What is the medication for somnambulism (sleep walking)?

Treatment of Sleepwalking (Somnambulism)

Clonazepam is the first-line medication treatment for sleepwalking, with a starting dose of 0.5-1.0 mg at bedtime. 1

Understanding Sleepwalking

Sleepwalking (somnambulism) is a non-REM sleep parasomnia characterized by complex behaviors during sleep, including walking. It affects approximately 2-14% of children and 1.6-2.4% of adults 1. While occasional episodes may be managed conservatively, recurrent sleepwalking with risk of injury requires pharmacological intervention.

Treatment Algorithm

1. First-line pharmacological treatment:

   • Clonazepam 0.5-1.0 mg at bedtime 2, 1
   • May be taken 1-2 hours before bedtime if sleep onset insomnia or morning drowsiness occurs 2
   • Effective in approximately 90% of cases 2

2. Alternative medications (if clonazepam is contraindicated or ineffective):

   • Other benzodiazepines 2
   • Tricyclic antidepressants 1
   • Selective serotonin reuptake inhibitors (SSRIs) 1

3. Treatment of underlying causes:

   • Evaluate and treat sleep-disordered breathing (SDB) 3
   • Consider nasal CPAP if SDB is present 3
   • Address other potential sleep disorders like restless legs syndrome or periodic limb movements 1

Safety Considerations

• Environmental safety measures are crucial:

  • Remove potentially dangerous objects from the bedroom
  • Pad hard and sharp surfaces around the bed
  • Cover windows with heavy draperies
  • Consider placing the mattress on the floor to prevent falls 2

• Special considerations for elderly patients:

  • Start with lower doses (0.25 mg)
  • Monitor closely for side effects 4
  • Use with caution in patients with dementia or gait disorders 2

Monitoring and Follow-up

• Beneficial effects of clonazepam are typically observed within the first week of treatment 2
• Discontinuation of treatment usually results in recurrence of symptoms 2
• Long-term treatment may be necessary, as studies have shown sustained efficacy with low risk of dosage tolerance 5

Important Caveats

• While clonazepam is the most established treatment for sleepwalking, there is a lack of high-quality randomized controlled trials specifically for somnambulism 6
• Paradoxically, some hypnotic medications like zolpidem may actually induce sleepwalking in some individuals 7
• Clonazepam should be used with caution in patients with concomitant obstructive sleep apnea 2
• Long-term benzodiazepine treatment for parasomnias has shown sustained efficacy with low risk of tolerance or abuse when properly prescribed and monitored 5

By addressing both the symptom (sleepwalking) and any underlying sleep disorders, this approach provides the most comprehensive management strategy for patients with somnambulism.