Sleepwalking, or somnambulism, means that a person might jump out of bed, walk around, or even engage in different activities, such as eating, without being aware.
Individuals who sleepwalk usually have no memory of the event.
This parasomnia, or disruptive sleep disorder, occurs in around 40 percent of children. However, this prevalence reduces dramatically by adulthood, dropping to between 2 and 3 percent.
In this article, we define sleepwalking and explain the symptoms, causes, and treatments for this common disorder.
Sleepwalking is an involuntary event that occurs during sleep. People refer to this as a parasomnia. Other parasomnias include sleep paralysis, confusion arousals and night terrors.
In particular, sleepwalking is a disorder of arousal that occurs while the brain is in stages 3 and 4 of deep non-rapid eye movement sleep (NREM). This period of sleep happens during the first third of the night.
A trigger shifts the brain from deep sleep into a transitional state between sleeping and waking. As dreaming only occurs during rapid eye movement (REM) sleep, people who sleepwalk are not acting out their dreams.
A sleepwalking event may last from several minutes to up to an hour.
Individuals with this type of parasomnia typically experience disorientation and confusion. The sleepwalking individual’s mind is asleep but their body is awake, allowing the individual to perform complex behaviors, such as eating, walking around, and engaging in conversations.
During episodes of sleepwalking, the individual shows decreased awareness and responsiveness to their surroundings. The sleepwalker appears clumsy and may trip over furniture, walk into mirrors or through windows, or fall down the stairs, potentially resulting in injury.
The frequency of sleepwalking episodes varies between people. Some have only isolated, rare occurrences, while others may have multiple events per night. Among children, 2–3 percent sleepwalk at least one time per month.
The majority of sleepwalking episodes do not result in any harm or accidental injury. Individuals will likely return to bed without incident or may find themselves waking up unharmed in a different part of their home.
N-REM is the deepest part of the sleep cycle, when the brain is most resistant to awakening. During this period of sleep, the brain repairs itself and balances necessary chemicals and hormones.
The exact cause of sleepwalking is not well understood, although research suggests the maturing brains of children are most vulnerable.
Known triggers of sleepwalking include:
- sleep deprivation
- alcohol and other sedative agents
- illnesses that cause fever
- certain medications, including phenothiazines, chloral hydrate, zolpidem, and lithium
- associated disorders, such as night terrors and sleep apnea
Children who wet the bed are also more likely to sleepwalk.
Sleepwalking can involve many movements, behaviors, and activities that are not typical of sleep. Some behaviors may be out of character or life-threatening, such as driving a car or discharging a weapon.
Examples of activities a person might carry out while sleepwalking include:
- sitting up in bed with a blank stare
- walking around the room or house
- urinating in inappropriate places, for example, in a closet
- rearranging furniture
- climbing out a window
- leaving the house
- driving a car
Although the majority of sleepwalking incidents are harmless, sleepwalking can be dangerous and might seriously harm the individual experiencing the event and people in the nearby vicinity.
For example, a person might turn on a kitchen appliance while sleepwalking that places people in the house at risk or leave the house without an awareness of oncoming traffic or hazards.
The sleepwalking individual is in an altered state of consciousness and has impaired judgment. On learning of their sleepwalking behavior the next day, people may experience shock or surprise and have no recollection of their night-time behavior.
Some people who sleepwalk as adults are more likely to recall fragments or vague impressions of the event.
All individuals who sleepwalk more often than an occasional episode should visit a healthcare provider for evaluation. Most of the time, a medical professional can reach a diagnosis of sleepwalking by gathering a thorough medical history.
They will also request that the person who sleepwalks completes a sleep/wake diary to provide details of any occurrences of sleepwalking, such as the duration and time of the event, the movements and actions that took place, and the presence of any identifiable triggers.
Blood tests may help rule out a hormone imbalance.
In order to look for other existing sleep disorders, such as obstructive sleep apnea (OSA), a doctor may recommend a polysomnography, or sleep study, for sleepwalking adults.
They may also take an electroencephalogram (EEG) to determine whether the sleepwalking could be a type of seizure.
The treatment of sleepwalking centers around improving sleep hygiene, identifying and managing potential triggers, and protecting the individual who sleepwalks from harm.
Although the occasional sleepwalking event does not generally affect sleep quality, recurrent episodes can lead to significant worry for both the individuals and their families. They can also cause physical harm to the person experiencing these events.
A person who experiences one or two sleepwalking episodes per month does not require medical treatment. Sleepwalking is harmless and eventually resolves without treatment.
As sleepwalking can result in accidents and self-injury from falls or leaving the house, a person who is prone to repeat episodes must put in place safety measures.
Safety measures to protect a person while sleepwalking include:
- locking windows and doors that lead outside
- placing mattresses directly on the floor or using a sleeping bag
- uncluttering the sleeping area and removing dangerous objects from the bedroom, including mirrors and floor obstructions
- keeping firearms or other weapons locked and out of reach
- padding and cushioning nearby furniture and the floor beside the bed
- in homes that have more than one level, sleeping in a bedroom on the ground floor to avoid the stairs
- installing a bedroom door alarm
- equipping the top of the stairs with a barrier or toddler gate
Preventing all episodes of sleepwalking is not likely. However, a person can reduce the frequency of sleepwalking episodes by being aware of and managing the common triggers that are under their control.
Management of more frequent sleepwalking episodes includes:
- keeping a regular sleep schedule and getting adequate sleep
- maintaining a sleep-friendly environment with comfortable bedding, cool temperatures, and room-darkening window covers
- eliminating and controlling stress
- managing medication that might be causing sleepwalking
- drug therapies that can help control symptoms, including lorazepam, clonazepam, amitriptyline or trazodone
Treating any other sleep disorders, such as OSA or restless leg syndrome (RLS), may help. Handling underlying medical problems, including gastroesophageal reflux disease (GERD), depression, and anxiety may help reduce the frequency of sleepwalking.
For the majority of individuals, sleepwalking is harmless.