Sleepwalkers may jump out of bed, walk around or even act out different activities, ranging from eating and rearranging furniture to leaving the house and driving a car. Individuals who sleepwalk usually have no memory of the event.
The cause of sleepwalking is not well understood and rarely involves any serious underlying medical or psychiatric problems. Treatment of sleepwalking is centered on improving sleep hygiene, identifying and managing potential triggers and keeping the sleepwalking individual safe from harm.
Here are some key points about sleepwalking. More detail and supporting information is in the main article.
- Parasomnias, common in the general population, arise as the brain transitions between rapid eye movement sleep (REM), non-rapid eye movement sleep (NREM) and wakefulness
- Sleepwalking is an incomplete disconnection of wakefulness from sleep that occurs during NREM sleep
- Sleepwalking occurs in about 15% of children, peaking between age 8 and 12 years and typically resolving during adolescence
- Children who sleepwalk will often talk in their sleep and have night terrors
- For most children, treatment is unnecessary; the child is usually unaware of the event at the time of occurrence and does not recall the event in the morning
- Childhood-onset sleepwalking continues into adulthood in 20% of cases
- Adult sleepwalking affects 2.5% of the general population
- Around 1 out of every 3 people will sleepwalk at some point in their lives
- Individuals have a 10-fold or higher increased risk of developing sleepwalking if one or both parents were sleepwalkers
- Stress can play a significant role in triggering sleepwalking
- Drug and alcohol consumption has been linked to sleepwalking activity
- Sleepwalkers should be kept safe and gently guided back to bed without being fully woken.
What is sleepwalking?
Sleepwalking is a parasomnia - an unwanted event that occurs during sleep. Other parasomnias include sleep paralysis, confusion arousals and night terrors.
Sleepwalking occurs during the first third of the night in non-rapid eye movement sleep.
Sleepwalking is a disorder of arousal that occurs while the brain is in deep non-rapid eye movement sleep (NREM stages 3 and 4). This period of sleep happens during the first third of the night.
In a sense, sleepwalking is an error in timing and balance, where something triggers the brain out of deep sleep and into a transitional state between sleeping and waking. As dreaming only occurs during REM (rapid eye movement) sleep, sleepwalkers 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 who are awakened during sleep are typically disoriented and confused. 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 exhibits decreased awareness and responsiveness to their surroundings. The sleepwalker appears clumsy and may trip over furniture, walk into mirrors, walk through a window or fall down stairs, potentially resulting in injury.
The frequency of sleepwalking episodes varies from person to person. Some have only isolated, rare occurrences, while others may have multiple events per night.
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 in a different location in the house.
Causes of sleepwalking
N-REM is the deepest part of the sleep cycle, when the brain is most resistant to awakening. This period of sleep is when the brain repairs itself and balances necessary chemicals and hormones.
The exact cause of sleepwalking is not well understood, although research suggests children are most vulnerable because a child's brain is still maturing.
Known triggers of sleepwalking include:
- Comorbid sleep disorders, particularly obstructive sleep apnea (OSA)
- Sleep deprivation
- Fever or illness
- Menstrual cycle or pregnancy
- Extreme exercise or fatigue
- Environmental stimuli
- Bladder fullness
- Sleeping in strange surroundings
- Emotional or situational stress
- Childhood separation anxiety
- Medications including phenothiazines, chloral hydrate, zolpidem and lithium.
Signs and symptoms of sleepwalking
Sleepwalking is a general term that can involve many varieties of movements and activities that are not typical of sleep. Some behaviors may be bizarre and life-threatening such as driving a car or discharging a weapon.
Episodes of sleepwalking can range from sitting up in bed to driving a car.
Examples of 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
- Engaging in sexual activity.
Although the majority of sleepwalking incidents are harmless, sleepwalking can be dangerous and can lead to serious harm to the individual experiencing the event, as well as innocent bystanders.
The sleepwalking individual is in an altered state of consciousness and has impaired judgment. When told of their sleepwalking behavior the next day, they may be dumbfounded, with no recollection of their nighttime behavior. Some adult sleepwalkers are more apt to recall fragments or vague impressions of the event.
Diagnosis of sleepwalking
All individuals who experience more than an occasional sleepwalking episode should see a health care provider for a complete evaluation. Most of the time, sleepwalking can be diagnosed through gathering a good history.
The provider will review the patient's medical history and current state of health. They will ask for a sleep/wake diary that provides details of any events such as the time of an event, how long it lasted, what movements and actions were involved and if there were any identifiable triggers. Blood work may also be carried out to rule out a hormone imbalance.
In order to look for other existing sleep disorders such as OSA, a sleep study (polysomnography) may be recommended for sleepwalking adults. An electroencephalogram (EEG) may also be obtained to determine if the sleepwalking could be a type of seizure. EEG abnormalities have been reported in up to 47% of patients with parasomnias.
Treatment and prevention of sleepwalking
Although sleep quality is generally not affected by the occasional sleepwalking event, recurrent episodes of sleepwalking can not only lead to significant worry for both the sleepwalking individuals and their families, but can also cause harm to the sleepwalker.
Maintaining a sleep-friendly environment is one measure that can help reduce the risk of sleepwalking.
Infrequently occurring (one to two times per month) sleepwalking episodes do not require medical treatment but rather reassurance that sleepwalking is a benign condition that eventually resolves on its own.
Because sleepwalking can result in accidents and self-injury from falls or leaving the house, safety measures must be put in place.
Sleepwalking safety measures include:
- Locking windows and doors leading outside
- Placing mattresses directly on the floor or using a sleeping bag
- Keeping the sleeping area uncluttered and removing dangerous objects from the bedroom, including mirrors and floor obstructions
- Keeping firearms or other weapons locked and out of reach
- Using padding on nearby furniture and the floor beside the bed
- Using a bedroom on the ground floor in a multilevel home
- Installing a bedroom door alarm
- Equipping the top of the stairs with a barrier or toddler gate.
Not all episodes of sleepwalking can be prevented. However, it is possible to lessen the frequency of episodes by being aware of and managing the common triggers that are under an individual's control.
Management of sleepwalking 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 managing stress is essential to getting sleepwalking under control
- Managing medication: there are also drug therapies that can be used to control symptoms - choices of medications might include lorazepam, clonazepam, amitriptyline or trazodone.
Although sleepwalkers have an increased risk for headaches and migraines when awake, while sleepwalking, they are unlikely to feel pain even after suffering an injury. These are the findings of research published in the journal Sleep.
According to the American Academy of Sleep Medicine, as many as 17% of children sleepwalk. Now, a new study suggests children are much more likely to do so if their parents have a history of sleepwalking, indicating there may be a genetic element to the disorder.
Sleepwalking is a parasomnia - an unwanted event that occurs during sleep. It runs in families and occurs most often in young children. Although it typically resolves by adolescence, 20% of sleepwalking children will continue to sleepwalk into their adulthood.
For the majority of individuals, sleepwalking is harmless. Management of sleepwalking consists of maintaining a regular sleep-wake schedule to ensure adequate amounts of sleep, environmental and behavioral modifications to promote safety, and identifying and avoiding potential triggers.