Sleepwalking, or somnambulism is a sleep disorder defined as a type of parasomnia and characterized by sitting up in bed, standing and walking during sleep. The action typically occurs earlier in the night, during NREM sleep, and particularly one or two hours after falling asleep. This type of parasomnia often scares other members of the household. The disorder is more common in children than adults, and most kids outgrow it when they are ten years old. Sleepwalking in adults is often confused or mistaken for another coexisting sleep disorder or medical condition.

Sleepwalkers may injure themselves or damage their environments. Due to this, this sleep disorder is considering dangerous. People struggling with this parasomnia sometimes trip, fall or even urinate during one of their episodes. One episode of sleepwalking typically lasts around 5-10 minutes.

Isolated episodes of sleepwalking are also possible, and they don’t indicate a serious problem that requires visiting a doctor or starting treatment. Only recurrent sleepwalking is classified as a sleep disorder.

If you are living with a sleepwalker, it’s very important to protect him or her from potential injuries.

Symptoms

As mentioned in the beginning, sleepwalking episodes typically occur early in the night, usually only one or two hours after falling asleep. It never happens during naps, and when it comes to frequency, it can occur rarely or very often. One episode lasts several minutes, usually not longer than 10 minutes.

How does a sleepwalker look like? A person suffering from somnambulism may get of bed and walk around or just sit up in bed and open his or her eyes. Sometimes they can make small hand movements. Their eyes may look glazed or glassy, and they often stare with their eyes open and with a blank expression. They typically don’t communicate with others or respond to questions, but in some cases, they may react inappropriately or say things that don’t make sense.

They can move quietly around the house or run, trying to escape from something. Often, they move well around familiar objects but are prone to falling down the stairs or tripping over an obstacle.

It’s also not uncommon for sleepwalkers to go into the kitchen and start snacking. Somnambulism is often linked to sleep-eating, a separate sleep disorder that is characterized by eating or drinking several times during the night and especially during sleep time. Since sleep-eaters aren’t entirely aware of what they eat, they could be at risk for getting injured or poisoned, since they snack or drink non-food items like cigarettes, toys or even cleaning fluids.

It is very difficult to wake up a sleepwalker from one of his or her episodes. After being awakened, the affected person may feel confused, disoriented and fatigued. Due to fatigue, they may have problems functioning optimally during the day. Somnambulism sufferers typically don’t remember experiencing an episode in the morning. Apart from sleepwalking, patients can also experience sleep terrors.

A person who is sleepwalking can sometimes also do one or more of the following things:

  •    Do routine activities such as talking, getting dressed, eating
  •    Leave the house
  •    Drive a car
  •    Engage in unusual behavior, such as urinating in a closet
  •    Jump out a window
  •    Engage in sexual activity without awareness
  •    Get injured (by falling down the stairs or tripping)
  •    Become violent (more often after suddenly waking up, than during an episode)

Causes

Sleepwalking is classified as a parasomnia, and all parasomnias are characterized by undesirable behavior or experience during sleep. Somnambulism is a sleep disorder of arousal, meaning it occurs during N3 sleep or the deepest stage of NREM sleep. Another disorder that often occurs with sleepwalking is sleep terrors. The condition is more common in individuals who spend more time deep sleep stages.

For centuries, sleepwalking was associated with psychiatric disorders such as hysteria, or with some psychological problems, such as a guilty conscience. One of the most popular sleepwalking depiction can be seen in Shakespeare’s MacBeth, where Lady MacBeth plays out actions related to her own guilt.

Today, science has disproved these centuries-old myths. Numerous things can cause somnambulism, and there are also factors that contribute to the development of this condition, such as stress, sleep deprivation, fever, sleep interruptions, sleep schedule disruptions, traveling, and so forth.

The parasomnia can also be triggered by other conditions that disturb sleep, such as sleep-related breathing disorders (such as sleep apnea), RLS (restless legs syndrome), GERD (gastroesophageal reflux disease), heart rhythm problems, nighttime asthma, nighttime seizures, PTSD, and so forth.

Taking certain drugs, such as hypnotics (used for relaxation or sleep), neuroleptics (used for treating psychosis), stimulants (used to boost activity), and antihistamines (used for treating symptoms of allergy), and certain medications used for psychiatric disorders can also trigger somnambulism. Substance abuse and alcohol can also contribute to sleepwalking. Some individuals report drunk sleepwalking or sleepwalking while intoxicated.

Risk Factors

There are two major risk factors for somnambulism – genetics, and age. Studies show that sleepwalking runs in families, and it’s more common to struggle with this sleep disorder if one or both of your parents experienced it. When it comes to age, as we mentioned in the beginning, sleepwalking occurs in children more often than adults. In adulthood, the condition will more likely be related to other underlying health conditions.

Complications

Sleepwalking itself doesn’t always have to be a concern. However, sleepwalkers can sometimes injure themselves or others due to their behavior in sleepwalking episodes. Injuries typically occur when sleepwalkers walk near furniture or stairs or wander outdoors (noctambulism). Some of them may jump out of a window or get into their car and start driving. People suffering from somnambulism may also eat something inappropriate.

Due to prolonged sleep disruption, sleepwalkers may experience increased daytime sleepiness, which can further lead to school, work or behavior issues. Due to embarrassment, they may also experience problems with their social relationships.

Lastly, sleepwalkers can injure others or disturb their sleep.

How Common is Sleepwalking?

According to a Stanford study, 10% of people experience sleepwalking at some point in their life, and 3.6% of adults experienced sleepwalking in 2018. Like all other parasomnias, somnambulism is commonly experienced by children aged from 6 to 12. It’s also more common in boys than girls. Since in most cases sleepwalking occurs with sleep terrors, some researchers believe the two disorders are connected.

Diagnosis

In order to diagnose sleepwalking, doctors don’t generally have to perform special tests or sleep studies. Taking your detailed health history and inspecting your sleep patterns and habits is often sufficient. Doctors also always check if your somnambulism is caused by an underlying sleep disorder or other medical condition.

Occasional episodes of sleepwalking shouldn’t worry you because they typically resolve on their own. However, it’s a good idea to mention this to your doctor during a routine exam.

You should see a doctor if your somnambulism episodes have the following characteristics:

  •    They often occur (more than one to two times a week or several times a night)
  •    They lead to dangerous behavior or injury
  •    They cause significant sleep disruption either to you or your household members
  •    If you struggle with excessive daytime sleepiness
  •    If the episodes appear for the first time as an adult
  •    If they continue after your child’s ten years  
  •    If they affect your overall quality of life

Sleepwalking Treatment – How to Stop Sleepwalking

You have probably heard that you should never wake up a sleepwalker. However, this is a myth, and in case your partner or child sleepwalks, it’s very important to try to wake him or her or carefully guide the affected person back to bed.

The first thing you have to do is to make sure the sleepwalker’s environment is safe, and that they are safe (since some of them can wander out or try to jump out of a window). Sleepwalkers often go to bed on their own after some time, but it’s better to gently guide them or carefully wake them up. It’s very important not to wake up the person abruptly or to physically restrain them (unless they are in danger). Doing so can make them lash out and act violently.

Waking a person out of the episode is very helpful because it prevents them from experiencing another episode when going back to sleep. However, when one deep sleep cycle passes, a new sleepwalking episode may occur in a new one.

As mentioned, children outgrow sleepwalking on their own and treatment is therefore not necessary. Improving your sleep hygiene and sleep habits can help you alleviate some symptoms of sleepwalking, especially fatigue, and excessive daytime sleepiness.

Here are some essential sleep tips you should practice to prevent sleepwalking:

  •    Bedtime routine – as you undoubtedly know by now, a bedtime routine is not only useful for children, but also to adults. Since episodes can be triggered by stress and anxiety, giving yourself some time to relax and unwind can be very beneficial. To relax and prepare yourself for sleep, we recommend taking a warm bath or reading a relaxing book.
  •    Sleep/wake schedule – create a sleep and wake schedule that works you, and try to stick to it every day.
  •    Bedroom environment – make sure your bedroom is perfect for sleep. It should be dark, cool and quiet. Your mattress should be comfortable and able to provide quality support.
  •    Limit fluid intake – avoid coffee and other caffeinated beverages because they can severely disrupt your sleep.
  •    If your partner or child sleepwalks at the same time most nights, gently wake them up 15 to 30 minutes before they would normally sleepwalk to prevent the episode from occurring.
  •    If your child is affected, establish a regular bedtime routine for it, and promote healthy sleep habits.

Apart from improving your overall sleep hygiene, you should also avoid stressful situations and anxiety, modify your sleep environment so it’s hazard free, and empty your bladder before sleep. Some therapist practice hypnosis for alleviating stress and anxiety that contributes to experiencing sleepwalking episodes. Medications, such as benzodiazepines, should reduce the intensity and frequency of sleepwalking episodes.

To treat sleepwalking, your doctor might prescribe one of the following drugs:

  •    Prosom – a sedative that will help you to fall asleep faster, stay asleep longer, and wake less frequently during the night.
  •    Klonopin – an anticonvulsant that is often used to calms the brain and nerves. It is used to treat seizures and panic attacks. This medication could reduce sleepwalking frequency by decreasing the amount of electrical activity in the brain.
  •    Trazodone – an antidepressant that increases the levels of serotonin in the brain, and it’s used to treat depression, anxiety, and some sleep disorders developed due to stress.

Lastly, cognitive behavioral therapy (CBT) or hypnotherapy may also be recommended.

How to Prevent Sleepwalking Accidents?

As mentioned before, in order to prevent accidents, you must keep the areas of your home where a person may sleepwalk safe and hazard-free. You should remove any harmful objects that may cause the sleepwalker to trip over and fall. It’s also important to keep the windows and doors locked to prevent wandering out of jumping out of a window (noctambulism).

In case your child struggles with this parasomnia, don’t allow him or her to sleep on the top of a bunk bed. Fitting safety gates at the top of the stairs is also recommended. Lastly, it’s vital to warn babysitters, relatives or friends who look after your child at night that he or she may sleepwalk. Also, you should explain to them how to react and gently take them back to bed or wake them up.

Lastly, it’s a good idea to set an impromptu alarm by attaching a bell to the sleepwalker’s bedroom. The bell should jingle in case the sleepwalker opens it. It might wake them up or wake you up – in both cases, it will help the affected individual get back to bed sooner.

The Bottom Line

It is very important to know that somnambulism is not harmful to your health. However, since it puts you at risk for hurting yourself and others, you should still take it seriously. Children in most case outgrow the condition on their own, while in adulthood, it’s typically caused by an underlying medical condition.

If you or your household members sleepwalked once or twice, it’s not a big deal. However, if somnambulism becomes frequent, you should see a doctor, and determine whether the condition is idiopathic or caused by an underlying health condition. No matter whether a cause exists or not, sleepwalking is still manageable and treatable. By changing your sleep habits, improving your sleep hygiene, experimenting with natural sleep aids and even taking prescription medication, you can manage this weird nighttime phenomenon, and get the good night’s rest that you need.

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