Sleepwalking is a sleep disorder where individuals walk or engage in other activities while still asleep. This condition often has a genetic basis and can run in families. Typically, sleepwalkers can return to bed and continue sleeping without external help.

Key Takeaways

• Sleepwalking involves performing activities while asleep, with individuals usually returning to bed and resuming sleep on their own.

• Waking a sleepwalker can be challenging and may lead to confusion, as they often have partial or no memory of the event.

• Sleepwalking is more common in children and young adults than in older adults, and it generally diminishes by the teenage years. Specific treatment is rarely necessary.

What is Sleepwalking?

Sleepwalking, or Somnambulism, involves getting up and walking around while still in a state of sleep. Isolated incidents of sleepwalking typically do not indicate serious problems or require treatment. However, frequent episodes may suggest an underlying sleep disorder. In adults, sleepwalking is often linked with other sleep disorders or medical conditions. Ensuring the safety of a sleepwalker to prevent injuries is crucial.

Sleepwalking primarily occurs during deep Non-Rapid Eye Movement (NREM) sleep, specifically N3 sleep, early in the night.

Is Sleepwalking Normal?

While staying in bed during all sleep stages is typical, sleepwalking is relatively common, particularly in children or if someone is awakened during deep sleep.

Sleepwalking and Parasomnia

Sleepwalking is classified as a parasomnia, which refers to undesirable behaviors or experiences during sleep. It occurs during the deepest stage of NREM sleep (N3) and is considered an arousal disorder. Other NREM disorders, such as sleep terrors, may also occur alongside sleepwalking.

Prevalence of Sleepwalking

Sleepwalking is more frequent in children and younger adults compared to older adults. As people age, they experience less N3 sleep, making sleepwalking less common. If an older adult experiences sleepwalking, it may indicate medical conditions affecting mental functionality and neurocognitive disorders.

In children, sleepwalking often begins between ages 6 and 12 and usually resolves before or shortly after puberty. Research indicates that sleepwalking can be inherited, and individuals with irregular sleep patterns or chronic sleep deprivation are at higher risk.

What Causes Sleepwalking?

Several factors can contribute to sleepwalking, including:

• Physical Factors: Vigorous exercise, fever, or fatigue.

• Sleep Disruption: Sleep deprivation, irregular sleep schedules, frequent traveling, or environmental changes such as noise and light.

• Mental Health: Stress, PTSD, panic disorder, long-term depression, and anxiety.

• Medications: Certain drugs, including sedative-hypnotics, neuroleptics, anxiolytics, central stimulants, and antihistamines, can induce sleepwalking.

• Underlying Conditions: Sleep-disordered breathing (e.g., untreated obstructive sleep apnea), alcohol consumption, restless legs syndrome, gastroesophageal reflux disease (GERD), and neurological conditions such as migraine, head trauma, encephalitis, and epilepsy.

Risk Factors for Sleepwalking

• Genetics: Sleepwalking often runs in families. The likelihood of sleepwalking is higher if one or both parents have a history of the disorder. Some research has identified specific gene loci and genetic patterns.

• Age: Sleepwalking is more common in children and tends to occur less frequently in adults. When it starts in adulthood, it is often related to other underlying conditions.

Symptoms of Sleepwalking

Sleepwalking episodes can last from a few seconds to over 30 minutes, with most lasting less than 10 minutes. Common symptoms include:

• Sitting up and appearing awake while still asleep.

• Walking around or performing complex activities (e.g., moving furniture, dressing, driving).

• Returning to bed without disturbance.

• Falling asleep in unusual places.

• Confusion if awakened, with partial or no memory of the event.

• Impaired orientation, slow language, and reduced cognitive function.

• Occasionally violent behavior in male sleepwalkers.

Diagnosing Sleepwalking

Diagnosis involves a comprehensive medical history, including initial symptoms, frequency, duration, and any relevant health conditions or medications. Frequent or severe sleepwalking episodes may require more in-depth evaluation.

Diagnosis methods include:

• Medical History: Reviewing symptoms, health status, and family history.

• Polysomnography (PSG): To rule out other disorders like REM Sleep Behavior Disorder (RBD) or nocturnal seizures and to identify triggering factors.

• Mental Health Evaluation: For individuals with emotional issues, assessing for conditions like anxiety or stress.

Treatment for Sleepwalking

Most sleepwalkers do not need specific treatment but should take safety measures to prevent injury, such as removing hazards from their environment and securing stairways.

In some cases, medication may be prescribed, including benzodiazepines, tricyclic antidepressants, or selective serotonin reuptake inhibitors (SSRIs). For sleepwalkers with conditions like sleep apnea, effective treatment of the underlying issue often reduces sleepwalking incidents.

For potentially violent behavior, regular evaluation at a sleep disorders center may be necessary to rule out mental health issues.

Managing Sleepwalking

• Social Support: Family members should ensure a safe sleep environment by locking doors and windows, removing hazards, and managing any potential risks. They should also address the sleepwalker's psychological state and support adherence to a consistent bedtime routine.

• Behavior Management: Avoid discussing sleepwalking in a way that could increase anxiety. Develop good sleep habits, avoid excessive fatigue, and maintain a positive mental state. Proper diet, exercise, and relaxation techniques can also help.

• Monitoring: Keeping a sleep diary can help track the frequency and circumstances of sleepwalking episodes. Regular follow-ups with healthcare providers are recommended to assess progress and make necessary adjustments to treatment.

Tips to Prevent Sleepwalking

• Maintain a positive and healthy mental state to reduce stress and anxiety.

• Create a clean, quiet sleeping environment.

• Avoid triggers like overeating, smoking, and alcohol before bed.

• Develop consistent sleep and wake times, and prevent sleep deprivation.

Complications

Sleepwalkers may experience physical injuries from falls or accidents, such as driving while unaware. Ensuring safety and seeking appropriate management is crucial to mitigate these risks.