Sleepwalking

Sleepwalking holds a strong place in popular imagination. Sleepwalking may be used to explain strange occurrences, and In movies and TV, it’s not uncommon to see characters moving about absentmindedly and in a sleep-filled daze during key scenes. For this reason, there are a lot of misconceptions and gaps in knowledge when it comes to sleepwalking.

Thankfully, this condition, also known as somnambulism, affects only a small percentage of the population, and normally is not a serious or lasting problem. However, it can still have real effects for the people impacted by it. In this article, we’ll describe what sleepwalking is and will go into detail about its causes, risks, diagnosis, and treatment.

What Is Sleepwalking?

The medical term for sleepwalking is somnambulism, and it is a type of parasomnia. Parasomnias are unusual behaviors that happen while a person is sleeping, and somnambulism is one of the more common and well-known of these conditions. Despite the name, sleepwalking is not limited exclusively to pacing around while still asleep. It can encompass a range of actions that a person make take without being aware that they are doing them.

As we sleep, we progress through different sleep stages. An entire sleep cycle normally lasts around 90 minutes. Each stage involves different levels of brain activity. The last stage of the sleep cycle is known as REM (rapid eye movement) sleep, which involves a high level of brain activity. The other stages are known as NREM (non-REM) sleep. Sleepwalking normally happens during the last phase of NREM sleep (also known as N3).

Sleepwalking is more common in children and in adolescents. Most of the time, it does not happen frequently and is not a problem that lasts into adulthood. A meta-analysis of different epidemiological studies of somnambulism found that its lifetime prevalence is 6.9%, meaning almost 7% of the population experiences this at some point in their life. In this study, it was found that about 5% of children and 1.5% of adults had experienced an episode of sleepwalking within the prior 12 months.

What Are the Symptoms of Sleepwalking?

The symptoms of somnambulism involve varied types of actions while a person is asleep and without awareness that they are taking these actions. Examples can include:

  • Simply sitting up in bed with the eyes open
  • Small movements with the hands while sitting in bed
  • Walking around the home
  • Standing including staring into space
  • Mumbling or speaking incoherently
  • Being non-responsive or responding incoherently or inappropriately
  • Undertaking routine activities like getting dressed or going to the bathroom, including urinating in inappropriate places
  • Attempting to drive a car or other more complex actions

An episode of sleepwalking normally lasts less than 10 minutes but can go on for up to half an hour. Some episodes may be very short. Regardless of the length of the episode, a person who sleepwalks generally has no recollection that any of these actions have taken place.

What Are the Health Risks of Sleepwalking?

There are three main risks associated with somnambulism. The first arises from what a person may do while sleepwalking. Because of their lack of awareness, a person who is sleepwalking is at a high risk of tripping and falling or otherwise causing themselves bodily harm. The more complex the action, the higher the risk, especially in rare cases where someone tries to operate a vehicle or machinery.

Second, sleepwalking can be associated with lower quality sleep overall, which may increase the chances that a person will experience fatigue, daytime sleepiness, mood changes, cognitive changes, or other problems associated with lack of sleep. If someone knows that they sleepwalk, they may be anxious about going to bed, which can further exacerbate sleeping problems.

Third, sleepwalking may disturb family members. It can be upsetting to see a loved one sleepwalking, and it may create anxiety for them as well. It can also cause damage to a home if a person urinates in inappropriate places or otherwise does things that they shouldn’t while sleepwalking.

What Are the Causes of Sleepwalking?

It is not always clear why a person sleepwalks, but there are some things that are associated with it.

  • Prior sleep deprivation: people who have ongoing fatigue and lack of sleep are at greater risk. This is also the case for people with poor sleep hygiene.
  • Family history: somnambulism appears to be more common in people who have a first-degree relative who is known to sleepwalk.
  • Things that increase the likelihood of arousal during sleep: this can include things like drinking lots of caffeine, using stimulant drugs, exercising intensely, or even watching high-intensity movies or TV shows before bed.
  • Things that stimulate N3 sleep: this can include some sleeping pills and medications as well as alcohol.
  • Some mental or medical conditions: some underlying conditions, including seizures, can make sleepwalking more likely.

As mentioned previously, it is more common in children and adolescents than in adults, so age is also a risk factor.

How is Sleepwalking Diagnosed?

Somnambulism can be a difficult condition to diagnose precisely because people who sleepwalk do not know that they do it. Often they only seek medical care because a family member or friend has seen them sleepwalk or because they have injured themselves during an episode of sleepwalking.

If somnambulism is suspected, a doctor usually does a health history and physical exam. During the health history, the doctor collects information about any recent symptoms as well as any pre-existing medical issues. In the case of sleepwalking, this history may involve talking with family members who might be more aware of the issue and its prevalence. During the physical exam, the doctor can check for any abnormalities or other health issues.

Though it is not often prescribed for sleepwalking, an overnight sleep study, known as polysomnography, may be used. By spending a night in a sleep lab, doctors can monitor your body and brain while you sleep to gather data about your sleep cycles. Obviously, they can also observe your behavior (including any sleepwalking) while you are in the lab.

Anyone who has had multiple bouts of sleepwalking, has injured themselves sleepwalking, or has sleepwalking that persists from childhood or adolescence into adulthood should meet with a health professional to determine the most appropriate diagnostic steps.

How is Sleepwalking Treated?

In most cases, specific treatment for sleepwalking is not necessary because it is not an ongoing or recurring issue. This is especially the case if it occurs in children as in this population the problem normally goes away naturally with time.

One key aspect of treatment for sleepwalking can relate to harm reduction. This means reducing the ways that a person may become injured while sleepwalking. For example, this can include:

  • Keeping a nearby light on as this may reduce a person’s ability to stay asleep once they are up and moving.
  • Using a bed alarm that goes off if a person gets up.
  • Keeping dangerous or sharp objects away from the bed.
  • Removing items that are potential tripping hazards, such as clothes, boxes, or cords, from the floors in and around the bedroom.
  • Placing the mattress directly on the floor instead of on a higher bed frame or platform.

To try to prevent sleepwalking from happening in the first place, there are a few steps that may be recommended. These include:

  • Improving sleep hygiene: by getting better and more consistent sleep, a person is less likely to sleepwalk. Good sleep hygiene also involves avoiding some of the risk factors for sleepwalking such as consumption of caffeine or alcohol late in the day.
  • Stress reduction: because anxiety may contribute to sleepwalking, calming and stress reduction techniques may help. This can include things like trained self-hypnosis. It can also involve seeing a counselor or psychiatrist who can use talk therapy (cognitive behavioral therapy) to try to address any underlying issues that may cause stress or anxiety.

The only medications that are regularly used for somnambulism are benzodiazepines, specifically the drug clonazepam. This is not normally the first line of treatment but is used if the above methods are not effective. This drug can work in the short-term by reducing the likelihood that a person will be stimulated during N3 sleep.

Can You Safely Wake a Person Who is Sleepwalking?

Yes. It is an urban legend that you can’t wake someone up when they are sleepwalking. That said, it can agitate someone when they are woken up since they are likely to be unaware of their surroundings. In some cases, it can be easier and better for all parties to slowly lead or guide a person who is sleepwalking back to bed rather than waking them up.

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