From the Guidelines
For a 49-year-old female with new onset sleepwalking and night terrors, I recommend adding a comprehensive laboratory workup including complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid function tests (TSH, free T3, free T4), vitamin B12 and folate levels, vitamin D level, and ferritin to the initial laboratory studies. When evaluating this patient, it's crucial to consider potential underlying medical causes of parasomnia symptoms, as suggested by the Alzheimer's Association clinical practice guideline for diagnostic evaluation and testing 1. Some key points to consider in the laboratory workup include:
- Metabolic disturbances, which can be identified through a comprehensive metabolic panel (CMP)
- Thyroid dysfunction, assessed through thyroid function tests (TSH, free T3, free T4)
- Vitamin deficiencies, including vitamin B12 and folate levels, as well as vitamin D level
- Inflammatory conditions, which can be evaluated through inflammatory markers such as ESR and CRP
- Hormonal changes, particularly in perimenopausal women, which may contribute to sleep disruptions and can be assessed through a sleep-specific hormone panel including melatonin and cortisol levels Further evaluation with polysomnography and neuroimaging might be warranted if initial tests are unrevealing, to rule out neurological causes, as guided by the patient’s individual medical, neuropsychiatric, and risk profile 1. It's also essential to screen for medication side effects, substance use, and psychological factors that could be contributing to these new sleep disturbances.
From the Research
Laboratory Studies for New Onset Sleepwalking and Night Terrors
To approach the diagnosis and management of new onset sleepwalking and night terrors in a 49-year-old female, it's essential to consider various laboratory studies that can help identify underlying causes or contributing factors.
- Thyroid Function Tests: Given the association between hyperthyroidism and sleepwalking, as reported in a study 2, assessing thyroid function through tests like TSH, free T4, and free T3 can be crucial. This is particularly relevant because the study found that successful treatment of hyperthyroidism led to the disappearance of sleepwalking episodes.
- Polysomnography (PSG): Although not directly mentioned as a first-line laboratory test, PSG can be valuable in diagnosing and understanding sleep patterns, especially if there's suspicion of other sleep disorders like sleep apnea or restless leg syndrome that might contribute to sleepwalking or night terrors.
- Psychiatric and Psychological Evaluations: While the primary approach to sleepwalking and night terrors might not involve psychiatric medications as a first line, evaluating for underlying psychiatric conditions or stressors can be important, as these can sometimes trigger or exacerbate sleep disorders 3, 4.
- Screening for Sleep Disorders: Other sleep disorders such as obstructive sleep apnea, insomnia, or restless leg syndrome can contribute to or exacerbate sleepwalking and night terrors. Thus, screening for these conditions through specific questionnaires or tests might be warranted.
- Hormonal Evaluations: Considering the case of premenstrual sleep terrors and injurious sleep-walking 5, evaluating hormonal influences, especially in female patients, could provide insights into periodic exacerbations of sleepwalking and night terrors.
Considerations
- The presence of new onset sleepwalking and night terrors in an adult suggests the need to investigate for underlying medical or psychiatric conditions that could be triggering these events.
- A thorough medical history, including questions about sleep patterns, stress, and any recent changes in health or medication, is essential.
- Given the variety of potential causes and the complexity of sleep disorders, a multidisciplinary approach involving sleep specialists, psychiatrists, and primary care physicians may be necessary for comprehensive management.