What is sleepwalking

Sleepwalking also called somnambulism, is a type of sleep disorder that involves you doing things in your sleep you are not aware of at the time and that you usually can’t remember when you wake up. Sleepwalking (somnambulism) is a disorder of arousal, where the brain is triggered to rouse the body while in a deep sleep. Sleepwalking is a parasomnia. A parasomnia involves undesired events that come along with sleep.

Simply put, sleepwalking (somnambulism) causes people to get out of bed and move around while they’re still asleep. They might quietly creep about the house, run through the home urgently, or even climb out a window, or walk out a door. Sleepwalkers might talk or shout as they are walking. Their eyes are open and have a confused, “glassy” look and if you ask them questions, they may respond very slowly or not at all. Before walking, a sleepwalker 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. Sleep walkers 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, a sleepwalker 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.

Interestingly, sleepwalking tends to occur early in the night, in the first third of the night when you’re in the deepest stages of slumber, called NREM (non-rapid eye movement sleep) sleep. Another NREM disorder is sleep terrors, which can occur together with sleepwalking. In this part of the sleep cycle, your brainwaves are slow and your gray matter is quiet and inactive. But your body is quite active—this time of night is when you toss and turn the most. Every now and then, sleepwalking 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.

Somewhere between one and 15 percent of people are sleepwalkers, and children are more commonly affected than adults. The rate of it in children is as high as 17 percent. It can begin as soon as a child is able to walk. It peaks by the time they are eight to 12 years old.

Children between the ages of four and eight are the most likely to sleepwalk, and they’re more at risk if they suffered from night terrors when they were babies. Sleepwalking in children affects both boys and girls equally. Children typically outgrow the disorder by the age of 12.

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.

Sleepwalking isn’t just a disorder for the young, some people continue to sleepwalk into adolescence and adulthood with nearly 4 percent of adults in the United States do it, too.

Rarely, sleepwalking may begin at any time in the adult life, even when someone is in their seventies. In adults, men are 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 of both parents had sleepwalking episodes as a child or adult.

Sleepwalking complications

Sleepwalking itself isn’t necessarily a concern, but a person who sleepwalks can:

• Hurt themselves — especially if they walk near furniture or stairs, wander outdoors, drive a car or eat something inappropriate during a sleepwalking episode
• Experience prolonged sleep disruption, which can lead to excessive daytime sleepiness and possible school or behavior issues
• Be embarrassed or experience problems with social relationships
• Disturb others’ sleep
• Rarely, injure someone else nearby

Sleepwalking causes

What causes sleepwalking

There’s no one clear-cut reason why people sleepwalk, but several factors can influence its occurrence:

• Genetics: Like most other disorders and diseases, sleepwalking can run in families. Identical twins frequently sleepwalk, and you’re ten times more likely to do it if a first-degree relative also does.
• Environmental Triggers: Insufficient sleep is a common catalyst for sleepwalking. But an inconsistent sleep schedule can boost your risk, as can stress and alcohol. These are just more reasons to practice good sleep hygiene!
• Medical Conditions: Many ailments can make you more prone to sleepwalking, including irregular heartbeats, reflux, sleep apnea, epilepsy, post-traumatic stress disorder, panic attacks, and asthma.

Sleepwalking can also be linked to Parkinson’s, Alzheimer’s, as well as seizure disorders. If you have recently started ambling about while you snooze, it’s wise to consult your doctor.

You are also more likely to sleepwalk if you:

• get too little sleep
• have irregular sleeping hours
• feel stress or anxiety
• are ill or have a fever
• take certain drugs and medicines
• use or abuse alcohol

Many children who sleepwalk have night terrors as well.

Risk Factors for sleepwalking

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)
• Stroke
• The premenstrual period
• Bloated stomach
• Physical or emotional stress
• Obstructive sleep apnea (OSA)
• Other sleep-related disorders or events
• Travel
• Sleeping in unfamiliar surroundings
• Some medications, such as hypnotics, sedatives or certain medications used for psychiatric disorders
• Alcohol use and abuse
• Noise or light
• Fevers in children
• Restless legs syndrome
• Gastroesophageal reflux disease (GERD).

Sleepwalking symptoms

Some people simply walk around then go back to bed. But some sleepwalkers also talk, shout, eat, or even move furniture or drive a car.

A sleepwalking episode usually lasts for only a few minutes, although it can be longer. Some people sleepwalk only rarely, while others do it a lot. Some may sleepwalk many times in one night.

Sleepwalking itself is not harmful, but sleepwalkers might do something that could cause injury such as climbing out of a window or walking into objects. If you sleepwalk, there is a chance you might harm either yourself or the people around you.

Sleepwalking can also interfere with the quality of sleep both of you and those you live with.

Sleepwalking can involve strange, inappropriate and even violent behaviors.

Someone who is sleepwalking may:

• Get out of bed and walk around
• Sit up in bed and open their eyes
• Have a glazed, glassy-eyed expression
• Do routine daily actions
• Be difficult to wake up during an episode
• Be confused
• Quickly return to sleep
• Not remember what happened
• Not respond or communicate with others
• Be disoriented or confused for a short time after being awakened
• Not remember the episode in the morning
• Have problems functioning during the day because of disturbed sleep
• Have sleep terrors in addition to sleepwalking

In rare cases someone who is sleepwalking may:

• Leave the house
• Drive a car
• Engage in unusual behavior, such as urinate in a closet
• Engage in sexual activity without awareness
• Get injured, for example, by falling down the stairs or jumping out a window
• Do routine activities, such as getting dressed, talking or eating
• Become violent during the period of brief confusion immediately after waking or, occasionally, during sleepwalking

Sleepwalking diagnosis

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 the advice of a board certified sleep medicine physician.

A sleep specialist will often ask you to 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 (see Figure 1 below). 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.

A sleep medicine physician will try to determine if there is something else that is causing your sleepwalking or making the symptoms worse, such as:

• Another sleep disorder
• A medical condition
• Medication use
• A mental health disorder
• Substance abuse

The sleep medicine physician may want to examine your sleep using an in-lab sleep study. Also known as a polysomnogram, a sleep study charts your brain waves, heart beat, and breathing as you sleep. It also looks at how your arms and legs move and records your behavior during sleep on video. This will help show if you get out of bed and do anything unusual during your sleep study.

Figure 1. Epworth Sleepiness Scale Questionnaire

How to score the Epworth Sleepiness Scale

All Epworth Sleepiness Scale item-scores are intended to be integers (0-3). However, some people cannot decide on one number and report half-values. It is recommended that these scores be taken at face value. If, after adding them up, the total Epworth Sleepiness Scale score includes a half, it should be rounded up to the next whole number. If one or more item-scores are missing, that Epworth Sleepiness Scale is invalid because it is not feasible to interpolate missing item-scores. The Epworth Sleepiness Scale score (the sum of 8 item-scores) is the only number required under most circumstances.

• If total score less than 8 – indicates reported normal daytime alertness
• 8 to 11 – indicates mild sleepiness
• 12 to 15 – indicates moderate sleepiness
• 16 to 24 – indicates severe sleepiness

How to stop sleepwalking

Simple steps that can put an end to a dangerous condition.

Unless you’ve ever experienced sleepwalking yourself, it can be tough to understand how scary it feels to know that you transported yourself somewhere new without ever waking up. And if you have sleep walked, then you know how eager you can be to put an end to it as fast as possible. There are many different reasons why sleep walking happens, and the important thing is to talk to your doctor to discuss different treatment options.

As part of your treatment, you might spend time in a sleep lab being observed so that the specialists can learn why you might be sleep walking. You also might be offered hypnosis, where you are hypnotized and then told to wake up as soon as your feet touch the floor. The idea is that when you are fast asleep and start to go somewhere, you’ll instantly wake up.

Another option: You could be taught stress-reduction techniques like meditation, since a high amount of daily stress can be a culprit.

While you’re exploring the different treatments, you still need to take certain precautions so that you don’t hurt yourself or someone else.

1. First, lock the doors and windows and either hide your house keys in a place where you don’t normally put them or give them to someone else to store. This will keep you from leaving the house. Do the same with your car keys, so you can’t get behind the wheel and go for a drive in the middle of an episode.
2. Next, get rid of anything in your room that could be dangerous, like razors, scissors, knives, or even prescription medications. Lock them up in a room that’s far away from your bedroom. If you live with a partner or roommate, tell them to ask you what you’re doing if they see you wake up. If you’re sleepwalking, you won’t answer or your words will come out sounding strange and confused. If that happens, tell them to gently lead you back to bed. If you live alone, put a few objects in your way that you might bump into (so you’ll wake up).
3. And as a last resort, get an alarm system and set it so that if a door opens, an alarm loudly goes off, which will wake you up.

Should you wake a sleepwalker?

There is no clear answer. Some experts believe that you should, since sometimes people hurt themselves or others while sleepwalking. Others believe you should not, because it can be quite hard to do and they might become startled or lash out.

The best advice is that if you’re going to try to wake them, do it slowly and carefully.

How to Safely Wake a Sleepwalker

If you must wake a sleepwalker, here’s how to do it safely.

If, however, you live with someone who sleepwalks, you might be concerned about the person’s safety, so you may wonder what you should do if you catch the person in the act.

You may have heard that it’s not safe to wake someone who is actively sleepwalking, but that’s not always the case. Although it’s important to recognize that waking someone who is actively sleepwalking can be difficult and dangerous—sleepwalkers have even been known to attack those who try to wake them—sometimes it’s essential to do so. Sleepwalkers who are allowed to meander around are likely to hurt themselves, since they aren’t in control of their actions, and they could even hop in a car and hurt both themselves and others.

Waking a sleepwalker properly can help keep both you and the sleepwalker safe. The best trick is to help the sleepwalker return safely to his or her bed without waking him or her, if possible. Taking care not to touch the sleepwalker too much, gently turn him or her in the direction of her bed, and walk near the person until he or she gets back into bed.

If returning a sleepwalker safely back to bed doesn’t work, use loud, sharp noises (from a safe distance) to wake up the person instead. This will most likely startle the sleepwalker, but it’s better than shaking the person in close range, because that might trigger the sleepwalker to feel attacked and lash out and hurt you.

People who wake up from sleepwalking are often confused, disoriented, and scared, so be thoughtful once the person actually does wake. Explain to the person: “You’ve been sleepwalking.”

Sleepwalking treatment

Treatment for occasional sleepwalking usually isn’t necessary. In children who sleepwalk, it typically goes away by the teen years.

Treatment may include:

• Treating any underlying condition, if the sleepwalking is associated with sleep deprivation or an underlying sleep disorder or medical condition
• Adjusting medication, if it’s thought that the sleepwalking results from a drug
• Anticipatory awakenings — waking the person who is sleepwalking about 15 minutes before he or she usually sleepwalks, then staying awake for a few minutes before falling asleep again
• Medication — such as benzodiazepines or certain antidepressants. Medication isn’t usually used to treat sleepwalking. However, medicines such as benzodiazepines or antidepressants are sometimes used if you sleepwalk often or there’s a risk you could seriously injure yourself or others. These medications can help you sleep and may reduce the frequency of sleepwalking episodes.
• Learning self-hypnosis — when done by a trained professional who is familiar with parasomnias, people who are receptive to suggestions during hypnosis may benefit by achieving a deep state of relaxation through which a change in unwanted activities during sleep is promoted
• Therapy or counseling — a mental health professional can help with suggestions for improving sleep, stress-reduction techniques, self-hypnosis and relaxation

Lifestyle and home remedies

If sleepwalking is a problem for you or your child, try these suggestions.

• Make the environment safe. If sleepwalking has led to injuries or may do so, consider these precautions: Close and lock all windows and exterior doors before bedtime. You might even lock interior doors or place alarms or bells on the doors. Block doorways or stairways with a gate, and move electrical cords and other tripping hazards out of the way. Sleep in a ground-floor bedroom, if possible. Place sharp or fragile objects out of reach, and lock up all weapons. If your child sleepwalks, don’t let him or her sleep in a bunk bed.
• Gently lead the person sleepwalking to bed. It’s not necessary to wake up the person. Although it’s not dangerous to the person to be awakened, it can be disruptive if he or she becomes confused and disoriented, and possibly agitated.
• Get adequate sleep. Fatigue can contribute to sleepwalking. If you’re sleep deprived, try an earlier bedtime, a more regular sleep schedule or a short nap, especially for toddlers. If possible, avoid sleep-time noises or other stimuli that could interrupt sleep.
• Establish a regular, relaxing routine before bedtime. Do quiet, calming activities before bed, such as reading books, doing puzzles or soaking in a warm bath. Meditation or relaxation exercises may help, too. Make the bedroom comfortable and quiet for sleep.
• Put stress in its place. Identify the issues that cause stress and ways to handle the stress. Talk about what’s bothering you. Or if your child sleepwalks and seems anxious or stressed, talk with him or her about any concerns. A mental health professional can help.
• Relax before going to bed, such as having a warm bath, reading or deep breathing
• Look for a pattern. For several nights, note — or have another person in your home note — how many minutes after bedtime a sleepwalking episode occurs. If the timing is fairly consistent, this information is useful in planning anticipatory awakenings. If your child sleepwalks at the same time most nights, try gently waking them for a short time 15-30 minutes before they would normally sleepwalk – this may stop them sleepwalking by altering their normal sleep cycle.
• Limit drinks before bedtime, particularly those containing caffeine, and go to the toilet before going to sleep.
• Avoid alcohol. Drinking alcohol can interfere with a good night’s sleep and may be a trigger for sleepwalking.