Dreamlike Mentations During Sleepwalking and Sleep Terrors in Adults

SLEEPWALKING AND SLEEP TERRORS CONSIST OF A SERIES OF COMPLEX BEHAVIORS THAT ARE INITIATED DURING SUDDEN AROUSALS FROM SLOW WAVE sleep (SWS). Episodes often begin with sitting up in bed and looking about in a confused manner. Sleepwalking and sleep terrors show considerable overlap and share many features. Indeed, at least 1 of the following is present in both of the disorders: (1) difficulty arousing the person, (2) mental confusion when awakened from an episode, (3) complete or partial amnesia for the episode, and (4) dangerous or potentially dangerous behaviors during the episode.1 Both disorders arise from SWS, frequently cooccur in the same family or patient, and have a strong genetic background.2 In contrast with SWS, rapid eye movement (REM) sleep has, for a long time, been considered as the neurobiologic basis of dreaming. Nevertheless, complex mentations are reported in 5% to 74% of non-rapid eye movement (NREM) sleep awakenings.3–8 The extent to which the reported mentation may legitimately be described as “dreaming” is still debated.8,9 Indeed, there are qualitative and quantitative differences between NREM- and REM-sleep dreams. NREM-sleep dreams, especially when elicited during the first half of the night, are usually reported as being shorter, less complex, less vivid, and more “thought like” than REM-sleep dreams.7,10–12 NREM sleep dreams can also be a recollection of the previous REM-sleep dreams. Although there are sporadic descriptions of the mental content associated with sleepwalking or sleep terrors in the literature,13–18 there is a general consensus against a complex dream activity associated with the sleepwalking/sleep terrors.19 Moreover, some authors have proposed that the sleepwalking/sleep terrors is triggered by the physiologic changes occurring during the arousal state (e.g., accelerated heart rate and respiratory changes) rather than by the mental activity preceding the arousal state.20 In a cohort of patients with sleepwalking/sleep terrors, we investigate whether dreamlike mentations are frequent at the very moment of the episode and compare the sleep structure and daytime sleepiness of these patients with those of healthy matched control subjects.