Keywords: Sleepwalking, mental illness, parasomnia, non rapid eye movement, Ogun Oru, stress, sleep deprivation, neurotransmitters, Mens rea, Actus reus, automatism, Nigeria.
Sleepwalking and Mental Illness in Nigeria. What is sleepwalking all about? Is it a spiritual matter as many Nigerians see it, or is it a form of mental illness? Are there legal implications to the disorder?
All over the world, sleepwalking has been an issue that has not been fully understood. For this reason there are so many myths and mysteries surrounding sleepwalking. Some believe that sleepwalking is mental illness, while others believe that it is demonic. But science comprising of neurology and psychiatry have done so much to help unravel some of these myths.
What is sleepwalking?
Sleepwalking is a sleep disorder that occurs when one is asleep. It belongs to the sleep disorders called parasomnia. Parasomnias are abnormal behaviours that happen when one is asleep.
It occurs at the deepest part of sleep, that is the 3rd stage of the Non Rapid Eye Movement (NREM) sleep. And it mainly happens during the early part of sleep. So it usually occurs 90 minutes after falling asleep. And as a parasomnia, it results into performing certain behaviours while asleep. These abnormal behaviours in sleepwalking can last for a few seconds to 30 minutes.
Do Nigerians sleep walk?
Not much study has been performed in Nigeria on sleepwalking. This is because it is not easy to induce the disorder and study it. And it is usually shrouded in secrecy in Nigeria due to myths surrounding the disorder. So prevalence figures from the few researches done will not really show the actual prevalence of sleepwalking in Nigeria.
In a study done in southwest Nigeria in an adult population gave a prevalence of 7%. The breakdown of this result is that 10.4% are seen in males and 3.7% in females. But unfortunately, sleepwalking is seen more in children, globally. And it is more in boys. The prevalence rate in children is difficult to get in Nigeria.
The age of onset of the disorder is from the age of 2 years. But it can start anytime between 2 years and 13 years. And the disorder may disappear as the child gets older. But for some people, in 80% of the cases, it is chronic. This means that it can last into adulthood.
The beliefs of Nigerians about sleepwalking.
Sleepwalking and mental illness in Nigeria are seen more as spiritual possessions. Most Nigerians believe that sleepwalking is a spiritual matter. The Yoruba people believe that sleepwalking and other psychiatric disorders that happen mainly at night are due to demons. They believe that a demon possesses the person sleepwalking, while the person is dreaming. And it is actually a fight between the person’s human spouse and his or her spiritual spouse. In Yoruba language, it is known as Ogun Oru.
The disorder is treated via traditional rituals that aim to remove the demon possession. They also believe that Christian prayers can be effective in removing the demons.
Sleepwalking and Mental Illness in Nigeria.
Sleepwalking is sleep disorder as well as a mental health condition. It is not mental illness, but it is connected to different types of mental illness.
Causes and risk factors of sleepwalkers.
Science has not been able to fully unravel everything concerning sleepwalking, including what causes it. But there are many things that are now known.
There is most often a family history of sleepwalking. This means that for those having sleepwalking disorder, the parent or parents also have the disorder. So if one parent has the disorder, there is a 45% chance of the child getting it. And if both parents have it, the chance increases to 60%.
2. Sleep deprivation:
Not getting adequate sleep, or having irregular sleep, can predispose to sleepwalking.
Stress from any source, be it physical or psychological is a risk factor. It can predispose to fragmented sleep and in turn to sleepwalking.
4. Brain injury:
Injury to the brain from any source, can predispose to the disorder.
5. Neurological conditions:
Conditions such as dementias, Parkinson disease, seizures, restless leg syndrome, migraine, etc. are risk factors.
6. Medical conditions:
These include fevers in children, snoring, heartburn, hyperthyroidism, etc.
Some medicines used to treat other conditions can predispose to sleepwalking. This is because some of these medicines increase the time spent at the stage 3 of the NREM sleep.
8. Abuse of substances:
Substances of abuse such as alcohol, etc. are risk factors also.
9. Psychiatric conditions:
These include mental illness such as depression. Those who suffer from depressive disorders are almost 4 times more likely to sleep walk than those without depression.
Also, the people who suffer from obsessive compulsive disorder, post traumatic stress disorder, panic attack, etc. are at risk.
10. Child abuse issues:
Children who had been sexually abused are more likely to sleepwalk than those not sexually abused.
The neurobiology of sleepwalking.
What really goes on in the brain of those that sleepwalk is not yet fully understood. But certain things have been identified.
1. Issues at the NREM sleep stage:
It is known that sleepwalking occurs at the deepest part of the sleep cycle. This is when every part of the brain is supposed to be relaxed or asleep. But for reasons not understand, the person will attempt to wake up at this stage of the sleep cycle. What bring about this about is not yet fully ascertained.
2. Brain issues:
Certain parts of the brain remain awake and active, while other parts of the brain are asleep. So the areas that are involved in emotions and complex muscle movements remain awake. But the frontal cortex and the hippocampus are asleep. The frontal cortex and the hippocampus are actually supposed to put the brakes on the awake brain areas. Unfortunately, they cannot do so because they are asleep.
The areas responsible for memory and storage of information are asleep; so on waking nothing of the incident is remembered.
Also, a delay in the maturation of the central nervous system can cause sleepwalking. This is one of the reasons it is more common in children.
3. Issues of neurotransmitters:
Certain chemicals in the brain called neurotransmitters are also involved in sleepwalking. These neurotransmitters include serotonin, GammaAminobutyric Acid (GABA). The neurotransmitter GABA actually functions to paralyze the muscles during sleep, under normal circumstances. But for those who sleepwalk, the brain cells that produce GABA are not yet fully developed.
These is seen low level of magnesium, which function to improve the level of GABA in the brain.
Sleep walking behaviours.
1. Facial expression:
On suddenly getting up from the bed, the facial expression is usually blank or dazed. Any attempt to wake such a person will leave him or her looking confused.
2. The five senses:
The eyes are usually open, but they are unable to see with it. And all the other senses are not functioning. So they are unable to feel pain.
They usually do not talk, but when they do, their words are either inaudible, or incoherent.
4. Simple actions:
They are able to perform simple actions such as sitting on the bed motionless, or picking on the bed sheet. Standing on the bed is also a possible action. The person may walk to the window and stand there as if looking out. But in actual fact, he or she is unable to see anything.
5. Complex actions:
These include running, dressing, cooking, engaging in sex, driving, urinating at the wrong place, etc. But the behaviours can also be violent, whereby they can hit, kill with a knife or a gun, etc.
6. Memory issues:
At the end of the whole actions, the person will go back to bed and sleep. And on waking up in the morning, the person remembers nothing of all that transpired while asleep.
While performing any of the complex actions, there could end up being a crime scene. It could be via driving, someone can be run over with the car, or there could be death from violence.
At the court, before a crime is said to have occurred, there must be what is called Mens rea and Actus reus. Mens rea means that there must be a criminal intent from the beginning. That means that it must be proved that the defendant thought about the incident and planned it. In Actus reus, it must be proved the act is criminal.
So in sleepwalking, Mens rea cannot be proved because the action took place out of an automatism. And during automatisms, the person cannot control his/her actions. Thus the defendant cannot be said to be guilty. And most often such a person is acquitted.
Complications from sleepwalking.
Some of the complications that result from sleepwalking can range from poor sleep, excessive daytime sleeping, to very serious conditions. These serious conditions include harm to self and to others, with death of a victim. Fire incidents can also occur.
Psychiatric conditions such as major depressive disorders, anxiety, panic attack, etc. Even suicide can occur.
1. For the relatives:
There are things the relatives of those that sleepwalk can do to prevent harm to the individual. The keyword here is safety.
First thing to do is to make the environment safe. This can be done by ensuring that the person lives on the ground floor of the building. Then ensure that all exit doors and windows are securely locked or bared. Remove all things that can cause stumbling along the way. Ensure that all sharp objects, including knives and guns cannot be reached by the person.
There is actually no need to wake the person, unless it is absolutely necessary. All that is often needed is to guide the person back to bed.
Anticipatory awaking can be done, by waking up the person before the sleepwalking takes place. Then the person is kept awake for 20 minutes after the incident would have ended. But this action requires that the sleepwalking occurs on daily basis and lasts for a known period of time.
2. For the individual:
Ensure that one gets adequate sleep. Making use of sleep hygiene, every night is advised.
All attempts should be made to reduce stress in life. And avoid the use or abuse of all substances.
Actually, no treatment is required unless it is affecting the person’s daytime functions. The treatment includes the use of medications from a psychiatrist and psychotherapy, like cognitive behavioral therapy.
There is need to treat any accompanying psychiatric conditions, like depression, etc. Also, there may be need to adjust the dose or stop any medication that is bringing it about.
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