neurologic disorders
Parasomnias
Somnambulism
Sitting, walking, or other complex behaviors occur during sleep, usually with the eyes open but without evidence of recognition. Somnambulism is most common during late childhood and adolescence and occurs after and during arousal from nonrapid eye movement (NREM) stage N3 sleep. Prior sleep deprivation and poor sleep hygiene increase the likelihood of these episodes, and risk is higher for 1st-degree relatives of patients with the disorder. Episodes may be triggered by factors that cause arousals during sleep (eg,caffeine, other stimulant drugs and substances, behaviors that disrupt sleep) or that enhance N3 sleep (eg, prior sleep deprivation, excessive exercise). Patients may mumble repetitiously, and some injure themselves on obstacles or stairs. Patients do not remember dreaming after awakening or the following morning and usually do not remember the episode. Treatment of somnambulism is directed at eliminating the triggers for these episodes. It also involves protecting patients from injury—eg, by using electronic alarms to awaken patients when they leave the bed, using a low bed, installing door alarms, and removing sharp objects from the bedside and obstacles from the bedroom. Occasionally, patients are advised to sleep on mattresses on the floor. Benzodiazepines, particularlyclonazepam0.5 to 2 mg orally, at bedtime can help if behavioral measures are not completely effective, but these drugs have significant adverse effects. 