Sleepwalking

Sleepwalking (somnambulism) is a sleep disorder where a person gets out of bed and performs various activities while still deeply asleep. It usually happens during deep non-REM sleep and individuals typically have no memory of the event. While more common in children who often outgrow it, it can also affect adults. The main concern is the risk of injury during an episode.

What is Sleepwalking?

Sleepwalking, also known as somnambulism, is a type of sleep disorder called a parasomnia. It involves complex behaviors, such as walking or performing routine activities, while a person is in a state of deep sleep. During an episode, the individual is not fully conscious and typically has no memory of what happened.

Sleepwalking usually occurs during the deepest stage of non-rapid eye movement (non-REM) sleep, often in the first third of the night. This is when the brain is in a state where it's deeply asleep but can still activate motor functions. The person's eyes are often open, but they may have a glassy, unfocused stare and will not respond to attempts to communicate. While sleepwalking, a person might do simple things like sitting up in bed, looking around confused, or getting out of bed and walking. They might also perform more complex actions, such as dressing, talking, eating, opening doors, or even attempting to drive a car. These actions are often routine and familiar to the individual. It is generally difficult to wake someone who is sleepwalking. If they are woken, they may be confused, disoriented, or even agitated for a short time. The most significant risk associated with sleepwalking is the potential for injury, either to themselves or others, because they are not aware of their surroundings or actions.

Symptoms

The primary symptom of sleepwalking is getting out of bed and moving around while still asleep. Other common signs include a blank or glassy stare, unresponsiveness, difficulty waking the person, and no memory of the event afterward. Behaviors can range from simple movements to complex actions.

During a sleepwalking episode, you might observe several distinct behaviors. The person may sit up in bed and appear confused, or they might get out of bed and walk around the room or house. Their eyes are typically open, but they often have a vacant or glassy stare, and they may not recognize people or respond to questions. Sleepwalkers can perform a variety of actions. These can include routine activities like dressing, talking, eating, or moving objects. In some cases, more complex or potentially dangerous actions can occur, such as leaving the house, going to the bathroom, or even attempting to drive a car. The person is usually difficult to wake up during an episode. After an episode, if the person wakes up on their own or is gently roused, they will likely be confused or disoriented for a few minutes. A key characteristic of sleepwalking is that the individual typically has no memory (amnesia) of the sleepwalking event when they fully wake up in the morning. Episodes can last from a few minutes to half an hour or more.

Causes & risk factors

Sleepwalking often has a genetic link, meaning it can run in families. Key risk factors include sleep deprivation, stress, and certain medical conditions or medications. It is more common in children, but various factors can trigger or worsen episodes in both children and adults.

A strong risk factor for sleepwalking is having a family history of the condition. If one or both parents were sleepwalkers, their children are more likely to experience it. This suggests a genetic predisposition plays a significant role in who develops sleepwalking. Several other factors can trigger or worsen sleepwalking episodes. These include a lack of sleep (sleep deprivation), high levels of stress or anxiety, and extreme fatigue. In children, fever can sometimes trigger sleepwalking episodes. Certain medications, such as sedatives, hypnotics, some antidepressants, and antihistamines, may also increase the likelihood of sleepwalking. Underlying medical conditions can also contribute to sleepwalking. These include sleep-disordered breathing conditions like obstructive sleep apnea, restless legs syndrome, gastroesophageal reflux disease (GERD), and hyperthyroidism. Other neurological conditions, such as migraines, head injuries, or stroke, have also been associated with sleepwalking in some adults. Alcohol and recreational drug use can also increase the risk.

How it's diagnosed

Diagnosing sleepwalking typically involves a thorough review of your medical history and symptoms. Your doctor will ask about your sleep patterns and any observed behaviors during sleep. In some cases, a sleep study may be recommended to rule out other sleep disorders or confirm the diagnosis.

When you see a doctor about suspected sleepwalking, they will usually start by taking a detailed medical history. This includes asking about your sleep habits, any medications you are taking, and if there's a family history of sleepwalking or other sleep disorders. They will also want to know about the specific behaviors observed during sleepwalking episodes, how often they occur, and how long they last. It can be helpful to keep a sleep diary for a couple of weeks before your appointment. In this diary, you can record your sleep schedule, any sleepwalking incidents, and other relevant information like stress levels or medication use. If you live with others, their observations of your sleepwalking episodes are very valuable, as you won't remember them yourself. In most cases, a physical exam is also performed to check for any underlying health conditions. If your sleepwalking episodes are frequent, severe, potentially dangerous, or if your doctor suspects another sleep disorder like sleep apnea, they might recommend a sleep study (polysomnography). This involves spending a night in a sleep lab where sensors monitor your brain waves, breathing, heart rate, and leg movements during sleep. This helps to confirm the diagnosis and identify any contributing factors.

Treatment options

Treatment for sleepwalking often begins with ensuring safety and addressing any underlying causes. For children, episodes often decrease with age and may not require specific treatment. For adults, managing stress, improving sleep hygiene, and sometimes scheduled awakenings can help. Medications are typically reserved for severe or dangerous cases.

The first priority in managing sleepwalking is to ensure the safety of the individual. This involves taking precautions at home, such as locking windows and doors, removing tripping hazards, and sleeping on a ground-floor bedroom if possible. If the person has a history of falling out of bed, a mattress on the floor can be a good safety measure. Addressing any underlying causes or triggers is also crucial. This might involve treating conditions like sleep apnea or restless legs syndrome, managing stress and anxiety, or adjusting medications that could be contributing to the episodes. Improving overall sleep hygiene, such as maintaining a regular sleep schedule, creating a relaxing bedtime routine, and avoiding caffeine and alcohol before bed, can also be beneficial. For frequent or predictable episodes, a technique called scheduled awakenings (or anticipatory awakenings) may be recommended. This involves gently waking the person about 15-20 minutes before their usual sleepwalking time for a few nights, then letting them fall back asleep. This can disrupt the sleep cycle that leads to sleepwalking. While some medications, such as low-dose benzodiazepines or certain antidepressants, have been used for severe cases, the Cochrane Library notes there is currently insufficient evidence to determine the effectiveness of any specific intervention for sleepwalking. These medications are generally considered for short-term use when other methods are not effective or when there is a significant risk of injury.

Recovery & outlook

The outlook for sleepwalking is generally good, especially for children, who often outgrow the condition by their teenage years. For adults, sleepwalking can sometimes persist or begin later in life. While usually harmless, the main concern is the risk of injury during an episode. Managing triggers and ensuring safety are key to a positive outlook.

Most children who experience sleepwalking will naturally stop by the time they reach their teenage years. The frequency and intensity of episodes often decrease as their brain matures and their sleep patterns become more stable. For these children, specific medical treatment is usually not needed, and the focus remains on safety measures at home. In adults, sleepwalking can sometimes be a chronic condition, or it may start for the first time in adulthood. When sleepwalking begins in adulthood, it's more likely to be associated with other underlying medical conditions, stress, or medication use. Identifying and treating these contributing factors can often lead to a reduction or cessation of episodes. While sleepwalking itself is not typically dangerous, the primary concern is the potential for injury. People can trip, fall, or accidentally harm themselves or others while unaware of their surroundings. With appropriate safety measures, management of triggers, and sometimes behavioral therapies or medications, many individuals can effectively reduce the frequency and risk associated with sleepwalking episodes, leading to a better quality of life and improved sleep safety.

When to see a doctor

You should see a doctor if sleepwalking episodes occur frequently, lead to injuries, or cause significant disruption or embarrassment. It's also important to seek medical advice if sleepwalking starts for the first time in adulthood, or if it's accompanied by other concerning symptoms or behaviors during sleep.

While occasional sleepwalking, especially in children, may not require a doctor's visit, there are specific situations when medical attention is recommended. You should consult a healthcare professional if sleepwalking episodes become frequent, meaning they happen often enough to cause concern or disrupt your sleep or the sleep of others in your household. It is particularly important to see a doctor if sleepwalking leads to injuries, either to yourself or to others. This includes falls, bumps, cuts, or any other physical harm that occurs during an episode. If the sleepwalking behaviors are becoming increasingly complex, dangerous, or causing significant embarrassment or distress, professional evaluation is warranted. Additionally, if sleepwalking begins for the first time in adulthood, it's crucial to see a doctor. Adult-onset sleepwalking can sometimes be a sign of an underlying medical condition, another sleep disorder, or a reaction to medication. Your doctor can help determine the cause and recommend appropriate management or treatment.

Frequently asked questions

Is it dangerous to wake someone who is sleepwalking?

It is generally not dangerous to wake a sleepwalker, but it can be difficult. If you do wake them, they may be confused, disoriented, or even agitated. Instead of trying to startle them awake, it's often safer to gently guide them back to bed to prevent injury.

Can sleepwalking be a sign of a serious mental health problem?

Sleepwalking is not typically a sign of a serious mental health problem. It is a sleep disorder. However, high levels of stress, anxiety, or certain mental health conditions can sometimes act as triggers or risk factors for sleepwalking episodes. If you have concerns, discuss them with your doctor.

Do people remember what they do when they sleepwalk?

No, people typically have no memory of their sleepwalking episodes. This is because sleepwalking occurs during deep non-REM sleep, a state where the brain is not fully conscious or capable of forming new memories of the event.

How can I make my home safe for a sleepwalker?

To make your home safe, remove tripping hazards from floors, lock windows and doors, and consider installing gates at the top of stairs. If possible, have the sleepwalker sleep on a ground-floor bedroom. Keep dangerous objects out of reach and ensure sharp items are securely stored.

Is sleepwalking more common in children or adults?

Sleepwalking is significantly more common in children, particularly between the ages of 3 and 7. Most children outgrow it by their teenage years. While less common, it can also affect adults, sometimes starting for the first time in adulthood due to various triggers.

Can stress cause sleepwalking?

Yes, stress and anxiety are known risk factors that can trigger or worsen sleepwalking episodes in both children and adults. Managing stress through relaxation techniques, therapy, or lifestyle changes can sometimes help reduce the frequency of sleepwalking.

Sources

• MedlinePlus — Sleepwalking
• Mayo Clinic — Sleepwalking
• Cochrane Library — Sleepwalking