Author Gabriel Pallante PT, DPT, IAMTC, IADN Cert. Specialist

Key Takeaways

• Quality sleep is crucial for regulating and repairing the body, impacting mood, mental function, blood sugar regulation, and heart health.
• Sleep follows cyclical stages influenced by circadian rhythms, including wakefulness, non-REM stages (N1, N2, N3), and REM stages. Circadian rhythms also influence energy levels, eating patterns, hormone levels, body temperature, and REM sleep quality.
• Sleepwalking affects approximately 3 million people every year in the United States alone, especially in the under 12 age group and anyone with episodes activated by the sympathetic autonomic nervous system (SANS) during sleep.
• Parasomnia refers to a sleep disorder characterized by undesirable behaviors or experiences during sleep, including REM-related and non-REM-related disorders.
• Stimulating the parasympathetic autonomic nervous system(PANS) promotes relaxation and optimal sleep. Techniques such as dry needling and manipulations can help regulate the PANS.

Note: These key takeaways are a concise summary of how skilled physical therapists can regulate autonomic nervous system function to treat sleep disorders. For a deeper understanding of treatment options for sleep disorders, check out the recommended blog content.

Parasomnia is a disorder of undesirable behaviors or experiences that occur during sleep or during partial arousals from sleep, some being related to non-REM and or REM. REM related sleep disorders include behavior disorders, recurrent isolated sleep paralysis, and nightmare disorders. Non-REM related sleep disorders include confusional arousals, sleep walking, night terrors, and sleep-related sexual abnormal behaviors. Sleep walking, also known as somnambulism, affects about 3 million people in the United States every year. Most commonly affecting people under the age of 12. There is finally a treatment for sleepwalking and it starts with regulation of the autonomic nervous system (ANS) through dry needling and manipulations.

Uninterrupted sleep is how we regulate and repair. It is when your brain cleans itself, your muscles repair broken fibers, bones grow, memories get stored, and so much more. Your body gets a full tune-up. That is why children are always sleeping; they are growing around the clock. A good sleep routine can improve your mood and mental function, regulate your blood sugar, and keep your heart healthy. If a pharmaceutical company were able to capture all the benefits of sleep, and put it into pill form it would be the most expensive drug in the world. Until the day that happens, we are just going to have to keep getting the benefits the old fashioned way, by sleeping. The key to getting the most from sleep is by focusing on the quality of your sleep. One of the best ways to regulate a good sleep routine is by influencing the autonomic nervous system.

The key to quality sleep is in your parasympathetic ANS (PANS), the rest and digest response. When the PANS is stimulated, it means you are experiencing the opposite of stress – relaxation. Things like exercise, a good show on netflix, and a night out on the town can be helpful tools to relax or blow off some steam. Each of those activities stimulates the opposite of the PANS. Even the routine hustle-and-bustle of everyday life can crank up our sympathetic ANS (SANS), the fight or flight response. With dry needling and joint manipulations, the autonomic nervous system can more consistently achieve homeostasis, or biological balance.

Related: Check out Online Dry Needling 1: Dry Needling & The Autonomic Nervous System

Humans are diurnal, meaning active during the day. When the sun rises, so do we and it is just a matter of time until we go back down; like clockwork. More like a rhythm. A chronobiologist would say “circadian rhythm to be precise”. Circadian rhythms follow a 24-hour cycle. These cycles influence physical, mental, and behavioral changes. The most common light-related circadian rhythm is the sleep-wake cycle (SWC) which influences how much energy you have to burn during the day, how much and when you should eat, hormone levels, body temperature, and the quality and quantity of Rapid Eye Movement (REM) sleep, the most important part of the human sleep state. Other parts of our SWC include REM, non-REM, and awake.

REM is the 5th stage of sleep: wake, non-REM 1 (N1), non-REM 2 (N2), non-REM 3 (N3), and REM, the part of the sleep cycle where the body receives major health benefits. When you begin to drift away into the SWC, the brain begins to alter brainwaves. Think of it as tuning into different stations. It changes its frequency from awake beta waves, to alpha waves in N1, then to theta waves in N2, to delta waves in N3, the deepest stage of sleep. As the brain transitions through the various stages, switching station to station, it wakes just before entering REM. Cycles are: awake, N1, N2, N3, N2, awake then REM. Each cycle is about 90-110 minutes. On an average night, the brain has 4-5 cycles. During the first cycle, time spent in REM is brief. As the night progresses, the amount of time in REM increases whereas non-REM decreases.

At its core, sleepwalking is a non-REM disorder caused by SANS. In a typical SWC the PANS is dominant enough to keep you tucked into bed in the sleep state, regardless of the light N1 stage. During the SWC of a sleepwalker, the brain transitions between N1-N2-N3, but the body’s SANS is excited which wakes the body without a conscious record. In essence, the body is awake but your brain never hits “record”.

Somnambulism is very common in children as the autonomic nervous system continues to develop. Considering that four in every one hundred adults and a little more than one-in-four (29%) children sleepwalk, it is something that may seem harmless on the surface but could negatively impact the sleepwalker’s life and the lives around them.

Although a sleepwalker’s body might be moving around their homes, there is no recollection of their activity. Picture this, you are dead asleep in the kitchen when someone in your house has an embarrassing encounter with you making some late-night snacks and having a totally nonsensical conversation with your sleeping alter-ego, and wandering around the house. Potentially hilarious home videos starring the resident sleepwalker.

No two sleepwalking experiences are the same. Sometimes, it’s not a family member waking you up. One time, Scott Falater was woken by law enforcement. He murdered his wife while sleepwalking – testimony supported by psychologist Rosalind Cartwright. It took about eight hours for that testimony to get dismantled by the prosecution. Due to the fact that sleepwalkers lose control of their bodies and have no recollection of the outrageous things they can do, the jury needed eight hours of deliberation before finding him guilty. In the case of Scott Falater, the crazy things he did were not actually while sleepwalking; he just hid behind the plausibility of an innocent person doing strange things while sleepwalking.

Now the chances of a sleepwalker strangler are extremely low, the chances of waking up surrounded by evidence of a sleepwalking snacker is much higher. There are plenty of benign stories that could generate a good laugh immediately after the episode. However, there are some stories that could be a little longer before they are considered comical – if ever. Sleep driving, sleepwalking naked around your apartment building, sexual activity while sleeping, and other potentially dangerous activities can pose a serious problem to people.

Modern medicine and evidence based research found lifestyle changes which can optimize environmental factors to improve the chances of quality sleep. Based on the mechanisms of sleep and abnormalities found in sleepwalkers, dry needling to amplify PANS stimulation can keep people relaxed enough to avoid waking during the SWC. The best way to excite the PANS is by inserting hair-thin needles into the craniosacral spinal regions, ears (vagus nerve stimulation), and other parasympathetic innervated muscles followed by spinal manipulations will provide enough ANS regulation to sleep through the night.

Gabriel Pallante PT, DPT, IAMTC, IADN Cert. Specialist

References

1. How to wake and stop a Sleepwalker. WebMD. Accessed May 24, 2023. https://www.webmd.com/sleep-disorders/features/5_steps_stopping_sleepwalker#:~:text =Sleep%20deprivation%20is%20a%20common,no%20specific%20treatment%20for%20 sleepwalking.
2. Parasomnia. Parasomnia | Michigan Medicine. Accessed May 24, 2023. https://www.uofmhealth.org/conditions-treatments/brain-neurological-conditions/parasom nia#:~:text=Parasomnias%20include%20disorders%20with%20undesirable,during%20p artial%20arousals%20from%20sleep.
3. Pennmedicine.org. Accessed May 24, 2023. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-tre ated-a-to-z/sleep-walking.
4. professional CC medical. Sleepwalking (somnambulism): Causes, symptoms & treatment. Cleveland Clinic. Accessed May 24, 2023. https://my.clevelandclinic.org/health/diseases/14292-sleepwalking.
5. Sleepwalking: What is somnambulism? Sleep Foundation. May 18, 2023. Accessed May 24, 2023. https://www.sleepfoundation.org/parasomnias/sleepwalking. 6. Somnambulism – StatPearls – NCBI Bookshelf. Accessed May 24, 2023. https://www.ncbi.nlm.nih.gov/books/NBK559001/.
6. Sleepwalking. Mayo Clinic. July 21, 2017. Accessed May 24, 2023. https://www.mayoclinic.org/diseases-conditions/sleepwalking/symptoms-causes/syc-203 53506.
7. Mercante, B., Ginatempo, F., Manca, A., Melis, F., Enrico, P. and Deriu, F., 2018. Anatomo-physiologic basis for auricular stimulation. Medical acupuncture, 30(3), pp.141-150