What is sleepwalking?
Sleepwalking is a condition in which someone gets out of bed and possibly performs activities while they are still asleep. The medical term for sleepwalking is somnambulism. The condition is fairly common among children, who usually outgrow it by their teens. However, if sleepwalking continues, it could become a problem due to dangers the sleepwalker could encounter.
People who are sleepwalking are still asleep even if their eyes are open. They might get up and just wander around, or they could get dressed and perform tasks, like rearranging furniture or doing housework. In extreme cases, they could even take the car keys and try to go for a drive. After they have gone back to bed and get up in the morning, they have no memory of doing anything during the night.
Sleepwalking is classified as a behavior disorder called parasomnias, along with sleep problems such as nightmares, bedwetting, and even sleep-related hallucinations. Parasomnias occur in the deepest stages of non-rapid eye movement (NREM) sleep. The nighttime activity comes on suddenly and can stop just as suddenly. The most important issue related to sleepwalking is to ensure the sleepwalker is safe and cannot get hurt or cause harm to others. If sleepwalking becomes disruptive, it is important to find the cause and stop or limit the activity.
Contact a doctor if someone is sleepwalking more than twice a week, if the sleepwalker leaves the house, if child sleepwalking occurs in the second half of the night, or if the person sleepwalking is also experience stiffening of the body, jerky movements, or drooling.
Seek immediate care (call 911) if someone who is sleepwalking experiences or causes a serious injury that results in a medical emergency, such as a fracture, head trauma, or bleeding wound.
What are the symptoms of sleepwalking?
Sleepwalking, by definition, is getting up out of bed and walking around while still asleep. The behavior is not always immediately obvious to an observer. Someone who sleepwalks may also appear to be awake and:
- Look at you but not respond to questions or if they do respond, they may not make sense
- Move about clumsily or awkwardly
- Sit up in bed and perform repetitive motions, like smoothing the bed covers, tugging on a sleeve, or rubbing their eyes
- Urinate in places other than the toilet, such as the closet
Other common symptoms of sleepwalking
Other common symptoms of sleepwalking are:
- Aggressive behavior when woken
- Being difficult to wake
- Being disoriented and confused if woken while sleepwalking
- Fatigue and sleepiness the next day
- Talking while asleep
Sleepwalking among adults can happen any time throughout the night. Children, on the other hand, tend to do their sleepwalking within the first hour or two of falling asleep.
Sleepwalking itself is not a serious condition, but it could be the sign of a more serious sleep disorder and it could cause injury. This could happen if the person gets hurt while sleepwalking or the next day as the exhausted person tries to drive a car or perform a task that needs concentration. If this occurs, then it may be time to see a doctor.
Over the years, some people believed it was dangerous to wake up a sleepwalker. This is not the case, but doctors instead recommend trying to get sleepwalkers back to sleep rather than waking them, which may cause them to be confused or disoriented.
What causes sleepwalking?
Sleepwalking can have many causes. Some may be related to lifestyle activities while others to an underlying medical condition.
Lifestyle causes of sleepwalking
- Going to bed with a full bladder
- Sleep deprivation due to staying up too late
- Sleep disruptions due to having young children, travel (time zone changes), shift work, or other issues that prevent you from going to bed at your usual time
- Substance use, alcohol or drugs
Medical causes of sleepwalking
- Brain or head injury
- Certain types of medications, especially those meant to help you sleep or drugs used to treat psychiatric disorders
- Fever, particularly in children
- Restless legs syndrome
- Sleep disorders, such as sleep apnea
The common thread through all of these causes is the inability of the sleepwalker to get a good, restful night’s sleep.
What are the risk factors for sleepwalking?
Not all people with risk factors will become sleepwalkers. But aside from disturbed sleep patterns, there are two known risk factors for sleepwalking:
- Family history, or genetics. If a parent has a history of sleepwalking, there is an increased chance his or her children will also sleepwalk. If both parents sleepwalk, the children have an even higher risk.
- Age. Sleepwalking is common in children, but they usually outgrow it by the time they reach their teens. If sleepwalking continues into adolescence, contact your child’s doctor.
Reducing your risk of sleepwalking
If you are at risk for sleepwalking, you may be able to lower your risk by:
- Speaking with your doctor or pharmacist if you take medications that could disturb your sleep
- Reducing or eliminating alcohol or drug use
- Working on stress management, either through meditation and mindfulness, cognitive behavior therapy, or other relaxation techniques
- Seeking treatment for medical issues that can affect sleep, such as GERD
When speaking with your doctor about sleepwalking, try to provide as much information as possible, such as how often the sleepwalking occurs, if there are any patterns you noticed, or how long this has been going on. Keeping a journal about your nighttime activity can also be a helpful tool to bring with you to your appointment.
What are some conditions related to sleepwalking?
Sleepwalking is one of many parasomnias. Others include:
- Bedwetting, or sleep enuresis, when urination occurs while sleeping
- Confusional arousals, when you seem awake, but are confused and foggy. People who wake with confusional arousal do not usually remember the incidents.
- Exploding head syndrome, a startling name for the experience of hearing a bang or other loud noise just as you fall asleep. You may also see a flash of light or have muscle twitches or jerks. There is rarely pain.
- Recurrent isolated sleep paralysis, a particularly frightening experience in which you wake up, but you are unable to move or speak. You may also hallucinate. Your body naturally causes your muscles to freeze while you are sleeping, so you do not act out while dreaming. But for some people, the paralysis lingers after waking.
- Sleep or night terrors, which may cause you to wake up with intense fear, possibly screaming and flailing your arms and legs. Sleep terrors are more common among children and can be very frightening.
- Sleep-related eating disorder, in which you experience episodes of out-of-control eating while you are still sleeping, also with no or little memory of the activity when waking the next day.
How do doctors diagnose sleepwalking?
Sleepwalking can be hard to diagnose if the sleepwalker lives alone. The person may not realize he or she sleepwalks, or how often, because there is nobody else to observe it. However, if you are concerned that you or someone else sleepwalks, a doctor may be able to diagnose the cause. Some reasons why you may want to see a doctor include:
- Your child is still sleepwalking after they have entered their teens.
- The sleepwalker is getting hurt, using sharp or dangerous objects, or falling down the stairs.
- The sleepwalker leaves the house.
- The sleepwalker is finding it hard to function the next day because of fatigue and sleepiness.
- The sleepwalking episodes are frequent, with more than two episodes per week.
- There are other concerning behaviors, such as sleep apnea.
To determine the cause, your doctor may:
- Review your family history. Does anyone in your family sleepwalk, especially a parent?
- Review your medical history. Do you have any conditions that make sleeping difficult? Does your lifestyle make sleeping difficult?
- Ask you to fill out questionnaires: You, your partner, or someone else in the home might fill out questionnaires about sleep behaviors.
- Order sleep study tests. Called polysomnography, sleep study tests are often done in a clinic, but some can be done at home. Using sensors to detect brain waves, body movements, oxygen levels, and heart and breathing rate, your doctor can see how well you sleep and for how long.
How is sleepwalking treated?
There are no therapies to cure sleepwalking. Treatment is geared towards minimizing triggers, which can reduce how often sleepwalking occurs. If someone is an occasional sleepwalker and there is no danger, treatment is usually not necessary. But if the sleepwalking puts the sleepwalker (or others) in danger or causes disruptions, your doctor may try medical intervention.
Treatments for sleepwalking include:
- Treating the condition or disease, such as GERD, that may be contributing to sleepwalking
- Changing or adjusting medications that may cause sleepwalking
- Anticipatory awakening, a system that wakes the sleepwalker about 15 minutes ahead of their usual sleepwalking time. After staying awake a few minutes, they can go back to sleep again.
- Prescribing medications, such as certain antidepressants, that can help improve sleep
- Psychotherapy, which can help sleepwalkers recognize stress triggers and learn coping techniques, such as meditation and mindfulness, relaxation, and self-hypnosis.
Home remedies for sleepwalking
Promoting a better night’s sleep may help reduce sleepwalking adventures. Some tips for a more restful sleep include:
- Avoid alcohol. Although initially alcohol can make you sleepy, it makes it harder for you to stay asleep.
- Avoid consuming caffeine past the early afternoon.
- Avoid heavy meals or snacks within a few hours of bed time.
- Do not stay in bed if you cannot sleep. Wait 20 minutes and if you are still awake, get up and leave your bedroom to read, meditate, or do some other relaxing activity. Do not watch TV or work on your computer, as these can stimulate your brain and make it harder to fall asleep. Try going back to bed when you start to feel sleepy.
- If you must nap during the day due to fatigue, keep it short. Sleep for no more than a half-hour and not close to your bedtime.
- Make your bedroom a peaceful oasis that is only for sleeping or sexual activity. Remove any TVs and keep your phone away from your nightstand. Make sure the room is dark and quiet enough, that your pillow is comfortable, and you are at a comfortable temperature.
- Set a regular bedtime and wake time, no matter what day of the week.
What are the potential complications of sleepwalking?
Sleepwalking does not cause medical complications so much as it can lead to dangerous situations that result in injuries. If you have a sleepwalker in your home, it is important to eliminate safety risks as much as possible. This includes:
- Ensuring all doors and windows are latched or locked. Sleepwalkers may try to leave the home, even through windows. You may want to put motion sensors or alarms on the doors and windows. There are also bed alarms that will sound if the sleepwalker gets out of bed.
- Installing safety gates at the top of the stairs if the sleepwalker is a child.
- Keeping car keys out of reach.
- Locking away any sharp or dangerous items, particularly any weapons.
- Moving a child sleepwalker to a lower bed, if he or she typically sleeps in an upper bunk bed.
- Removing clutter from the areas where the sleepwalker may walk to reduce the risk of tripping over hazards like toys, loose rugs, or electrical wires.