Sleepwalkers Hit Snooze on Pain

Many sleepwalkers who injure themselves during their sleep do not experience pain until the next morning, which may lead them to the pharmacy for OTC pain relief.

Researchers recently compared 100 sleepwalkers with 100 adult controls to analyze disease characteristics, sleep, depressive symptoms, quality of life, and pain, including chronic pain, multidimensional pain inventory, headache, and migraine.

To assess pain perception, the participants were asked to complete questionnaires.

After adjustments, the researchers found that sleepwalking was associated with increased risk for headaches and migraines.

Sleepwalkers with chronic pain were also more likely to have daytime sleepiness, insomnia, and depressive symptoms, according to the researchers.

The sleepwalkers also had more frequent daytime sleepiness, depressive symptoms, and insomnia symptoms compared with the control group, the researchers found.

Two sleepwalker patients met criteria for major depressive disorder, and 1 patient met the criteria for generalized anxiety disorder.

The sleepwalkers involved in the study had a clinical history of sleepwalking with at least 1 episode annually and at least 1 episode in the previous 6 months.

The researchers found that 44 of the 100 sleepwalkers suffered from chronic pain; those patients were more likely to be female, to be older in age, and to have higher daytime sleepiness compared with the controls.

Pain locations varied greatly among the patients, the researchers noted. Head and back were among the most common pain locations for all participants.

The researchers did not uncover any links between chronic pain and body mass index, frequency of sleepwalking episodes, age at onset of sleepwalking, duration of disease, family history, associated sleep terrors, injurious behavior during episodes, total sleep time, sleep efficiency, sleep stage percentages, respiratory events, or periodic limb movements.

About half of the sleepwalking patients reported experiencing at least 1 lifetime injurious sleepwalking episode linked to pain, the authors continued.

The pain woke the patient immediately in only 10 cases, while the other 37 patients who reported at least 1 lifetime painful sleepwalking episode did not feel pain during the episode but felt pain later in the night or the morning after during wakeful periods.

The study participants spent the night in the sleep laboratory to monitor movements; however the researchers did report 2 extreme examples of pain incurred during sleepwalking in previous incidents.

One incident involved a patient jumping out a third-floor window while sleepwalking. The patient sustained severe fractures and did not perceive the pain until being fully awakened.

The other patient climbed onto the roof of his house, fell, broke his leg, and did not wake up until the morning.

Another example was cited by a sleepwalking patient’s wife, who explained that her husband did not wake up or express that he was in pain for several minutes after falling down a staircase during a sleepwalking episode.

“Our results show increased frequency of chronic pain, migraine, and headache together with altered pain perception during parasomnia episodes in patients with sleepwalking, suggesting a relationship between dissociated brain activity and the co-occurrence of local awakenings, local sleep, and nociceptive dysregulation,” the study authors concluded. “We may conclude that greater attention should be paid to assessing pain in sleepwalkers.”

These study findings were published in Sleep.