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By: Kevin Asp, CRT, RPSGT on January 8th, 2021

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Sleepwalking (Somnambulism): Signs, Symptoms, Causes, and Treatment Options

Parasomnias | sleepwalking | somnambulism

In an informal conversation, you might bring the term "sleepwalking" up as a casual way of talking about a lack of focus or energy. But, for numerous adults and children, sleepwalking is a real problem with significant consequences. As a sleep professional, it is crucial you educate patients with parasomnias, like sleepwalking, as these sleep disorders can have physically destructive and lasting effects.

What Is Sleep Walking (Somnambulism)?

Sleepwalking (somnambulism), is a type of behavior disorder originating while you're in a deep sleep. It falls in the class of parasomnias. It leads to walking around or performing other behaviors while you're still mostly sleeping. It's more common in kids than it is in adults. There are more chances of it occurring in people:

  • With a family history of this disorder
  • Who are prone to repeated awakenings at night
  • Who are sleep deprived

It's hard to tell how often it occurs due to the fact individuals who sleepwalk typically don't remember doing so. 

Who Sleepwalks? 

Sleepwalking occurs more often in kids than adults, as mentioned. Children between four and eight years old are most likely to experience sleepwalking. They usually outgrow the condition by the time they reach 12 years old. One study showed 29% of kids around two to 13 years old experienced sleepwalking, but most were around 10 to 13 years old. Sleepwalking, again, doesn't just occur in children. Almost 4% of adults in the U.S. experience sleepwalking.

What Causes Sleepwalking? 

So, why do people sleepwalk? Sleep experts believe sleepwalking usually occurs when an individual is in a deep sleep stage and becomes awoken partially in a manner that triggers physical activity while they remain mostly asleep.

According to the Sleep Foundation, there are certain factors that influence the occurrence of this "partial awakening." For instance, sleepwalking causes may include:

  1. Sleep deprivation: A lack of sleep may be connected with a heightened risk of sleepwalking, which might be due to spending more time in deep sleep after experiencing sleep deprivation for a certain time period.
  2. Family history and genetics: Research shows an obvious pattern where certain individuals are predisposed genetically to sleepwalking. Around 22% of kids who have parents with no sleepwalking history will experience this disorder, but 47% of kids who sleepwalk actually have one parent with a history of it and another 61% of kids who sleepwalk have two parents that have a history of it.
  3. Certain medications: Medicines with a sedative effect might push individuals into a certain type of sleep that will increase their likelihood of experiencing sleepwalking.
  4. Alcohol: Consuming alcohol during the evening could create instability in an individual's sleep stages and might increase their risk of sleepwalking.
  5. BrainiInjury: Disorders affecting the brain, such as encephalitis, might trigger sleepwalking.
  6. Fever: Fever has caused children to have a higher chance of sleepwalking and it might be connected to a higher number of nighttime illness-driven arousals.
  7. Obstructive sleep apnea (OSA): This is a type of sleep condition where your airway becomes blocked and causes short pauses in your breathing while you're sleeping. These lapses can occur dozens of times during the night, creating interruptions in sleep that might lead to sleepwalking.

Are There Sleeping Walking Myths? 

There are a number of sleepwalking myths, including:

Myth #1: You shouldn't wake up a person who is sleepwalking.

It could actually be dangerous not waking them up. If a person is going to hurt themselves or other individuals while they're sleepwalking, you certainly want to wake them up. Usually, however, you should simply not wake them up and just guide them back to their bed. 

Myth #2: Sleepwalking isn't dangerous.

There have been people sleepwalking who have engaged in dangerous activities and could harm themselves or others if you don't take precautions. Some dangerous activities sleepwalkers have been seen to engage in are:

  • Climbing out the window
  • Leaving the house during the winter
  • Driving

You can usually protect sleepwalkers by taking some precautionary measures like locking the windows and doors at night and hiding dangerous items at night like scissors or knives.

Myth #3: Sleepwalking mostly occurs in adults

As mentioned above, sleepwalking actually occurs more in children (17%) than it does in adults (4%). While kids are more likely to experience sleepwalking, it could persist into adulthood.

Myth #4: Sleepwalking doesn't affect daytime behavior.

Sleepwalking definitely affects daytime behavior. It could disrupt sleep and cause sleepiness the next day. Sleepiness in kids usually is manifested as hyperactivity and inattention instead of dozing off.

What Sleepwalking Signs/Symptoms? 

When individuals sleepwalk, they might sit up and look like they're awake when they're actually sleeping still. They might get out of bed and start walking around. They might perform complex activities like going to the bathroom, moving furniture or getting dressed. Some individuals might even drive their car while they're asleep.

Signs and symptoms of sleep walking include:

  • Acting disoriented or confused when the individual wakes up
  • Having a blank look on the face
  • Aggressive behavior when being woken up by another person
  • Engaging in detailed activities while sleeping
  • Opening eyes during sleep
  • Walking during sleep
  • Talking during sleep (not making sense)
  • Sitting up during sleep and appearing awake

Generally, episodes of sleepwalking are brief (last only seconds or minutes), but they could last more than 30 minutes. If left undisturbed, most sleepwalkers will just go back to sleep, however, they might do this in an unusual or different place, which is why you should gently guide them back to bed.

What Stage of Sleep Does Sleepwalking Occur?

It's good to know the different sleep stages and sleepwalking. There are stages to the normal sleep cycle that range from light drowsiness to deep sleep. In the rapid eye movement (REM) sleep stage, your eyes are moving around quickly and your dreaming vividly. 

Sleepwalking is a condition of arousal, which means it happens while in the N3 stage of sleep or deep sleep , which is during the deepest state of NREM or non-rapid eye movement sleep. 

When Is Sleepwalking Dangerous or a Concern?

Sleepwalking can cause serious health consequences. If an individual trips, falls, or collides with something while they're running or walking, it can lead to injury. They can mishandle a sharp object or try driving a car during a sleepwalking episode which can be life-threatening. They can display violent behavior to themselves or others.

Sleepwalking episodes of actions might bring about embarrassment. For instance, after a sleepwalking episode, you might feel ashamed about:

  • Aggressive outbursts
  • Sexually explicit behavior
  • Urinating in the wrong place

Also, sleepwalking can disrupt bed partners, housemates, or roommates as well. Sleepwalking episodes could disrupt their sleep.

What to Do to Stop Sleepwalking From Occurring?  

If you (or a loved one) sleepwalk, there are certain steps you can take to help stop:

Step 1: Improve sleep hygiene. Sleep hygiene is your sleep-related habits and environment. Poor sleep hygiene like drinking alcohol or caffeine too close to bedtime or an inconsistent sleep schedule can contribute to sleep deprivation and sleep issues. Encouraging a more dependable and stable sleep hygiene can help reduce the risk of sleep deprivation which can trigger sleepwalking.

Step 2: Implement a "power-down" hour prior to going to bed. Find ways to relax and unwind before bedtime like reading a few chapters in a book or taking a warm bath.

Step 3: Create a safe environment. Harm reduction is an essential consideration for individuals who sleepwalk. Some ways you can reduce safety risks are:

  • Closing and locking windows and doors
  • Keeping weapons or sharp objects out of reach and locked away
  • Installing lights with motion sensors
  • Removing tripping hazards from the ground
  • Using bed alarms or door alarms that go off if the individual gets out of bed

Step 4: Anticipate awakening. Anticipatory awakening is where you wake the person up shortly before they're likely to have a potential sleepwalking episode. Since sleepwalking is connected to a certain stage of sleep, it frequently occurs around the same time every night. So you can prevent them from experiencing a partial awakening that could lead into sleepwalking by simply waking them up just before they would start to arouse.

Step 5: Consult with the physician about other options if this issue persists.

What are Sleepwalking Treatment Options? 

Medicine and other types of medical treatments usually aren't necessary for sleepwalking. Treating the underlying health condition that causes sleepwalking, such as OSA, might help reduce episodes. This is why you'll want to see your physician if sleepwalking is a persistent problem. Seeing the doctor will help ensure there's no underlying health problem that is causing the issue.

Some sleepwalking treatment options are: 

  1. Medication. If sleepwalking persists, medicines like antidepressants or benzodiazepines might help decrease episodes. Benzodiazepines are medicines that are often used for treating anxiety, but they are also useful in treating sleep disorders too. Diazepam (Valium) and Clonazepam (Klonopin) are also useful in decreasing sleepwalking episodes. Benzodiazepines and antidepressants might both help decrease your anxiety and stress - factors that can increase your chances of sleepwalking.
  2. Hypnosis. This is an alternative therapy that's useful for some individuals who sleepwalk. Hypnosis involves bringing you into an extremely focused and relaxed state of mind. The therapist will then make healthy suggestions that are tailored to your medical problem. These suggestions are said to sink into your consciousness in a more meaningful, deeper way because you're more open to receiving them.
  3. Lifestyle changes. Changing some lifestyle habits may help you stop sleepwalking. For instance, you can create a relaxing bedtime routine and stick to a sleep schedule. If you use drugs or drink, stop. If you're taking medicine, ask your physician if it could be playing a role in your sleepwalking.

Again, most experts advise against suddenly waking people up who are experiencing a sleepwalking episode. A jolting awakening could provoke confusion, fear, or anger because they're not aware of their situation. If possible, gently guide them back to their bed so they're less likely to wake up disoriented.


About Kevin Asp, CRT, RPSGT

Because of the implementation of his best practices of Implementing Inbound Marketing in its Medical Practice, he turned the once stagnant online presence of Alaska Sleep Clinic to that of "The Most Trafficked Sleep Center Website in the World" in just 18 months time. He is the President and CEO of inboundMed and enjoys helping sleep centers across the globe grow their business through his unique vision and experience of over 27 years in sleep medicine.

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