No bedtime problems are reported. Chris falls asleep fine.
A child who has sleepwalking or night terrors may not have bedtime problems, but it often can occur. Sleep deprivation and irregular sleep schedule can be primary causes of sleepwalking. Additionally, if a patient describes restless leg symptoms (uncomfortable feelings in the legs or arms that affect the ability to fall asleep) or significantly restless sleep, then please refer to the section on restless legs as a sleep disorder. This disorder can also cause sleep deprivation contributing to sleepwalking.
For many families without a regular bedtime routine, it can be difficult to determine if irregular bedtimes are one of the issues contributing to sleepwalking. A sleep diary can be beneficial in tracking sleep pattern and events at night.
Chris shows minor signs of daytime sleepiness – having a hard time getting up some mornings, and some yawning and inattentiveness reported at school.
Usually, daytime sleepiness is not frequently seen unless a child is having daily or weekly sleepwalking. A child with sleepwalking could be sleepy during the day if they are not getting enough sleep, which can be a factor in having more sleepwalking events.
Chris has been seen sleepwalking at night. He goes back to sleep easily and doesn’t remember. Other types of nighttime awakenings are not reported. However, it is important to discuss all types of awakenings at night that a patient could be having including watching TV, snacking, going to caregivers’ room, using the restroom, or other events.
One of the primary features of sleepwalking is that a child leaves the room or at least gets out of bed at night but may not be aware that they are getting up.
Signs & Symptoms Related to Sleepwalking:
- Sleepwalking is a cause for awakening at night
- Often there is a family history of sleepwalking or night terrors
- Child may not remember what happened
- May act clumsy or disoriented or wander in unusual areas
- Awakenings may be triggered by sound, touch, or other stimuli
- Can be related to stress or anxiety
- Usually can go back to sleep well, unless caregiver tries to fully awaken
- Should occur at a fairly predictable time of the night - usually within 30 minutes to 2 hours after falling asleep
- Multiple events per night is unusual but could happen - the timing of these multiple events is important in the overall history taking
Chris has an inconsistent bedtime schedule, going to bed later some nights during the week when he has sports activities and staying up and sleeping in on weekends. Aside from the sleepwalking events, he seems to get enough sleep at night.
This is an important component of the history since it will directly relate to overall sleep quantity. It’s also helpful to track the regularity of sleep in relationship to the known times of sleepwalking. Also, if there is significant difference in total sleep amount on the weekdays versus the weekends, this can be a contributing factor to sleepwalking. For example, a child that goes to bed late on the weekends may have a sleepwalking event on Sunday night, related to not enough sleep on the prior night.
Chris does not show signs of snoring or sleep apnea.
Screening for obstructive sleep apnea is important. Obstructive sleep apnea (OSA) may be related to sleepwalking but usually is not the primary cause. However, if OSA (obstructive sleep apena) is causing poor sleep quality as well as arousals at night, sleepwalking can be noted in these cases.
Questions to ask in regards to obstructive sleep apnea include frequency of snoring, dry mouth on awakening, mouth breathing, appearing to struggle to breath, witnessed apneas or snorting or gasping at night if observed.