Increased depth of Slow-wave Sleep;

Abnormal Heart Rhythms;

Fever;

Anxiety and Fear

Acid reflux;

Obstructive Sleep Apnea;

Restless Leg Syndrome; and/or

Stress or panic attacks, or dissociative states (for example, multiple personality disorder).

Medical Factors:

  • Certain types and class of medicines like anti-anxiety, sleep-inducing drugs, anti-histamines, anti-arrhythmic heart drugs and/or some stimulants are also supposed to trigger sleepwalking episodes in some individuals.

6 Symptoms of Sleepwalking:

Most people cannot tell when they themselves or others have been sleepwalking, but some of these symptoms are clues of what to look for. Sleepwalkers make odd movements. May get up and seek out of a window or door. So if you hear something at the window or door, it's either you or your loved one.

They will get up and walk quietly but aimlessly around the room or house maybe talking or mumbling incoherently. A lot of times, sleep walkers act out their dreams, which is why they may seem clumsy, dazed and fumble around objects.

Have you noticed any of these nighttime behaviours?

If you look into their eyes and the eyes seem wide open with a glassy look to them, they're most likely sleep walking. Sleepwalkers respond slowly with simple thoughts and may contain nonsense phraseology or absent responses when questioned what they are doing.

Sleepwalking episodes may repeat behaviours over and over, and/or even result in the sleeper having a temper tantrum, throwing objects.

5 Sleepwalking in Pregnant Women:

As many as 78% of women report more disturbed melatonin levels too are higher during pregnancy, and increased levels of prolactin in the body may all lead to more delta or slow-wave sleep.

Sleepwalking consists of a series of complex behaviors that are initiated in non-REM slow wave sleep at the onset of your sleep cycle and result in walking during sleep. This sleep disorder occurring during pregnancy and exacerbated by this condition has been reported by many a pregnant women.

Pregnant women (or as such any adult or child) with sleepwalking disorder may wander aimlessly or actually perform complex actions that often make no sense. Sleepwalking may halt/cease automatically or as a sleepwalker you may return to bed, oblivious to the fact that you left it in the first place. You get up in your sleep and sit up in the bed, you may walk around and then fall into a light stage of sleep.

Sometimes you may walk to the bathroom, or start cleaning, or do something as hazardous as cooking, driving, grabbing some object or even commit homicide,you may go to another part of the house or even outside.

It is not uncommon for you as a sleepwalker to mumble or seem to even carry on a conversation, but upon waking up, mostly you may not recollect even the conversations you may have had with any of the members in your house during this episode, though you may appear to be somewhat aware of it. Like many sleepwalkers, you will go back to bed or simply lie down in another location in the home.

You may, as a sleepwalker, appear placid to those who observe you, and at times appear with a blank face, unresponsive to efforts made by your near and dear ones to communicate with you. For many others, it is common to be awakened by a bed partner, roommate, or family member.

Episodes of sleepwalking usually last from one to five minutes, but may last as long as one hour. Behavior can range from simply sitting at the end of the bed, to leaving the room or going outside, to getting in the car or even doing a more complicated activity such as preparing a meal.

4 Risk Factors of Sleepwalking:

Many pregnant sleepwalkers have narrated their strange yet unique experience of waking up during their sleepwalking episodes. They often describe a dream that they were actually acting out in sleep, i.e. opening a door, dancing, or getting dressed.

Many a times, if somehow interfered, sleepwalkers do become irritated, and have tried to eliminate the obstacle. This usually happens when a sleep partner or family member attempts to wake a sleepwalker, which results in the sleepwalker becoming disoriented. Sometimes an individual can become quite agitated during sleepwalking without external intervention. Violent or aggressive behavior may result from the dream scenarios that govern many sleepwalking episodes.

In its most severe form, sleepwalking episodes can take place almost every night and those of you who are affected can be prone to physical injury. Falls and injuries may occur if the person walks into dangerous situations, like out of a door and into the street or through a window.

You can do strange things in your sleep

A few pregnant women have said that they had a fall during one of their sleepwalking episodes and have had either fractured their hand or badly hurt their big toe, without even realizing that they had hurt themselves. So such episodes can be risky if you are pregnant and have a fall. Because after such an episode of sleepwalking, when asked, they do not remember being conscious as they might be in a dream but acting it out in real.

As a result of such episodes, pregnant sleepwalkers tend to feel embarrassed, anxious, and confused to learn about their nightly sleepwalking. And hence this goes unreported and undiagnosed.

Pregnant women who frequently sleepwalk complain of fatigue, decreased awareness, and unrest during the day.

Sleepwalking, like other sleep conditions often affects others. It causes a major disruption to family life and can cause a great deal of distress for those who suffer from them. 

3 Treatment:

A pregnant woman who has a sleepwalking disorder can take the following measures to be safe around the house by doing a little Self-care at home. This can include simple measures like getting adequate sleep and avoid fatigue or insomnia.

There are things she could do while she's awake to help avoid stress and anxiety that could cause her sleep walking by meditating or doing relaxation exercises. By learning how to relax she should be able to minimize the amount she sleep walks.

Furthermore if she avoids any kind of stimuli (auditory or visual) prior to bedtime that might heighten her awareness or cause her anxiety or stress she will likely be able to relax well enough to rest all night long without any sleep disturbances.

If sleep walking keeps happening, she can keep herself safe in her house by taking the following measures:

Keep a safe sleeping environment, free of harmful or sharp objects;

Sleep in a bedroom on the ground floor if possible to prevent falls;

Lock the doors and windows;

Remove obstacles in the room that are potential hazards;

Cover glass windows with heavy drapes;

Avoid the use of alcohol and any kind of depressants; and

Place an alarm or bell on the bedroom door and if necessary on any windows to warn you.

2 Medical Treatment:

Some drugs can be prescribed for sleepwalkers, such as a low dose of benzodiazepines, clonazepam, and tricyclic antidepressants. But pregnant women who has this disorder should not take these medications without consulting her obstetrician.

If sleepwalking is caused in pregnant women by underlying medical conditions like insomnia, sleep apnea, restless leg syndrome, stress, and acid reflux; then she should get herself treated first for these underlying medical condition.

Another good remedy would be try ‘Anticipatory Awakenings’. This remedy consists of waking the sleepwalker approximately 15-20 minutes before the usual time of her sleepwalking episode, and then keeping her awake through the time during which the episodes usually occurs.

Hypnosis has also been found as a helpful treatment for somnambulism.

There are conflicting viewpoints on whether it is harmful to wake a sleepwalker. Some experts say that sleepwalkers should be gently guided back to bed without waking them. Others counter that idea and state that waking a sleepwalker may result in their disorientation, but it is not harmful.

Sleepwalking for the most part is harmless and natural part of life. Pregnant women who experience sleepwalking tend to do so because of lack of sleep or is under heavy stress and anxiety. Once stress levels come down, you will notice that sleepwalking episodes disappear.

Also, on the positive note, many of the difficulties and problems caused by disrupted sleep during pregnancy gets resolved quickly once the baby is born.

More research is needed to document the concurrence of sleepwalking during pregnancy as this kind of negative impact due to sleep deprivation during pregnancy is under-recognized by both patients and the physicians.

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