Fully Awake To Somnambulism In Seconds?

by Mark
(California, USA)

Is it possible to enter a somnambulistic state directly from a fully awakened state, in a time of only several seconds?

The subject, a 14-year-old male in excellent physical condition, has exhibited the following behavior over the past eight months. In intervals ranging from once every few weeks to a couple of times a week, he awakens, reaches full alertness, is walking around and communicating normally, and then (about 15 minutes after awakening), with no warning, enters a state of impaired consciousness. During the impairment, he is ambulatory, and can give simple (up to a few words) answers to questions, but cannot follow simple instructions without aid. He appears confused as to his surroundings and circumstances, and about half the time, his comments indicate that he is experiencing visual hallucinations.

With very specific guidance, he can perform complex functions, such as eating. He has taken a shower and relieved himself on some such mornings but, because he hasn't been closely observed in the bathroom, it is unknown whether he did so before or after entering this state.
Also, most of the incidents include an occasional involuntary movement, such as nodding of the head or shaking of one hand (say, a few times during the entire 20 minute incident).

He emerges from the state about 15-25 minutes after entry, in a gradual progression that makes it difficult to identify exactly when the incident has finished. After emerging, he has no memory of it, and his behavior for the rest of the day is perfectly normal, as it is during the entire day on days (most of them) when he has no such incident.

1. Is such behavior consistent with any known form of parasomnia?

2. Could such behavior be caused or exacerbated by any sleep disorder?

3. What path would you recommend for further investigation?

TIA,

Mark

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Hey Mark,

Thanks for the detailed report. What you describe is different than any condition I have ever heard of, but my experience is very limited in that domain and a practicing sleep physician may have some more insights for you. I'll do my best to pass your words on to the teachers and doctors in the Stanford Sleep and Dreams community and let you know if anything comes of it.

The only insights that I would think to make given what you describe are twofold:

One, the most notable condition that parallels this experience of going straight from a fully awake state to a sleep-related state is narcolepsy, where an individual can be normally going throughout the day before being struck by an attack of REM sleep known as cataplexy. While this doesn't sound like what you describe exactly, I thought the parallel worth mentioning. You can learn more about narcolepsy from our site here.


Secondly, the only other thing that I'd think to mention just for general information purposes in case it helps you, is that sleepwalking episodes are more likely to occur early in the night, especially in the first third of sleep when NREM sleep stages are the longest. That said though, typically one progresses at least to NREM stages 3 and 4, when sleep is the deepest, before an episode occurs, which takes several minutes (it is thought that the sleepwalking itself is associated with a lightening of sleep from those deep stages). I hope to have more information on the journey through NREM and REM sleep on this site shortly, but in the meantime if you would like to read more about sleepwalking, you can see our main article on the subject here.

While those points don't directly address the scenario you have described, I thought them worth mentioning in case you didn't already know them and they lead to anything valuable for you.

What you say about the boy having no memory for the episodes upon emerging from them is very interesting and definitely presents a flag that would seem to point towards the involvement of sleep mechanisms in some way. Have you consulted any sleep physicians in person about this? If not, that would surely be a worthwhile thing to do I think.

I'll let you know on this page if I find out anything more on this. Best wishes on your quest for information, and do please update us if you find anything out.

Warmly,
Kevin