Sleepwalking vs. Dissociation in Mental Health

Q: Sleepwalking vs. Dissociation in Mental Health

Hello, online friend： It could be sleepwalking. <br>First, it's important to consider that it may be caused by sleep medications, as many people experience sleepwalking after taking Zolpidem. <br>If this is the case, it is advisable to avoid using it. <br>I recommend finding a tr

Sleepwalking or dissociation?

Hello, doctor.
I am a patient diagnosed with Depression, PTSD, and BPD, and I have been under the care of a primary physician (though recently the hospital assigned me a new doctor whom I dislike).
I have also been inconsistent with my medication (I dislike taking more than ten pills a day), and there haven't been significant adjustments to my medication regimen in recent years.
Recently, due to various stressors affecting my emotions, I have experienced some episodes that I am unsure whether to classify as sleepwalking or dissociation.

About six months ago, I was hospitalized in the psychiatric ward, and one night I suddenly got out of bed and started walking around.
The staff restrained me, and I was shocked to find myself tied up.
It was only later that others informed me that they suspected I was sleepwalking; that was the first incident.
The second incident occurred about a month ago.
I was emotionally stable and very tired, so I went to bed early.
The next morning, I woke up to find self-harm marks on my wrists, my hands covered in blood, but I couldn't find any sharp objects.
I had taken a selfie of myself bleeding on my phone.

The third incident happened two weeks ago.
That morning, I met with my counselor and discussed some past traumas, which left me emotionally unstable.
I ended up working late into the night.
Around 9:30 PM, I took a bus home while listening to music, completely unaware if I had fallen asleep.
The next morning at 6 AM, I found myself on a mountain, with some blood and self-harm marks on my hands, but again, I couldn't find any sharp objects.
My frequently used phone was turned off, and I discovered a downloaded image with English text that I wouldn't normally do.
Another phone, which I usually keep off, was turned on, and it had inputted the phone number of someone I trust, but I didn't actually call it.
Strangely, the bus I took does not go near that mountain; it would take over an hour to walk there from the nearest bus stop.
I checked my travel records and confirmed that I hadn't taken any other buses after that one, leaving me puzzled about what happened during those eight hours.
I am beginning to wonder if sleepwalking can occur in this manner.

The fourth incident was a few days ago when I accidentally went to a place that triggered past traumas.
That night, feeling emotionally unstable and fearing a recurrence of the strange events from two weeks prior, I tied my hands and feet with a rope and locked my door before sleeping.
The next morning, I found myself sitting on the floor, the rope was cut and left on the bed, but again, I couldn't find any sharp objects.

Could these situations be classified as sleepwalking or dissociation? I won't be able to see my new primary physician for another month, and I dislike him and don't want to discuss these issues with him, but I am also afraid of having further incidents.
I would like to understand this better, thank you.

Yin Ying Guo, 30~39 year old female. Ask Date: 2021/07/21

Dr. Wu Enliang reply Psychiatry

Hello, online friend: It could be sleepwalking.
First, it's important to consider that it may be caused by sleep medications, as many people experience sleepwalking after taking Zolpidem.
If this is the case, it is advisable to avoid using it.
I recommend finding a trusted physician and not seeing one you dislike.
Dr.
Wu Enliang.

Reply Date: 2021/07/21

More Info

Your situation is indeed complex and concerning, and it's important to approach it with care and understanding. Based on your description, it seems you are experiencing episodes that could be indicative of both sleepwalking and dissociation, which are distinct yet sometimes overlapping phenomena in the realm of mental health.

Sleepwalking, or somnambulism, typically occurs during non-REM sleep, particularly in the deeper stages. It involves complex behaviors while in a state of partial arousal from sleep, where the individual may walk, talk, or perform other activities while being unaware of their actions. The episodes you described, such as getting out of bed and walking around without memory of the event, align with classic sleepwalking behavior. The fact that you were restrained during a sleepwalking episode in the hospital indicates that your actions were concerning enough to warrant intervention, which is common in such cases.

On the other hand, dissociation is a mental process used as a coping mechanism, often in response to trauma or extreme stress. It can manifest as a feeling of detachment from oneself or one’s surroundings, leading to gaps in memory or awareness of actions. Your experiences of waking up with injuries and no recollection of how they occurred, as well as the incident where you found yourself in an unfamiliar location, suggest a dissociative episode. This can happen in individuals with PTSD, especially when they are triggered by reminders of past trauma.

Given your history of depression, PTSD, and borderline personality disorder (BPD), it is not uncommon for these conditions to contribute to both sleep disturbances and dissociative experiences. Stress and emotional instability can exacerbate these symptoms, leading to episodes that blur the lines between sleepwalking and dissociation.

Here are some considerations and recommendations based on your situation:
1. Document Your Episodes: Keep a detailed journal of your experiences, noting the time, circumstances, and any triggers you can identify. This information will be invaluable for your mental health provider when you are able to meet with them.

2. Safety First: Given the potential for self-harm and the risk of injury during these episodes, it’s crucial to create a safe sleeping environment. While you mentioned using restraints, it may be more effective to remove potentially harmful objects from your sleeping area and ensure that doors and windows are secure.

3. Therapeutic Support: While you may have concerns about your new psychiatrist, it’s essential to communicate your experiences and feelings as openly as possible. They can help you navigate these symptoms and may suggest therapies such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), which are effective for managing symptoms of PTSD and BPD.

4. Medication Review: If you are struggling with medication adherence due to the number of pills, discuss this with your healthcare provider. There may be options to simplify your regimen or adjust dosages to better suit your needs.

5. Mindfulness and Grounding Techniques: Practicing mindfulness can help you stay present and reduce anxiety. Grounding techniques can also be useful in managing dissociative symptoms, helping you reconnect with your surroundings and your body.

6. Crisis Plan: Develop a plan for what to do if you experience another episode. This could include having a trusted friend or family member check in on you or having a crisis hotline number readily available.

In conclusion, your experiences are significant and warrant attention from a mental health professional. While it may feel daunting to discuss these issues with a new provider, doing so is crucial for your safety and well-being. Remember, you are not alone in this, and there are resources and support available to help you navigate these challenges.

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