Sleep disorders: somnambulism

By Cristiano Antonino On Nov 22, 2022

Let’s talk about somnambulism. One of the most important acquisitions of modern neuropsychopathology since its beginnings lies in the distinction between the analysis of form and that of content, observing the apparently abnormal behaviour of individuals

Hence the fact that any human activity can only be identified as pathological if certain expressive contents of its behaviour can be framed within an altered mode of expression.

To take an example, the statement ‘my wife is cheating on me’ could just as easily be the lucid ascertainment of a more or less evident reality as the delusional content of a paranoiac.

The ability to distinguish, on the part of the clinician, does not consist at all in actually establishing what the suspect spouse’s degree of fidelity is (for otherwise psychiatrists would constantly have to make use of investigative agencies), but rather in the search for general behavioural signs exhibited by the supposed patient that would lead to framing the statement ‘my wife is cheating on me’ within a delusional content.

This metaphor is a classic in the teaching of general psychopathology in universities, which usually ends, to the laughter of the student audience, in the realisation that the poor patient may eventually find himself in the dual position of madman and cuckold anyway.

Paroxysmal sleep behaviour disorders: somnambulism

Somnambulism, classified as a paroxysmal sleep behaviour disorder (paroxysmal means that the phenomenon has a sudden and abrupt onset as well as equally abrupt disappearance) is considered a benign developmental disorder, usually beginning around the age of 5-8 years and lasting no longer than the transition to adolescence.

It is considered benign because it is not associated with any other pathological manifestation, because it generally disappears with development and because no associations have been demonstrated between sleepwalking and the development of subsequent degenerative brain events.

The characteristic that has made somnambulism so popular in popular culture lies in the fact that we are all led to believe that the sleep state is connected with motor immobility, muscle relaxation and loss of consciousness.

Sleepwalking between myths and reality

The fact that a sleeping person gets out of bed and wanders around is certainly an impressive experience, which has clearly ignited multiple millenarian fantasies about its causes, fantasies as usual mortified by the advent of Western scientific medicine that has proselytised them to matters of biochemistry and electroencephalographic signals.

It seems that sleepwalkers do not do all these wanderings: they generally limit themselves to producing motor automatisms while sitting on the bed.

To bring this tedious aspect of the problem to a quick conclusion, I refer readers to the journalistic disclosures on REM sleep, on which I have little of interest to add.

Instead, I, too, have read in PUBMED (the scientific source on which we modern-medicine geeks go to scribble) about people who have been made the subject of interest because they were caught sending e-mails in a state of sleep.

Somnambulism and sleep texting

I looked for traces of an evolution of the phenomenon from the somnambulic production of text messages to the production of e-mails, but I found no great disturbance in the scientific world about this change of computer vector.

Perhaps the effort of turning on a mobile phone, accessing ‘send sms’ mode and typing the message is not that dissimilar to that of turning on a PC, going to e-mail and clicking on ‘send message’.

Honestly, it seems to me that the sequentiality of actions is comparable to that of – going down to the garage, starting the car, aiming at the mother-in-law who is watering the cyclamens and putting her under with a grin on her mouth.

So, I come back to the introduction of the problem: keeping two distinct aspects of human behaviour, i.e. the one pertaining to form and the one pertaining to content, separate without attempting to integrate them, runs the risk of causing major problems of interpretation.

If the content of the text message (or e-mail) is: “dear let’s meet tonight anyway your husband is sleeping”, I would say that the person who ‘thinks wrongly’ will tend to shift the general meaning of the event quite a bit, even assuming that the sender of the message is apparently in REM sleep phase.

The dear fellow researchers whose article I found relevant do not mention the contents of the messages sent by sleepwalkers.

They attached great importance to the formal fact of the event: they were sleepwalking patients, the phenomenon occurred during REM sleep.

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