A Case of Sleep Terrors with Sleepwalking Whose Therapeutic Effect by the Kampo Medicine Shokenchuto was Confirmed by Overnight Polysomnography / 日本東洋医学雑誌

We report a case of sleep terrors complicated with sleepwalking. The patient was 9-year-old boy who suddenly woke up, walked, or screamed in his sleep. These symptoms were sometimes induced by such as fever elevation or school events. In order to prevent injury while sleeping, he was suggested taking medicine to suppress the nocturnal behavior. After taking shokenchuto based on his findings of qi deficiency, the episodes gradually disappeared and the frequency of fever elevation decreased. In this report, we present the improvements of sleep parameters provided by overnight polysomnography, performed before and after treatment. Shokenchuto is known as one of the curative medicines for sleep terrors, but this is the first report showing objective therapeutic effects using overnight polysomnography.

A Case of Re-Emergent Sleepwalking in Adulthood, Primed by Sleep Deprivation and Triggered by Sleep Apnea

Non-rapid eye movement sleep parasomnias including sleepwalking tend to disappear spontaneously during late childhood and adolescent period. Sleepwalking is not as common in adults as in children. Sleepwalking in adults could happen with triggering factors such as hypnotics or metabolic derangement including hypoglycemia. We report a case of an adult patient with recurrent, frequent sleepwalking and complex motor behaviors during sleep in his mid- twenties after spontaneous remission of sleepwalking in the childhood. The triggers were severe sleep deprivation and obstructive sleep apnea. No more sleepwalking was reported after the treatment of sleep apnea by tonsillectomy.

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation / Medicina do sono Forense: uma revisao critica da literatura e breves comentarios sobre a situacao brasileira

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.

A medicina do sono é um campo relativamente novo dentro das Ciências Médicas. Seus aspectos legais encontram-se ainda na obscuridade, seja por falta de conhecimento dos mecanismos biológicos do desenvolvimento dos transtornos de comportamento e da violência praticada em estados alterados de sono, seja por virtual ausência de previsão legal do binômio tratamento/punição. Realizamos revisão atualizada da literatura para determinar as condições patológicas mais prevalentes envolvendo violência e sono, identificar seus fatores precipitantes mais comuns e os critérios médico-legais que podem auxiliar eventuais médicos-peritos ou assistentes na elaboração de pareceres abalizados em âmbito legal.

Sleep-Related Eating Disorder / 수면정신생리

Sleep-related eating disorder (SRED) is a newly recognized parasomnia that describes a clinical condition of compulsive eating under an altered level of consciousness during sleep. Recently, it is increasingly recognized in clinical practice. The exact etiology of SRED is unclear, but it is assumed that SRED might share features of both sleepwalking and eating disorder. There have been also accumulating reports of SRED related to the administration of various psychotropic drugs, such as zolpidem, triazolam, olanzapine, and combinations of psychotropics. Especially, zolpidem in patients with underlying sleep disorders that cause frequent arousals, may cause or augment sleep related eating behavior. A thorough sleep history is essential to recognition and diagnosis of SRED. The timing, frequency, and description of food ingested during eating episodes should be elicited, and a history of concurrent psychiatric, medical, sleep disorders must also be sought and evaluated. Interestingly, dopaminergic agents as monotherapy were effective in some trials. Success with combinations of dopaminergic and opioid drugs, with the addition of sedatives, has also been reported in some case reports.

Prevalence of Sleepwalking in an Adult Population

Background: Sleepwalking consists of a series of behavioral activities that occur during sleep. These activities may be simple; complex or aggressive in nature. They include motor activities; confusion; and amnesia for the events. Sleepwalking is a disorder of arousal from non-rapid eye movement (NREM) sleep. In children; episodes of sleepwalking are rarely violent; in adults; however; sleepwalking might include violence; which could endanger the patient or others and might precipitate legal issues. There is inadequate information on the prevalence and demographic correlates of sleepwalking in Nigeria. Objectives: One objective of this study was to determine the lifetime prevalence rate of sleepwalking in an adult population in Ile-Ife; in Southwestern Nigeria. Another objective was to determine the age and sex distribution of sleepwalking among those who have experienced it at least once in their lifetime. Materials and Methods: A random sample of 228 healthy individuals aged 18-60 years was obtained and the members were asked to fill out a survey form about lifetime prevalence rate of sleepwalking. Results: The overall lifetime prevalence rate of sleepwalking was 7(16 of 228 participants). It was 10.4in males and 3.5in females; but the difference was not statistically significant (p=0.07). Conclusion: This study has shown that sleepwalking is common in the population. In view of the psychological effects of sleepwalking and the potential physical and legal problems associated with it; adequate efforts should be made for early detection and prompt management of the condition

A Case of Sleepwalking Disorder Treated with Kanzo-shashin-to / 日本東洋医学雑誌

The effectiveness of Kanzoshashin-to on sleepwalking disorder is reported here. The patient was a 60-year-old male, who worked as a company employee. His main complaint was shouting, jumping out of bed and running around the room when he was in an unconcious sleep state. There was no notable related family history. He had had surgery for a herniated lumbar disk in 1971. His present condition began in about 1984, but no measures were taken at that time. In 1989, he underwent various tests at a local clinic and at the psychiatric department of a general hospital, but no definitive diagnosis was given. He received tranquilizers, which temporarily lessened the condition, but the effects were not lasting. The symptoms were still present at the time of a reexamination at his company clinic on February 2nd, 1994. Kampo abdominal diagnosis revealed the abdominal signs ‘shinkahiko’ and ‘Kyokyokuman, ’ or fullness and resistence in the upper abdomen and hypochondrium. Kanzoshashin-to was given on February 16th. One week after commencement of administration, the symptoms gradually improved, and he stopped shouting, running around and throwing things in a sleep state.