Sleep Violence Review

The potential for danger when an individual is abruptly awakened was already known by primitive tribes.

Their belief was that a sleeper should not be awakened because the soul does not have time to return to the body (1). Sleep-related violence has for a long time caught the imagination because its lacks of rational explanation for the acts.

The earliest detailed account of violent behavior during sleep can be found in The Odyssey (Homer, book 10). Elpenor, a companion of Ulysses, spent a part of the evening to drink with his companions. During the night, he was suddenly awaken by a noise. He was in a confusional state and he forgot all about coming down by the main staircase; he tumbled right off the roof and broke his neck.

In the legal records, one should return in 1313 to find a report from the Council of Vienne (France) stating that a sleeper killing or wounding someone should not be yield guilty (2). Malingering was also a matter of concern: Covarrubias, a Spanish canonist from the 16th century, concluded that an individual cannot be guilty for acts he committed while asleep unless he arranges matters in such a way to make believe he was asleep when committing the acts.

A similar warning was also emitted by Matthaeus, a Dutch jurist of the 17th century. Mackenzie, a Scottish jurist, also from the same century than Matthaeus, was signaling the fact. Both concluded that crime carried out by a sleeper are punishable if there is evidence of animosity toward the victim while awake (3).

Since 1900, three literature reviews (scientific papers, court reports, newspapers) of murdering while asleep have been published (see table 1): The first reviews (4,5) reflected the knowledge of sleep and its disorders: at least 8 cases cannot be considered as being in a confusional state at the moment the murder was committed. They were more likely to be sleepwalking episodes or did not contain enough information to be classified as sleep homicide. Since the review done by Bonkalo in 1974 (3), 29 other cases of homicide or assaults during sleep have been published in the scientific literature (Table 1).

Table 1.Literature review of cases with forensic implications
Authors N of cases Issue
Confusional arousals
Gudden (1905)(4) 18 10 homicides,8 non fatal assaults
Schmidt (1943)(5) 358 15 homicides,20 non fatal assaults
Langel deke (1955) 4 3 homicides,1 sexual assault
Bonkalo (1974)(3) 50 20 homicides,30 non fatal assaults
(included some of the cases quoted by Gudden and Schmidt)
Raschka (1984)(27) 1 assault
Nofzinger &Wettstein (1995)(28) 1 homicide (offender found guilty)
Somnambulism (with or without sleep terrors)
Hopwood &Snell (1933)(29) 1 Homicide
Podolsky (1961)(30) 6 5 homicides,1 suicide
Brookes (1974)(31) 1 Non fatal assault
Watkins (1976)(32) 1 Homicide
Luchins et al (1978)(33) 1 Homicide
Hartmann (1983)(34) 1 Homicide
Oswald &Evans (1985)(35) 3 3 non fatal assaults
Tarsh (1986)(36) 1 Non fatal assault
Howard &d Orban (1987)(37) 2 1 homicide,1 non fatal assault
Brahams (1991)(38) 1 Non fatal assault
Ovuga (1992)(39) 1 Homicide
Broughton et al (1994)(40) 1 Homicide
Moldofsky et al (1995)(17) 3 1 homicide,2 non fatal assault
Lemoine et al (1997)(41) 3 2 homicide,1 non fatal assault
Schenck &Mahowald (1998)(42) 1 Sexual misconduct


  1. Fraser JG. The Golden Bough. London: MacMillan, 1960.
  2. Walker N. Crime and insanity in England. University of Edinburgh Press, 1968.
  3. Bonkalo A. Impulsive acts and confusional states during incomplete arousal from sleep: criminological and forensic implications. Psychiatr Q 1974;48:400-409.
  4. Gudden D. Die physiologische und pathologische schlorftrunkenheit. Arch Psychiat 1905;40:989-1015.
  5. Schmidt G. Die Verbrechen in der schlaftrunkenheit. Journal of Neurology and Psychiatry 1943;176:208-253.
  6. Ohayon MM, Caulet M, Priest RG. Violent Behaviour During Sleep. J Clin Psychiatry 1997; 58:369-378.
  7. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: A new category of parasomnia. Sleep 1986;9:293-308.
  8. Schenck CH, Bundlie SR, Patterson AL, Mahowald MW. Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults. JAMA 1987;257:1786-1789.
  9. Shimizu T, Jnami Y, Sugita Y, et al. REM Sleep without muscle atonia (Stage 1-REM) and its relation to delirious behavior during sleep in patients with degenerative diseases involving the brain stem. Jpn J Psychiatr Neurol 1990;44:681-692.
  10. Sforza E, Zucconi M, Petronelli R, Lugaresi E, Cirignotta F. REM Sleep Behavioral Disorders. Eur Neurol 1988;28:295-300.
  11. Culebras A, Moore JT. Magnetic resonance findings in REM sleep behavior disorder. Neurology 1989;39:1519-1523.
  12. Schenck CH, Mahowald MW. Polysomnographic, neurologic, psychiatric, and clinical outcome report on 70 consecutive cases with REM sleep behavior disorder (RBD): sustained clonazepam efficacy in 89.5% of 57 treated patients. Clev Clin J Med 1990;57(suppl):9-23.
  13. Schenck CH, Mahowald MW. Injurious sleep behavior disorders (parasomnias) affecting patients on intensive care units. Intensive Care Med 1991;17:219-224.
  14. Lapierre O, Montplaisir J. Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 1992;42:1371-1374.
  15. Comella CL, Nardine TM, Diederich NJ, Stebbins GT. Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson's disease. Neurology 1998;51:526-529.
  16. Kavey NB, Whyte J, Resor SR Jr, Gidro Frank S. Somnambulism in adults. Neurology 1990;40:749-752.
  17. Moldofsky H, Gilbert R, Lue FA, Maclean AW. Sleep-related violence. Sleep 1995;18:731-739.
  18. Schenck CH, Milner DM, Hurwitz TD, Bundlie SR, Mahowald MW. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry 1989;146:1166-1173.
  19. Tachibana N, Sugita Y, Terashima K, Teshima Y, Shimizu T, Hishikawa Y. Polysomnographic characteristics of healthy elderly subjects with somnambulism-like behaviors. Biol Psychiatry 1991;30:4-14.
  20. Maselli RA, Rosenberg RS, Spire JP. Episodic nocturnal wanderings in non-epileptic young patients. Sleep 1988;11:156-161.
  21. Kales JD, Kales A, Soldatos CR, Caldwell AB, Charney DS, Martin ED. Night terrors. Clinical characteristics and personality patterns. Arch Gen Psychiatry 1980;37:1413-1417.
  22. Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry 1999;60:268-276.
  23. Ohayon MM, Zulley J, Guilleminault C, Smirne S. Prevalence and pathological associations of sleep paralysis in the general population. Neurology 1999;52:1194-200.
  24. Kavey NB, Whyte J. Somnambulism associated with hallucinations Psychosomatics 1993;34:86-90.
  25. Hurwitz TD, Schenck CH, Mahowald MW. Sleepwalking-sleep terrors-REM sleep behavior disorder: overlapping parasomnias. Sleep Research 1991;20:260 (abstract.)
  26. Langel deke A. Delikte in schlafzut nde. Der Nervenarzt 1955;26:28-30.
  27. Raschka LB. Sleep and violence. Can J Psychiatry 1984;29:132-134.
  28. Nofzinger EA, Wettstein. Homicidal behavior and sleep apnea: a case report and medicolegal discussion. Sleep 1995;18:776-782.
  29. Hopwood J, Snell HK. Amnesia in relation to crime. Journal of Mental Science 1933;79:27-41.
  30. Podolsky E. Somnambulistic homicide. Med Sci Law 1961;1:260-265.
  31. Brookes AD. Law, psychiatry and the mental health system. Boston, Little Brown & Co, 1974.
  32. Watkins L. The sleepwalk killers. London, Everest Books, 1976.
  33. Luchins DJ, Sherwood PM, Gillin JC, Mendelson WB, Wyatt RJ. Filicide during psychotropic-induced somnambulism: a case report. Am J Psychiatry 1978;135:1404-1405.
  34. Hartmann E. Two case reports: night terrors with sleepwalking-a potential lethal disorder. J Nerv Ment Dis 1983;171:503-505.
  35. Oswald I, Evans J. On serious violence during sleep-walking. Br J Psychiatry 1985;147:688-691.
  36. Tarsh MJ. On serious violence during sleepwalking. Br J Psychiatry 1986;148:476.
  37. Howard C, D'Orban PT. Violence in sleep: Medico-legal issues and two case reports. Psychol Med London 1987;17:915-925.
  38. Brahams D. Sleepwalking, "disease of the mind"? Lancet 1991;338:375-376.
  39. Ovuga EB. Murder during sleep-walking. East Afr Med J 1992;69:533-534.
  40. Broughton R, Billings R, Cartwright R, et al. Homicidal somnambulism: A case report. Sleep 1994;17: 253-264.
  41. Lemoine P, Lamothe P, Ohayon M. Violence, sleep and benzodiazepines. Am J Foren Psychiatry 1997;18(4):17-26.
  42. Schenck CH, Mahowald MW. An analysis of a recent criminal trial involving sexual misconduct with a child, alcohol abuse and a successful sleepwalking defense: arguments supporting two proposed new forensic categories. Med Sci Law 1998;38:147-152.
  43. Schenck CH, Mahowald MW. Motor dyscontrol in narcolepsy: Rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol 1992;32:3-10.