Sleep Disorders

Sleep talking/walking

07/27/2005

Question:

I have always talked and walked in my sleep. Never walked out of bed or anything but would sit up, look around and lay back down. Here recently though, my wife says my talking is very clear, loud and usually VERY vulgar. She says I am usually talking to her, saying her name and then just completely verbally bashing her. The things I am saying are generally exactly opposite of how I feel about her. She says she knows that is not really "me" talking and that it doesnt bother her very much. What does bother her and I, is the very first time it happened she said I was asleep and wanted to have sex with her, she said she told me NO because I was asleep. She said at that point I got very angry and physically violent. I saw the bruises on her legs the next day. I have absolutely no memory of this but this is unacceptable behavior and I want to fix whatever is wrong. I mentioned it to my DR. and he said it was just stress related and would pass. What should I do? I included my e-mail address in the optional area to recieve a notice when this question is answered. If you have access to my e-mail address and would like more specific details feel free to write. Thanks.

Answer:

Sleep talking, also known as somniloquy, and sleepwalking, also known as somnambulism, are not an uncommon problems, especially in children. While we don't know exactly how common talking in sleep is, it has been found that sleepwalking occurs in somewhere around 1-15% of the general population with a peak occurrence somewhere between the ages of 4 and 8. The causes of sleep talking and sleepwalking are not entirely known. Much of the time, the cause of these sleep behaviors can not be linked to any identifiable underlying problem or disease. And in most cases, the problems are not serious and tend to resolve over time or with age. However, for those that experience sleepwalking, many factors may predispose to its development and it may be a symptom of another primary sleep disorder.

Factors that may result in sleepwalking or worsen the condition in those who have the diagnosis include certain medications (especially some the drugs used to treat psychoses), fever, lack of sleep, loud noises and even a distended bladder. Other primary sleep conditions that may have sleepwalking as a symptom include obstructive sleep apnea, REM behavior disorder, sleep-related epilepsy and the nighttime sleep eating syndrome. Of interest, sleepwalking tends to occur more commonly in those who have a family history of sleepwalking.

The problematic sexual behavior you mention in your question may be associated with your history of sleep talking and sleep walking. This type of behavior, while uncommon compared to other sleep disorders, is gaining increasing recognition as more cases have recently been reported in the medical literature. It often is described as "sleep sex," though some authorities have recommended the term "sexsomnia," which may better describe its potential underlying causes. Because this type of behavior is not very common, there is not a lot of literature on it. It is believed that for most patients with this problem, it represent a form of a parasomnia, or abnormal behavior in sleep (sleep talking and sleepwalking also fit into this category).

Types of sexual behavior reported during sleep have included violent masturbation, sexual assaults, and continuous and loud sexual vocalizations. Individuals tend to have no recall of the events upon awakening in the morning. Potential causes of this type of behavior have been found to range from obstructive sleep apnea to a specific type of seizure disorder (epilepsy) to deep sleep (slow wave sleep) parasomnias to REM behavior disorder.

It is unlikely this is related primarily to stress. To determine if there is an identifiable cause for your problem, a thorough history and physical examination are needed. This should ideally be performed by someone trained in sleep medicine and obtaining a referral to a Sleep Specialist from your primary care physician is a good idea. Once a history and physical examination have been performed, the sleep physician will likely recommend further evaluation by a sleep study, which is usually necessary to determine the presence or absence of the conditions mentioned above. Specific treatments for each condition are available and will depend upon the results of the evaluation.

While awaiting further evaluation, which I strongly recommend, you should consider sleeping in a separate bed from your spouse. This will help to prevent potential relationship problems and/or physical harm from occurring until a treatment plan can be instituted. In addition, some general guidelines for helping to protect sleepwalkers are as follows:

Remove dangerous, sharp or pointed objects from the room.

Consider adding locks to the windows and doors.

Put heavy drapes in front of windows and glass doors.

Gently attempt to guide the sleepwalker back to bed without waking them.

AVOID strong stimuli - this could cause aggressive behavior.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need be.

Good luck and here's to better sleep!

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Response by:

Dennis Auckley, MD
Director, MetroHealth's Center for Sleep Medicine
Associate Professor
Division of Pulmonary, Critical Care and Sleep Medicine
MetroHealth Medical Center
School of Medicine
Case Western Reserve University