To most, walking through sleep is as captivating a condition as it is one that remains shrouded in mystery. Mai Samih helps us get a grip on the syndrome In old Egyptian movies, sleepwalking was depicted as a ridiculed myth -- such was the extent to which Egyptians were perplexed by the condition. Even today, many Egyptians still do not understand that sleepwalking is a sleeping disorder that can affect human beings of any age, causing them to get up and walk during their sleep. Sleepwalking belongs to a family of abnormal behaviours during sleep called parasomnias, which include bedwetting, teeth grinding and night terrors. Parasomnias represent the activation of physiological systems at inappropriate times during the sleepwalk cycle. In particular, these disorders involve activation of the autonomic nervous system, motor system, or cognitive processes during sleep or sleepwalk transitions. Ali Suleiman, professor of psychology and psychological guidance at Cairo University, says that during sleepwalking, patients may also engage in other activities in addition to walking, such as talking or eating. "Walking under sleep", as scientists sometimes refer to the disorder, typically occurs when a person is in the deep stages of sleep. The sleepwalker is unable to respond during the event and does not remember sleepwalking. In some cases, it is associated with incoherent talking. Suleiman explains that there are a range of factors that can trigger episodes of sleepwalking: environmental factors, such as sleep deprivation, stress, overuse of alcohol and the use of certain medications; medical conditions, such as fever and asthma; and psychiatric conditions, such as post-traumatic stress disorders or panic disorders. "When my 28-year-old sister had a bout of fever last year, she once woke up at 2am and threw her shawl in the wardrobe," remembers Asmaa Mokhtar. Since Mokhtar happened to be awake and witnessed her sister doing that, she went up to her and asked her what she was doing. Her sister answered, "I'm hiding the booty." The next day, Mokhtar's sister woke up screaming that she could not find her shawl and that someone had stolen it during her sleep. It was only then, Mokhtar admitted, that she believed sleepwalking could happen in real life, not just in movies. Suleiman says that a person who walks while asleep on a daily basis is, in most cases, mentally subdued. Depending on the severity of the case, sleepwalking episodes could occur once or twice a week or even once a month. In the case of a fever, he adds, it means that the person has reached a temporary loss of his psychological bearings. Sleepwalking can also be an attempt to fulfil a desire that a person is unable to satisfy in his or her real life, Suleiman expounds, whether the reason is the authority of society, the prevailing social ethics or a strong super ego that causes a sense of guilt. "Sleepwalking is only a symptom of a hidden disease," he explains. He also differentiates between the two concepts of "state" and "trait". The first is exemplified in a person who faces a difficult situation which temporarily changes his mood and could push him to a nocturnal stroll at least once in his life; while the latter is a constant phobia. "It was 3am when I heard my brother shouting and screaming," Doaa Adel says. "When I went to see what was going on, I saw my brother standing in the living room slapping and kicking an invisible enemy. As he headed back to his bedroom, I called out his name, but he did not answer me." Perplexed, Adel followed her brother to his room, only to find that he had fallen fast asleep. The next day, he denied the incident. Adel narrates her almost daily experiences with her 17-year-old sleepwalking brother. "The other day my mother discovered that my brother was not in bed at 5am. We looked everywhere for him and finally found him hiding under my bed, in deep sleep. My father carried him to bed. In the morning, my brother said that he did not remember the incident," Adel says. Scientifically, people who sleepwalk may engage in simple activities, such as eating, dressing or using the toilet. They may also engage in more complex activities, such as moving furniture or driving a car. Sleepwalking episodes may last for a few minutes or a half hour or longer. Sleepwalking occurs at any age but is more common in children as their psychological system is usually weak and not yet mature. According to the American Psychiatric Association(APA), 10 to 30 per cent of children have experienced at least one episode of sleepwalking and two to three per cent have frequent episodes. Among adults, one to seven per cent have experienced an episode of sleepwalking, and between one and five per cent have a sleepwalking disorder, characterised by frequent episodes that cause significant distress or dysfunction. Most children outgrow sleepwalking by adolescence. Adults who sleepwalk usually had done so as children. Professor Yasser Ahmed Nasr, lecturer of Psychiatry at Cairo University and Educational Consultant of psychological management, agrees, saying that sleeping disorders are considered one of the psychological problems that begin in childhood. "It starts happening between the ages of four and 12," Nasr said. Usually occurring at the beginning of the child's sleep, the sleepwalker is oblivious of the act as the kinetic system is awake, while the sensory system is not. From the perspective of a person who walks under sleep, it is as if it were a dream that is forgotten. Scientists discovered that a sleepwalker walking on the edge of a balcony, for example, is able to maintain his balance and walk long distances provided that he is not awakened. Nasr, who has a diploma from Cambridge University in family consultations and marital relations, reveals that sleep is divided into five cycles: stages one through four, which range from the lightest sleep to deep sleep, and the fifth stage, which is known as rapid eye movement (REM) sleep. During a typical night's sleep, a person moves from one cycle to the next approximately every 90 minutes. Sleepwalking usually occurs during deep sleep (stages three and four of the sleep cycle) in the first third of the sleep period, early in the night. It infrequently occurs during REM sleep, closer to morning. "My husband wakes up in the middle of the night, turns off all the electricity mains in the house, screams 'fire' and goes back to sleep," Reem Ahmed complains. "Sometimes he would say 'catch the robber' and would start opening the windows and the doors and would even wake me up to help him catch the burglar, which really frightens me. The next day he wakes up and acts as if nothing has happened." Ahmed said these episodes might occur on a daily basis and sometimes one or two weeks in between. According to Suleiman, who ran a psychological clinic in Germany for 10 years, nightmares could concur with a case of sleepwalking. "In such cases, the sleep stroller starts screaming while walking as the acts are on both the sub- conscious and the physical levels," he said. Suleiman stresses that all children can be cured from sleepwalking through applying good discipline and specific exercises to treat the condition. As for adults, their progress usually depends on their introspective abilities and by the use of the so called "projective technique". Those are methods used by psychologists to uncover deep-rooted thoughts that may not arise as a result of direct questioning. In short, they consist in getting patients to speak about something indirectly by "projecting" their thoughts on something else. This allows bypassing resistance to direct questioning that may make participants uncomfortable, or to tap into underlying thought processes that are not immediately available to respondents. "Sleepwalking is a self-limited condition," Nasr asserts, adding that it is rare that adolescents suffer from such cases. "If any, they would be cases that have not been cured earlier." Nasr said that the most perilous of all cases are those that subject children to danger, such as physical injuries. There are also negative and possibly non-reversible damaging psychological effects on children who are teased about their nocturnal habits, he adds. Unfortunately, there remain many uncured cases of sleepwalking due to the stigma surrounding the condition, with some cases in denial and others discouraged from talking to a psychiatrist. According to Suleiman, his patients suffering from sleepwalking syndrome make up less than 10 per cent of his patients. He said that part of the reason lies in that some of them resort to sorcerers to find a cure for their predicament. There are some rapid techniques to cure walking under sleep, according to Suleiman. "Something could be placed in the path of the sleepwalker, such as a bucket of hot water or ice cubes, to give a shock that would immediately awaken the sleepwalker," he explains. While Nasr does not recommend prescribing medicine, he believes that a child must have enough sleep. He also recommends a hot drink, such as anise or chard, right before the child goes to sleep. "In some cases we give sleeping pills, so that the child does not wake up during the non-REM sleep, the period when the child has a slight disorder in the nervous system." Scientific sleep studies demonstrate that a human being can dream more than once and wake up after every dream. Suleiman calls dreams "the sleep guard", because they absorb humans' mental activities and protect them from neural tension. The average sleeping hours for children under four is 10-12 hours per day and for adults it is 6-8 hours per day. Suleiman believes that during a dream every person suffers from a mental illness for a few seconds and regains sanity after the disease ends. Meanwhile, insane people, he expounds, live in a constant state of dreaming. If walking under sleep is caused by feelings of deprivation due to difficult social conditions, Suleiman says the remedy is to fulfil the psychological and financial needs of young people who suffer from the case. Suleiman believes that this begins with social solidarity. "We are facing these problems with closed eyes. I must say it's as if society itself is now sleepwalking through its problems."
