Sleepwalking: Understanding Somnambulism – The Sleep Doctor

Sleepwalking is a parasomnia that causes people to engage in certain behaviors while asleep. During sleepwalking episodes, a person that is asleep may get out of bed and perform actions such as sitting, walking, eating, and driving. Sleep talking also may occur. 

Sleepwalking can happen at any age, and estimates suggest that up to 4% of adults sleepwalk. For these people, as well as their families and cohabitants, sleepwalking can cause worry, stress, and even injury.

Fortunately, there are multiple treatment options available for sleepwalking. We take a closer look at sleepwalking, what can trigger it, and steps people can take to prevent injuries during sleepwalking episodes. 

What Is Somnambulism (Sleepwalking)?

Somnambulism, commonly referred to as sleepwalking, is a sleep disorder in which a person performs everyday activities while still asleep. Events range from simple behaviors such as getting out of bed, walking, and talking, to more complicated movements such as eating or attempting to drive. 

Sleepwalking incidents usually happen during the first few hours after a person falls asleep. The episodes are generally brief. Typically, they last less than 10 minutes, but longer periods of up to 40 minutes have been observed in children who sleepwalk.

A sleepwalking person is generally disoriented. Most sleepwalkers are unaware that they are sleepwalking and usually do not recognize other people. Some people learn about their sleepwalking behavior if they become partially aware during the episode or they recognize the signs of a sleepwalking episode in the morning. 

Childhood Sleepwalking

Sleepwalking is more common among children than adults and some reports suggest the disorder may begin as early as 2 years old. The likelihood of sleepwalking decreases with age and most children grow out of their sleepwalking by the time they reach puberty. However, it can sometimes persist into adulthood. 

Experts recommend that parents who have a history of sleepwalking in their own childhoods should anticipate that their children might sleepwalk and take steps to prepare for it. If your child sleepwalks, be sure to inform caregivers and others who may look after them. 

Symptoms of Sleepwalking

Because most people who sleepwalk typically do not remember instances of sleepwalking, it can be challenging for them to recognize if they have sleepwalking symptoms. Many people learn about their sleepwalking after someone else, like a caregiver or roommate, observes their sleepwalking behavior and informs them about it.

During a sleepwalking episode, a person may present with the following symptoms: 

• Wide open eyes 
• Confused or glassy stare
• Monotone, slowed, or limited speech
• Delayed response or actions 
• Reduced cognitive capabilities
• Agitated appearance

People who sleepwalk may find evidence of their sleepwalking episodes. They may wake up somewhere different than where they went to bed. Additionally, they may find injuries or bruises on their bodies or notice that objects in the home are displaced. 

Some people who sleepwalk may also experience changes in their day-to-day function. 

They may feel fatigued or tired and have unusual difficulty staying alert or awake during the day. 

What Causes Sleepwalking?

The exact reasons why people sleepwalk are not yet known. However, there are several factors associated with sleepwalking. 

Genetics and family history appear to play a role in the likelihood that someone will sleepwalk. A person has a higher chance of sleepwalking if they have a family member who sleepwalks or has night terrors.

Other possible causes of sleepwalking are related to lifestyle and habits. Situational stress and sleep deprivation are linked to incidence of sleepwalking. Being sleep deprived for a long time can worsen sleepwalking episodes. Alcohol consumption and the use of certain medications may also lead to sleepwalking.

Sleepwalking events may be triggered by some sleep disorders, including obstructive sleep apnea and restless legs syndrome.

Sleepwalking can be a standalone condition or it can coexist with other types of medical conditions. Sleepwalking has been linked to mental health conditions, overactive thyroid, migraines, head injury, and stroke.

Additionally, sleepwalking is associated with daytime fatigue and behavioral and emotional problems in children. In some cases, an infection with a high fever can trigger or worsen sleepwalking behavior in children.

Is Sleepwalking Dangerous?

In most cases sleepwalking is not a serious condition, but it can lead people to hurt themselves and others. A person sleepwalking can act out routine or inappropriate behaviors, such as driving a car or climbing out a window. 

Some of these sleepwalking behaviors may result in injuries such as bruising or cuts. Although people sleepwalking can navigate walking in familiar settings, they are more likely to bump into obstacles or fall down. Even after getting injured, sleepwalkers may not wake up. 

People sleepwalking can also act out violently toward others. They may act out aggressively and throw objects. They may even attempt to defend themselves if someone attempts to grab, restrain, or awaken them while they are sleepwalking. 

How to Treat Sleepwalking

The primary treatment for sleepwalking involves managing daytime behaviors. In cases where a person is at risk for injuring themselves or others, medication may be prescribed by a health care professional. 

Improving sleep habits can help eliminate sleepwalking triggers. Experts recommend establishing a relaxing bedtime routine and going to sleep at a consistent time each night. Getting sufficient sleep every night is also key to reducing the risk of sleepwalking.

Another treatment option for sleepwalking is scheduled waking. This approach requires that someone else monitor when a person typically sleepwalks and fully wake them up 15 to 30 minutes before that time. For best effect, these scheduled wakings should be done each night for two to three weeks.

Tips for Sleepwalkers

There are ways to avoid triggering sleepwalking episodes and help keep people who experience sleepwalking episodes from injuring themselves and others. In addition to developing a regular and consistent sleep schedule, improving the safety of sleep environments can help protect people who sleepwalk. 

• Avoid triggers: Stress, alcohol, lack of sleep, and exposure to noise can trigger sleepwalking or worsen episodes. Limiting alcohol consumption, improving sleep habits, and reducing stress can help prevent sleepwalking.
• Consider an alarm: Locking exits in the home such as windows and doors can help protect people who sleepwalk. An electronic house or room alarm can be used to help wake the sleeper up when they leave their bed. Likewise, installing a door alarm could help provide an alert to caregivers, bed partners, and the sleeper. 
• Improve room safety: To prevent sleepwalking-related injuries, people who sleepwalk may consider reducing the height of their mattress. Cushioning furniture in the sleeping area and keeping the floor free of obstacles can prevent falls. Sharp objects, weapons, or other dangerous items should be stored outside of the bedroom.
• Review medications with a doctor: Medications such as sleeping pills, sedatives, and antibiotics are linked to sleepwalking behavior. People who sleepwalk should speak with a doctor about any medications they’re currently taking and share concerns they may have regarding how these medications may be impacting their sleep. 

When to Consult a Doctor About Sleepwalking

If you have been told you show symptoms of sleepwalking, or you find evidence of sleepwalking events, talk with your doctor. Talking with your doctor is especially important if you are sleepwalking frequently or at risk of injuring yourself or others. A doctor can determine if you have the sleep disorder and develop a plan for safety and treatment. 

Your health care provider can also help identify potential triggers of sleepwalking. They can determine if further testing for other sleep disorders or health conditions potentially contributing to your sleepwalking is necessary. 

Frequently Asked Questions About Sleepwalking