Cases More Common Among Children : Sleepwalking: A Perplexing Peril

NEW YORK — It is an amazing story: An 11-year-old boy is found walking at night nearly 100 miles from his Illinois home and says he has no idea that he had apparently hopped a freight train in his sleep.

The boy had a history of sleepwalking, his mother told reporters. Most sleep disorder experts said in later interviews that the freight train trip could be another episode, although an unusually long-lasting and intricate one.

Sleepwalking has inspired countless cartoons, at least one movie and even a 19th-Century opera, “La Sonnambula,” about a young maiden who can’t explain to her fiance why she was discovered in another man’s room at an inn.

Real-life cases include the doctor who could not account for his weight gain until he started counting the slices of bread in his refrigerator at night.

“In the morning he was finding five slices missing,” said Dr. Ismet Karacan, director of the sleep disorders center at the Baylor College of Medicine in Houston.

Not Always Amusing

But doctors who treat sleepwalking say it can be far from entertaining.

They see people like the 34-year-old auto mechanic who walked off his second-floor porch and fell 20 feet, fracturing his spine. Or the 20-year-old man who awakened to find himself halfway through a smashed sliding glass door with blood spurting from his wrist.

They see the children who have injured themselves by falling down stairs, or who have been found teetering at the edges of swimming pools.

“Sleepwalking is not a funny story or something innocuous,” said Dr. German Nino-Murcia, director of Stanford University’s sleep disorders clinic.

“Sleepwalking can kill you. You can walk out of a window in a tall building and kill yourself, or kill somebody.”

“The brain really isn’t working when you sleep,” explained Merrill Mitler, research director at the Sleep Disorders Center of the Scripps Clinic and Research Foundation in La Jolla, Calif.

“There’s no notion of right or wrong, or safe and not safe, as far as we can tell. . . . (Some sleepwalkers) go out a window thinking it’s a door.”

In contrast to the train-riding incident in Illinois last month, standard sleepwalking episodes last only about 15 minutes or so and involve routine activities, such as walking from room to room or getting a drink of water.

Episodes occur in the first few hours of the night, during the deepest sleep.

Runs in Families

Sleepwalking runs in families. It appears in an estimated 5% or so of the general population, but the rate for children is 10% to 15%.

“We consider occasional episodes of sleepwalking to be pretty normal in children. . . . For most children, it’s really a benign disorder that goes away with time,” generally by age 15, said Dr. Richard Berlin, director of the sleep-disorders program at Berkshire Medical Center in Pittsfield, Mass.

Children appear to be more vulnerable because their sleep is deeper, and studies suggest that some kind of delayed maturity in the nervous system may lead to their sleepwalking, researcher Dr. Anthony Kales said.

Brain-wave studies also show that sleepwalkers are not acting out dreams, said Kales, director of the sleep research and treatment center at the Pennsylvania State University College of Medicine in Hershey.

Most adult sleepwalkers had childhood episodes. In adult cases, doctors often look for such explanations as stress, psychiatric problems or a side effect of medication.

Sometimes a type of epileptic seizure masquerades as sleepwalking in adults, as with a young schoolteacher who suddenly found herself in a police station, not realizing she had driven 20 miles nude before running a red light.

But such “partial complex seizures” are extremely rare, said Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorder Center at the Hennepin County Medical Center in Minneapolis.

Complex Activities

Sleepwalkers can do relatively complex things. “We’ve had people who have taken screens off their windows, opened their windows and gone out,” said Dr. Michael Sateia of the Dartmouth-Hitchcock Sleep Disorders Center in Hanover, N.H.

One young man repeatedly awoke to find himself in his yard, loading a shotgun from his pickup truck, said Minnesota’s Mahowald. He was successfully treated with hypnosis, Mahowald said.

In very rare cases, a sleepwalker can become violent. One woman whose sleepwalking was triggered by medication stabbed her daughter to death, said Stanford’s Nino-Murcia.

What can be done for a sleepwalker?

If a parent finds a child sleepwalking, the best approach is to gently guide him back to his bed without awakening him, said Dr. Michael Thorpy, director of the sleep-wake disorders center at Montefiore Medical Center in New York.

Awakening a sleepwalker does no harm, but it is not necessary and the sleepwalker often resists, he said.

In general, the first consideration in the care of a sleepwalker is his safety during wanderings, experts say.

Sleepwalkers can sleep on the first floor to prevent falls from upper-story windows. Special latches on outside doors and bedroom windows or a removable tether can foil sleepwalkers, who generally act clumsily.