In our current practice, we do not see many cases of somnambulism in adults. We do not have much information about their treatment and outcome. In difficult cases, some clinicians try to use benzodiazepines, which decrease slow-wave sleep. More recent reports suggest the use of zolpidem.

Sleepwalking disorder consists of a sequence of complex behaviours that are initiated in the first third of the night during deep NREM (stage III and IV) sleep. The architecture of normal sleep is impaired. In important cases - with dangerous behaviour – we need treatment.

Trazodone is an antidepressant with sedative effect due to H1 and α1 receptors blockade. Trazodone can rewrite the bad sleep architecture of depressive patients with insomnia and improve sleep in such cases. For these reasons, we try to use trazodone in somnambulism.

We had two case studies (males, 24 and 22 old), diagnosed with NREM arousal disorder, sleepwalking type, according to DSM-5. Both patients were treated with trazodone 50 mg/day, up-titrated with 50 mg/day every three days. The target used dose was 150 mg/day because this is the most sedative.

Somnambulism disappeared in both cases after the first dose of trazodone. We treated three month both patients and then down-titrated and stopped the treatment. After one year from stopping the treatment, the patients had not new episodes of somnambulism.

Trazodone has the power to rewrite, in those cases, the sleep architecture of somnambulism. This action is due to blockade the brain's arousal histamine and adrenaline systems.

Speaker honoraria from Angelini Pharmaceuticals Romania.