Medscape recently spoke with Michael J. Howell, MD, director of the Sleep Medicine Fellowship in the Department of Sleep Medicine at Minnesota Regional Sleep Disorders Center in Minneapolis, about the causes and consequences of sleepwalking, along with possible management strategies.

Medscape: When was sleepwalking first described?

Michael Howell, MD: There have been descriptions since the time of Hippocrates, Aristotle, and Galen. Probably the most famous description of a sleepwalker is Lady Macbeth, in The Tragedy of Macbeth by William Shakespeare. What he clearly describes is a sleepwalker who is dreaming. She is parading around and acting out the subconscious conflict that came from having murdered King Duncan, if I remember the play correctly.

It’s hard to confirm whether these early accounts are actually talking about sleepwalking—which is a confusional arousal that tends to come out of non-rapid eye movement (NREM) sleep—or dream enactment, which is a different condition arising out of REM sleep that tends to be more intense and include violent thrashing, punching, and kicking. Some variation of these abnormal behaviors have been described for a very long time.