Sleepwalking (Somnanbulism) Causes, Symptoms & Treatment

Sleepwalking

Also called: Sleepwalking Disorder, Somnabulism

Summary

Sleepwalking, or somnambulism, is a disorder marked by walking during sleep. Patients may also engage in other activities, such as talking or eating, during sleep. Sleepwalking typically occurs during deep sleep. 

Sleepwalking can occur at any age, but it is more common in children. Most children outgrow sleepwalking by the time they reach adolescence.

Some possible causes of sleepwalking are environmental factors (e.g., sleep deprivation and stress), overuse of alcohol, medications, medical conditions (e.g., fever, asthma) and psychiatric conditions (e.g., post-traumatic stress disorder, panic disorder). Sleepwalking also appears to be associated with migraine headaches.

Signs and symptoms include walking while asleep, having a blank stare and having no recollection of the episode after waking.

Sleepwalking can usually be diagnosed when a physician listens to a description of the events during a physical examination. In some cases, patients may be asked to participate in a sleep study or be referred to a mental health professional for further evaluation, especially if sleepwalking is chronic, causes daytime sleepiness, or is believed to result from a mental disorder.Sleepwalking may be treated in a variety of ways, depending upon the age of the patient and its cause. Most children do not require treatment. Some patients only need reassurance and support. Others may be treated with medications (e.g., benzodiazepines) or therapy (e.g., relaxation therapy). Some techniques for ensuring that an environment is safe for people who sleepwalk  include locking doors and windows, blocking stairways and removing objects that may cause trips and falls.

About sleepwalking

Sleepwalking is a disorder characterized by walking during sleep. Patients may also engage in other activities, such as talking or eating, during sleep. Sleepwalking is also called somnambulism.

Sleep is divided into five stages: stages 1 through 4, which range from the lightest sleep to deep sleep, and the fifth stage, which is known as rapid eye movement (REM) sleep. During a typical night’s sleep, a person cycles through these stages approximately every 90 minutes. Sleepwalking usually occurs during deep sleep (stages 3 and 4 of the sleep cycle) in the first third of the sleep period, early in the night. It infrequently occurs during REM sleep, closer to morning.

Sleepwalking is a type of parasomnia, a sleep disorder characterized by abnormal behaviors during sleep. Parasomnias include abnormalities within the stages of the sleep cycle.

While sleepwalking, people experience reduced alertness, have a blank stare and are usually unresponsive to attempts to speak with them or wake them. If awoken, a person will experience confusion for a few moments, but will return to a normal state of mental and physical functioning. Sleepwalking may include a variety of behaviors. In mild cases, sleepwalkers may sit up in bed, rub their eyes, appear awake, look around and pick at their clothing, bed sheets or blankets.

People who sleepwalk may engage in simple activities, such as eating, dressing or using the toilet. If patients talk while sleepwalking, the speech is typically garbled and incomprehensible. They may also engage in more complex activities, such as moving furniture or driving a car. Sleepwalking episodes may last for a few minutes or a half hour or longer. After sleepwalking, patients do not usually recall the episode.

One myth is that people should not be wakened while sleepwalking. It is not dangerous to awaken people who are sleepwalking, although it may be difficult and it is common for them to be confused and disoriented afterwards. Another common misperception is that people cannot be injured while sleepwalking. Injuries can occur as a result of trips, falls and other actions that may occur while sleepwalking. Sleepwalking can occur at any age, but it is more common in children. According to the American Psychiatric Association (APA), 10 to 30 percent of children have experienced at least one episode of sleepwalking and 2 to 3 percent have frequent episodes. Among adults, 1 to 7 percent have experienced an episode of sleepwalking, and between 1 and 5 percent have sleepwalking disorder, characterized by frequent episodes that cause significant distress or dysfunction. Most children outgrow sleepwalking by adolescence. Adults who sleepwalk usually did so as children.

Potential causes of sleepwalking

Most causes of sleepwalking among children are unknown. Children who sleepwalk may do it several times and then outgrow the behavior by adulthood. For some children, sleepwalking may be associated with fatigue, sleep loss, anxiety or changes in their environment at home or school.

Among adults, there are many potential causes of sleepwalking. They include:

  • Heredity. Research suggests that sleepwalking tends to run in families.
  • Environmental factors. Sleep deprivation, irregular sleep schedules and stress may all contribute to sleepwalking.
  • Excessive alcohol use. Consuming too much alcohol may induce sleepwalking in some individuals.
  • Medications. Numerous medications may disturb sleep cycles, including sedatives, antipsychotic medications, stimulants and antihistamines.
  • Medical conditions/sleep disorders. Numerous conditions and disorders may also affect sleep cycles and contribute to sleepwalking, including:
    • Nighttime seizures (convulsions). Sudden, involuntary movements of the muscles.
    • Obstructive sleep apnea. A disorder in which a person’s breathing stops and starts many times during sleep.
    • Night terrors. A sleep disorder in which patients abruptly awaken from deep sleep in a terrified state.
    • Pregnancy and menstruation. Both have been linked to higher incidence of sleepwalking.
  • Psychiatric conditions. Adults who sleepwalk may have another mental health condition. Some of those most commonly associated with sleepwalking include:
    • Post-traumatic stress disorder (PTSD). Psychiatric illness that occurs after a traumatic event in which the threat of injury or death was present (e.g., combat, natural disaster).
    • Panic disorder. Disorder marked by repeated, sudden attacks of intense fear that cause severe anxiety symptoms in the body.
    • Dissociative disorders. Disorders characterized by the sudden, temporary separation of thoughts, emotions, sensations or memories from the rest of the identity or sense of self.

Children who sleepwalk do not typically have emotional problems.

Signs and symptoms of sleepwalking

Signs and symptoms of sleepwalking include:

  • Walking during sleep
  • Exhibiting other behaviors, such as talking, eating or using the toilet, during sleep
  • Sitting up and appearing awake during sleep
  • Being unresponsive to others’ attempts to awaken them
  • Having a blank stare with eyes open during sleep
  • Being confused or disoriented after waking up
  • Having no recollection of a sleepwalking episode after waking up

Sleepwalking does not usually require visiting a physician. However, a physician should be notified if sleepwalking episodes:

  • Occur with other symptoms
  • Are frequent or persistent
  • Are accompanied by dangerous activities (such as driving)
  • Result in injury (e.g., from a fall)

Diagnosis methods for sleepwalking

Most cases of sleepwalking can be diagnosed by a physician who hears a description of the event. A physical examination with a medical history that includes a list of medications may help identify the cause. In some cases, patients may be asked to participate in a sleep study, which measures the physiological aspects of sleep. If sleepwalking is chronic, or if it is suspected that a mental disorder is causing it, patients may be referred to a psychiatrist or other mental health professional who may conduct a psychiatric evaluation or mental health assessment.

Some questions patients, family members or sleep partners may be asked about sleepwalking episodes include:

  • At what time during the sleep period did the sleepwalking occur?
  • Does the patient have any memory of the sleepwalking episode?
  • Did the patient experience daytime drowsiness or other consequences as a result of the episode?
  • Has the patient experienced any physical or emotional stress recently?

In some cases, patients may be referred to a sleep center where sleep patterns are analyzed in depth by health professionals who specialize in sleep disorders. At the sleep center, a polysomnogram (sleep study) will typically be performed. This painless test is conducted overnight while patients are sleeping. Electrodes are placed on the face and scalp before sleep. The test monitors electrical activity of the brain (electroencephalogram), electrical activity of the heart (electrocardiogram) and movements of the muscles (electromyogram) and eyes (electr-ooculogram). These are measured as patients move through the different stages of sleep.

Many people have an occasional episode of sleepwalking. To be diagnosed with sleepwalking disorder, however, patients must meet Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, which include:

  • Patients must have multiple episodes of getting out of bed while sleeping during the first third of the sleep period.
  • While sleeping, patients must have blank stares and be unresponsive to attempts to awaken them.
  • After waking, patients must have no recollection of sleepwalking episode.
  • Patients must regain mental and physical functioning within a few minutes after waking from a sleepwalking episode.
  • Sleepwalking must cause significant distress or dysfunction in social, work or other environments.
  • Sleepwalking must not be caused by a medical condition, medication or substance use.

Treatment and prevention of sleepwalking

The treatment of sleepwalking depends upon the age of the patient and its cause. Many children outgrow sleepwalking by the time they reach adolescence. In many cases, reassurance and support is the only treatment necessary for both children and adults. In some cases, measures to prevent injury may be taken, such as:

  • Locking windows and doors prior to bedtime.
  • Removing objects that may cause trips, such as furniture or electrical cords.
  • Placing gates on stairways to prevent falls.
  • Making sure the sleepwalking patient sleeps in a ground floor bedroom.
  • Placing an alarm or bell on the bedroom door.
  • Covering windows with heavy drapes.

Underlying medical or psychiatric conditions may be treated if they are determined to be the cause of sleepwalking. Some patients who experience sleepwalking are treated with medications, including:

  • Benzodiazepines. Medications that slow down the central nervous system. They are used to produce sedation, induce sleep, relieve anxiety and muscle spasms and prevent seizures. Extended use of benzodiazepines can result in physical and psychological dependence.
  • Antidepressants. Medications primarily used to treat depression, anxiety and problems with obsession. Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them – especially children – should be monitored closely for unusual changes in behavior.

    Other techniques used to treat sleepwalking include:
  • Relaxation therapy. Techniques such as listening to music or breathing exercises that help patients relax. This should be performed with the assistance of a behavioral therapist or hypnotist.
  • Mental imagery. Uses mental images as a way to impact attitudes and emotions. This should also be performed with the assistance of a behavioral therapist or hypnotist.
  • Anticipatory awakenings. The patient is awoken 15 to 20 minutes before an anticipated sleepwalking episode and kept awake for the time during which episodes occurred in the past.

Some techniques for improving sleep and possibly avoiding a sleepwalking episode include:

  • Avoiding or minimizing stress, anxiety and conflict.
  • Avoiding alcohol or the use of medications that suppress the central nervous system, such as sedatives.
  • Avoiding sleep deprivation, fatigue or insomnia.

Questions for your doctor about sleepwalking

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following sleepwalking-related questions:

  1. How can I tell if I (or my child) am sleepwalking?
  2. Is any episode of sleepwalking of concern?
  3. What is causing my (or my child’s) sleepwalking?
  4. Is it safe to wake someone who is sleepwalking?
  5. What should I do if I cannot wake someone who is sleepwalking?
  6. What is the best way for me to treat my (or my child’s) sleepwalking?
  7. Can sleepwalking be prevented?
  8. Will I (or my child) outgrow sleepwalking?
  9. If I (or my child) sleepwalked once, is it likely to happen again?
  10. Can sleepwalking be prevented?
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