Before we get into sleepwalking itself, let’s briefly go over parasomnias. This category of sleep disorders is characterized by abnormal movements, perception, and behavior while falling asleep and during and between any stages of sleep. Most parasomnias function as a combination of sleeping and wakefulness. Sleepwalking (or somnambulism) itself is a disorder that belongs to the parasomnia category. It makes the affected person get out of bed and start walking during their sleep or perform other waking actions. It’s also fairly common, with an estimated 3.6% of US adults having reported sleepwalking symptoms more than once per week.
The main threat of sleepwalking is the vastly increased risk of the person colliding with something or falling over, which can injure them. They can also cause damage to their surroundings, including other people (although this happens very rarely). Because of this, it is important to learn how to deal with a sleepwalker in a safe and controlled manner. There’s a myth circulating that claims that if you wake a sleepwalker while they’re moving around, it’s physically harmful to them. In general, there’s a lack of understanding of how sleepwalking works among the general public. That’s where this article comes in. We’ve made it our task to explain enough about sleepwalking that you can help your loved ones stay safe while they’re dealing with this disorder. We will look at causes, present prevention tips, and advice on how to properly wake a sleepwalker. Let’s get right into it.
What Causes Sleepwalking?
Unfortunately, we can only hypothesize about all the potential causes for sleepwalking. There is little to no evidence supporting most of these claims, but we have somewhat safe assumptions we can work with. We will briefly cover these so you can think about whether they apply to you or your loved one. The nature and symptoms of sleepwalking vary from person to person, so everyone can have their own cause and quirks.
Sleep deprivation is one of the most common causes of sleepwalking if the consensus is to be believed. Originally, it was thought that sleepwalkers couldn’t stay in slow-wave sleep for a standard amount of time, but recent studies show that they actually spend more time in slow-wave sleep than they ought to. As a result of this, increased slow-wave sleep has been considered a potential cause for sleepwalking. In some instances, a separate cause .called excessive tiredness has been connected to sleep deprivation, and it certainly makes sense.
Additionally, sleepwalking may have a genetic component to it. If both parents have sleepwalked, their child has around a 60% chance to sleepwalk themselves. If only one parent has dealt with this issue, that chance drops to roughly 45%. This doesn’t mean that the child will exhibit the same sleepwalk pattern as either parent, as other factors can (and will) affect this. In general, children and adolescents are much more prone to sleepwalking than adults, and sleepwalking can subside entirely as the person grows older.
Conditions such as Parkinson’s Disease are widely considered a cause of sleepwalking, even in patients who aren’t otherwise predisposed to it and have no sleepwalking history. Children with restless legs syndrome have a greater chance of also suffering from sleepwalking, as well.
How Do We Diagnose Sleepwalking?
If the causes are unclear and vague, then how do we diagnose sleepwalking? Well, the most accurate (or the only accurate) method we have is polysomnography. This is a multi-parametric sleep study that takes place over the course of a night in a specialist sleep lab. The diagnostic devices they use measure all your relevant bodily functions while you sleep, such as skeletal muscle movement, brain activity, eye movement or heart rhythm. While polysomnography is quite accurate and helpful, it is expensive and demands a lot of time from the patient.
The American Academy of Sleep Medicine (AASM) developed and published the International Classification of Sleep Disorders (ICSD). It was made in association with sleep research associations in Latin America, Europe, and Japan. It is a diagnostic resource used by clinicians and sleep researchers, particularly in the field of sleep medicine development. Along with two other resources we will mention, it is one of the most common pieces of referential and diagnostic material used by doctors everywhere. The most recent version, called ICSD-3, was released in 2014.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is designed to provide a common language and standardized criteria for classifying mental disorders. It’s not used only by clinicians and researchers, but rather a whole host of health-related organizations, such as health insurance agencies, the legal system, and drug regulation agencies. As of May 18, 2013, the DSM is in its 5th edition, also known as DSM-5. The idea for this manual came from how census collecting systems operated, as well as a United States Army manual.
The final widely used diagnostic tool is the International Statistical Classification of Diseases and Related Health Problems, often shortened to ICD (don’t confuse this with the ICSD, although their purpose is largely the same). The ICD is managed and maintained by the World Health Organization (WHO), the primary health authority in the United Nations. The ICD provides a standardized code for disease classification, but it doesn’t stop there. Every variation and combination of symptoms, backgrounds, anomalies and external factors can be classified thoroughly using this code. The most recent version, ICD-11, comes with ontological and terminological elements to be used in the area of digital health.
Another diagnostic method is a simple report, often submitted by the patient themselves, their parent (in case the sleepwalker is a child or adolescent), or partner. If you plan on submitting a report, however, be sure you’re aware of the sleepwalker’s behavior when they’re sleepwalking. The more detail you can provide, the easier it is to receive good advice. Sleepwalkers can exhibit a wide range of different behaviors, which includes (but is not limited to):
- Playing with the bedsheets, pillows and nearby objects
- Talking in their sleep prior to other behaviors
- Getting out of bed and walking around the house
- Going to the bathroom in inappropriate places (a lot of sleepwalkers will choose rooms where the light is still on; keeping the light on in the bathroom can help minimize the inconvenience)
- Becoming agitated and even violent (incredibly rare)
- Attempting to have sex with their sleeping partner
They may also initially look awake, as their eyes can be open, but they won’t be nearly as responsive to their surroundings as a waking person.
How Do You Properly Wake Up a Sleepwalker?
The main risks of sleepwalking often revolve around injury. Not only can a sleepwalker put themselves in danger due to how limited their perception is of the surrounding area, but they can also potentially harm others – for example, a sleepwalker can get into and start driving a car, seriously endangering themselves and anyone in their way. It’s not always unsafe to wake a sleepwalker, but you have to be aware of the situation. Here are some general guidelines we can recommend:
– If possible, try to avoid touching the sleepwalker. Anything more than a gentle touch can startle them, which can cause them to lash out and hurt the person trying to help. If you feel like you must wake the sleepwalker, first try loud, sharp noises. Be sure you’re at a safe distance when you attempt this, of course – that loud sound can startle them just as much as trying to shake them awake.
– If the sleepwalker is headed in a direction where they’re putting themselves at risk (such as a stairwell, the front door or front yard, or any room with plenty of sharp furniture edges), you often have to make direct contact with them. As gently as possible, turn the sleepwalker, so they start moving in the direction of their bedroom.
– Once they’re headed in the right direction (which is always towards their bed or another soft piece of furniture they can continue to sleep on), stay close to them and monitor their movement. You’re basically there as an extra pair of eyes, to prevent them from wandering into a corner or another risky obstacle. If they decide to “go to the bathroom” in the middle of this journey, don’t panic and fetch cleaning supplies without trying to make them stop. The good news is that most sleepwalkers tend to return to bed as soon as this happens.
– If you manage to wake them up, remember that they will be disoriented. Most people take anywhere from five to thirty minutes to regain their senses completely. Waking up in the middle of your home is a confusing, sometimes scary situation. Be there for them and help calm them down by slowly and softly explaining what happened. Offer them some water and rub some of it on their face to help them recover from possible dizziness.
Sleepwalking Prevention Tips
There’s no single guaranteed method of stopping a person from sleepwalking. However, there are measures you can take that reduce the risks associated with sleepwalking, and that occasionally automatically wake the person, or you – so you can help them using the advice listed above. Some of these measures cost no money, and you should try them first.
– Spend an hour before bedtime winding down. Any sort of heavy stimulus can cause sleepwalking in people with the predisposition for it. Make sure that the potential sleepwalker only engages in low-energy and relaxing activities for the whole hour before they go to sleep. Some options include a soothing bath, reading a book or planning tomorrow’s shopping. Some people enjoy listening to classical music or other relaxing tunes to unwind.
– Plan out your sleeping schedule. Sleep deprivation is often associated with sleepwalking, and every person can actively improve their sleep schedule by organizing their time a bit better. Try to fall asleep and wake up at the same time every day, including weekends and other days off work. Keep track of your sleeping habits. Avoid substances like alcohol and caffeine before bed. Additionally, check any prescription medication you take for side-effects. If they include sleeping problems, you may want to request alternate medicine options.
– Consult your doctor if you’re worried. Sleepwalking more than once per week is considered serious enough to warrant an investigation, and if you notice bruises and cuts that you don’t remember receiving (if you have pets, playtime with them can give you the odd scratch here and there), don’t hesitate to consult your physician. Ask your partner to keep a watchful eye on your behavior for a night or two, if they have the time to do so.
– Try to get rid of or hide sharp edges and other potentially dangerous obstacles. While you can’t always notice when someone starts sleepwalking, you can take preventative measures to reduce the risk of injury. Keep the light on in the bathroom in case they often try to relieve themselves during their sleepwalks. You can never make your house 100% risk-proof, but anything that helps is worth doing.
– Install a door alarm or bell that rings every time the sleepwalker’s bedroom door is opened or closed. This way, you can wake them up before they get too far, and it’s a helpful system to alert you just in case you need to intervene manually. The closer they are to the bedroom while sleepwalking, the easier it is to redirect them back to bed. This method costs money, but preventing injuries and helping the sleepwalker rest properly is worth any sum of money. Not that it’s terribly expensive, either, especially if you opt for bells (like the ones you see attached to shop doors).
Co-founder of Counting Sheep and Sleepaholic