Sleepwalking is also called “somnambulism.” It is a parasomnia. A parasomnia involves undesired events that come along with sleep.
Sleepwalking occurs when you get up from bed and walk around even though you are still asleep. It can also involve a series of other complex actions. Before walking, you might sit up in bed and look around in a confused manner. At other times, individuals may bolt from the bed and walk or run away. They may be frantic to escape from a threat that they dreamed or imagined.
You might talk or shout as you are walking. Your eyes are usually open and have a confused, “glassy” look to them. You might begin doing routine daily actions that are not normally done at night.
More often, it involves actions that are crude, strange, or in the wrong place. This might include urinating in a trash can, moving furniture around, or climbing out of a window. It can also result in hostile and violent behavior.
In rare cases, a patient will get in the car and drive away. He or she might even go for a very long distance. Indecent exposure and other sexual behaviors may also occur. Adults might dream or hallucinate while they sleepwalk. Some people will eat.
It can be very hard to wake a sleepwalker up. When you do wake up, you can be very confused. This is because you normally have no memory of the event. Adults sometimes recall bits and pieces of what took place. Less often, they will have a very clear memory of all that happened.
At times, you might even attack the person who wakes you. Men, especially, are often violent during these episodes. The walking can also suddenly end by itself. This might leave the individual in a very awkward place. At other times, the individual may return to bed while still asleep. He or she will have never awakened during the event.
Sleepwalking most often occurs in the first third of a night’s sleep or during other long sleep periods. This is during the slow-wave cycle of sleep. Every now and then, it can occur during a daytime nap.
Episodes can occur rarely, or very often. They can even happen multiple times a night for a few nights in a row. The main risk is injury to self, the bed partner, or others in the same home. It can also disrupt the bed partner’s sleep.
Sleepwalking can usually be seen as a fairly normal part of a child’s early sleep patterns. The child with calm sleepwalking may quietly walk toward a light or to the parents’ bedroom.
At times, kids will walk to a window or door, or even go outside. This can put them at great risk. Older children may be more vocal and active as they sleepwalk. Children who sleepwalk will often talk in their sleep and have sleep terrors.
Who gets it?
Sleepwalking is more common in children and affects both boys and girls. It can begin as soon as a child is able to walk. The rate of it in children is as high as 17%. It peaks by the time they are eight to 12 years old. Most children with it also had confusional arousals at a younger age.
Rarely, sleepwalking may begin at any time in the adult life, even when someone is in their seventies. Up to 4% of adults sleepwalk. In adults, men are much more likely to display aggressive behavior when they sleepwalk.
There is a strong genetic and family link to having it. Your chance of having it can double or almost triple if one or both parents had sleepwalking episodes as a child or adult.
Episodes of sleepwalking and sleep terrors share many of the same causes. These include the following:
- Sleep deprivation
- Hyperthyroidism (overproduction of thyroid hormones)
- Migraine headaches
- Head injury
- Encephalitis (brain swelling)
- The premenstrual period
- Bloated stomach
- Physical or emotional stress
- Obstructive sleep apnea (OSA)
- Other sleep-related disorders or events
- Sleeping in unfamiliar surroundings
- Some medications
- Alcohol use and abuse
- Noise or light
- Fevers in children
How do I know if I have it?
- At times, do you get out of bed and walk around while you are still asleep?
- Do you perform routine actions at strange times?
- Do you perform crude or bizarre actions during these events?
- Are any of these behaviors dangerous?
- Are you confused after others struggle to wake you?
- Is it hard for you to remember what took place?
If your answer to the first question and at least one of the others is yes, then you might have the sleepwalking disorder.
It is also important to know if there is something else that is causing your sleep problems. They may be a result of one of the following:
- Another sleep disorder
- A medical condition
- Medication use
- A mental health disorder
- Substance abuse
Do I need to see a sleep specialist?
Sleepwalking in children is fairly normal. It does not usually need medical treatment. Parents should simply keep a close watch on their child. An adult who continues or begins to sleepwalk is at a greater risk of injury. In this case, it would be a good idea to seek a doctor’s advice.
What will the doctor need to know?
You should complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. You can also rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life.
The doctor will need to know your complete medical history. Be sure to inform him or her of any past or present drug and medication use. Also tell the doctor if you have ever had any other sleep disorder.
Will I need to take any tests?
Your doctor will likely have you do an overnight sleep study if you are an adult. This is called a polysomnogram. The polysomnogram charts your brain waves, heart beat, and breathing as you sleep. It also records how your arms and legs move. This shows if there are other disorders, such as sleep apnea, that are causing your sleep problems.
The best sleep study will also record your sleep on video. This will help show if you get out of the bed and do anything unusual during the study.
How is it treated?
For children, it tends to go away on its own as they enter the teen years.
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. This may increase the risk of parasomnias such as sleepwalking. Symptoms of OSA include snoring, waking up gasping for air, and daytime sleepiness. Treatment of OSA may improve sleepwalking.
Tips for Parents
- Sleepwalking is a parasomnia that is very common in children. Although it usually is harmless, your child can be at risk of an injury. These tips will help you keep a sleepwalking child safe:
- Calmly help your child return to bed during a sleepwalking episode.
- Tie a bell to your child’s doorknob to alert you when the door is opened.
- If your child sleeps upstairs, install a safety gate at the top of the stairs.
- Make sure that all windows in the house are locked securely.
- Install locks out of your child’s reach on all doors that lead out of the house.
- If episodes occur regularly at the same time of night, briefly wake your child just before that time.
SOURCE: American Academy of Sleep Medicine; Reviewed by David Kuhlmann, MD
Updated August 31, 2007