Sleepwalking, known sometimes as somnambulism, is a behavior disorder that originates during deep sleep and results in walking or performing other complex behaviors while still mostly asleep. It occurs suddenly and without warning usually within the first three hours after sleep onset. Sleepwalking tends to run in families. It is more common in children than adults and is more likely to occur if a person has a family history of sleepwalking, is sleep deprived, or is prone to repeated nighttime awakenings. Sleepwalking and sleep talking both belong to a group of behaviors called parasomnias—unusual or harmful behaviors that occur during sleep.
Sleepwalking is more common in children. This might be because the brain is still developing and that neurons that release GABA are still developing in children. Sleepwalking in children tends to peak between 8 and 12 years old. Children who sleepwalk may also have a condition called confusional arousal, which occurs when a person appears to be awake but is confused or unaware. Sleepwalking is much more common in children and young adults than in older adults. This is not surprising as people age, they have less N3 sleep (deep sleep). Fatigue, lack of sleep, and anxiety are all associated with sleepwalking. In adults, sleepwalking may occur due to: Alcohol, sedatives, or other medicines, such as some sleeping pills; Medical conditions, such as seizures; mental health concerns. In older adults, sleepwalking may be a symptom of a medical problem that causes decreased mental function like a neurocognitive disorder.
It is a myth that waking up a person who is sleepwalking is dangerous. However, a person who is woken up from a sleepwalking episode may be confused or alarmed. Calling the sufferers’ name typically evokes no purposeful response and attempting to shake them into wakefulness will often meet limited success or produce a confused half-asleep individual.
During an episode of sleepwalking, a person may have open, glassy eyes with a blank look on their face. They are usually minimally responsive or incoherent in their speech. Other types of actions have also been described: routine actions like getting dressed, moving furniture, or urinating in inappropriate places. Sleepwalking episodes can last for a few seconds to a half an hour with most finishing in less than 10 minutes. The person may return to bed and go back to sleep on their own, or they may wake up confused while they are still out of bed.
Sleepwalking normally happens when a person is in a stage of deep sleep and gets partially awoken in a way that triggers physical activity while remaining mostly asleep. The following situations can trigger sleepwalking or make it worse: not getting enough sleep; stress and anxiety; infection with a fever, especially in children; drinking too much alcohol; taking recreational drugs; certain types of medication, such as some sedatives; being startled by a sudden noise or touch, causing abrupt waking from deep sleep; waking up suddenly from deep sleep because one needs to go to the toilet. All of these factors promote increased slow wave sleep (SWS) and NREM sleep instability.
A lack of sleep has been correlated with an elevated risk of sleepwalking, which may be due to more time spent in deep sleep after a period of sleep deprivation. Subjects should avoid sleep deprivation whenever possible, and thus adults significantly troubled by sleepwalking should not work rotating night/day shifts.
Medications with a sedative effect may push people into a type of sleep that increases their chances of having a sleepwalking episode. Some medications have also been linked to sleepwalking and sleep talking. Sleep eating is one of the most common medication-related behaviors, but driving and other unusual behaviors have also been reported.
Drinking alcohol in the evening can create instability in a person’s sleep stages and may heighten the risk of sleepwalking. In children, fever has been found to make sleepwalking more likely, and it may be related to an increased number of illness-driven arousals during the night.
Obstructive sleep apnea is a sleep disorder in which the airway gets blocked, causing short lapses in breath during sleep. These pauses, which can occur dozens of times per night, create sleep interruptions that may give rise to sleepwalking.
Various types of stress can affect sleep, including causing more fragmented or disrupted sleep that can increase the propensity for sleepwalking. Some types of stress may be related to discomfort or change such as when traveling and sleeping in an unfamiliar place.
It is a myth that a person cannot be injured while sleepwalking. Sleepwalkers are commonly injured when they trip and lose their balance. Safety measures may be needed to prevent injury. This may include moving objects such as electrical cords or furniture to reduce the chance of tripping and falling. Stairways may need to be blocked with a gate. Harm reduction is an important consideration for people who sleepwalk. Some ways that safety risks can be reduced include: keeping sharp objects or weapons locked away and out of reach; closing and latching doors and windows; removing tripping hazards from the floor; installing lights with motion sensors.
Sleepwalking can occur when sleep is fragmented by other sleeping problems. Obstructive sleep apnea (OSA) is a common medical problem that can lead to frequent arousals from sleep. Symptoms of OSA include snoring, waking up gasping for air, and daytime sleepiness. Treatment of OSA may improve sleepwalking. Similarly, if the use of sedatives or other medications is contributing to sleepwalking, the doctor may recommend changing the dosage or switching to a different drug.
Anticipatory awakening is waking someone up shortly before a potential sleepwalking episode is likely to occur. If your child sleepwalks at the same time most nights, try gently waking them for a short time 15 to 30 minutes before they would normally sleepwalk – this may stop them sleepwalking by altering their normal sleep cycle
Sleep hygiene refers to a person’s sleep-related environment and habits. Poor sleep hygiene, such as having an inconsistent sleep schedule or drinking caffeine or alcohol close to bedtime, can contribute to sleeping problems and sleep deprivation.
Improving sleep hygiene encourages more stable and dependable sleep while reducing the risk of sleep deprivation that can trigger sleepwalking. You may find the following advice helpful: try to go to bed at a similar time each night; make sure your bedroom is dark and quiet when you go to sleep; limit drinks before bedtime, particularly those containing caffeine, and go to the toilet before going to sleep; find ways to relax before going to bed, such as having a warm bath, reading or deep breathing.
Cognitive behavioral therapy (CBT) is a form of talk therapy that counteracts negative thoughts and actions. CBT for insomnia has demonstrated effectiveness in improving sleep, often by reframing how a person thinks about sleep. Careful application of CBT, including relaxation techniques, may help prevent stress-related episodes of sleepwalking.
