Sleepwalking: A Sleep Disorder

Sleepwalking occurs when you get up from bed and walk around even though you are still asleep. It can also involve a series of other complex actions. Before walking, you 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. 

You might talk or shout as you are walking. Your eyes are usually open and have a 
confused, “glassy” look to them. You 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.

If you talk to a person who is sleepwalking, they may partially respond or say things that don't make sense.

Most sleepwalking episodes don't last longer than 10 minutes. At the end of each episode, the person may wake up or they may return to bed and go back to sleep. If woken while sleepwalking, the person will usually feel confused and won't remember the episode.

Causes

The normal sleep cycle has stages, from light drowsiness to deep sleep. During the stage called rapid eye movement (REM) sleep, the eyes move quickly and vivid dreaming is most common.

Each night people go through several cycles of non-REM and REM sleep. Sleepwalking (somnambulism) most often occurs during deep, non-REM sleep (stage 3 or stage 4 sleep) early in the night. If it occurs during REM sleep, it is part of REM behavior disorder and tends to happen near morning.

Several different factors may be involved in the development of sleepwalking. These may include genetics (traits that run in families), environment, and medical conditions.

Genetics

Sleepwalking occurs more frequently in identical twins, and is 10 times more likely to occur if a first-degree relative has a history of sleepwalking. Therefore, it is thought the condition can be inherited.

Environmental Factors

Certain factors may cause a person to sleepwalk, such as:

• Sleep deprivation
• Chaotic sleep schedules
• Stress
• Alcohol intoxication
• Drugs such as sedative/hypnotics (drugs that promote relaxation or sleep), neuroleptics (drugs used to treat psychosis), stimulants (drugs that increase activity), and antihistamines (drugs used to treat symptoms of allergy)

Medical Conditions

Medical conditions that have been linked to sleepwalking include:

• Arrhythmias (abnormal heart rhythms)
• Fever
• Gastroesophageal reflux (food or liquid regurgitating from the stomach up into the food pipe)
• Nighttime asthma
• Nighttime seizures (convulsions)
• Obstructive sleep apnea (condition in which breathing stops temporarily while sleeping)
• Psychiatric disorders, for example, posttraumatic stress disorder, panic attacks, or dissociative states, such as multiple personality disorder

Symptoms

Sleepwalking is classified as a parasomnia: an undesirable behavior or experience during sleep. Sleepwalking is a disorder of arousal, meaning it occurs during slow wave sleep, the deepest stage of dreamless (non-rapid eye movement, or NREM) sleep. Another NREM disorder is sleep terrors, which can occur together with sleepwalking.

Sleepwalking usually occurs early in the night, often one to two hours after falling asleep. It's unlikely to occur during naps. A sleepwalking episode can occur rarely or often, and an episode generally lasts several minutes, but can last longer.

Someone who is sleepwalking may:

• Get out of bed and walk around
• Sit up in bed and open his or her eyes
• Have a glazed, glassy-eyed expression
• Do routine activities, such as getting dressed, talking or making a snack
• Not respond or communicate with others
• Be difficult to wake up during an episode
• Be disoriented or confused for a short time after being awakened
• Quickly return to sleep
• Not remember the episode in the morning
• Sometimes have problems functioning during the day because of disturbed sleep
• Have sleep terrors in addition to sleepwalking

Rarely, a person who is sleepwalking will:

• Leave the house
• Drive a car
• Engage in unusual behavior, such as urinating in a closet
• Engage in sexual activity without awareness
• Get injured, for example, by falling down the stairs or jumping out a window
• Become violent during the confused period after awakening or, occasionally, during the event

What To Do If Someone Is Sleepwalking

The best thing to do if you find someone sleepwalking is to make sure they're safe. Don't shout or startle the person so they wake up.

Gently guide them back to bed. If undisturbed, they'll often go back to sleep again. Sometimes, gently waking the person fully (particularly children) when they appear to be coming out of the episode, before settling them back to sleep, will prevent another episode occurring from the same deep sleep cycle.

Treatment

There is no specific treatment for sleepwalking. In many cases simply improving sleep hygiene may eliminate the problem. If you are experiencing symptoms, you should talk to your doctor or a sleep specialist about ways to prevent injury during the episodes and about the possibility of underlying illness. Also, be prepared to discuss with your doctor or pediatrician any factors, such as fatigue, medication, or stress, which may trigger symptoms.

Treatment for sleepwalking in adults may include hypnosis. In fact, there are many cases in which sleepwalking patients have successfully treated their symptoms with hypnosis alone. Also, pharmacological therapies such as sedative-hypnotics or antidepressants have been helpful in reducing the incidence of sleepwalking in some people.

For children who sleepwalk more often, your doctor may recommend a treatment method called scheduled awakening. This treatment works as follows: for several nights you record the time between when your child falls asleep and the beginning of the sleepwalking event. Then for the next several nights in a row, you arouse your child 15 minutes before the expected time of the event. You do not need to completely awaken the child, simply disturb the sleep enough to a brief arousal. This disrupts the sleep cycle transiently and may abort the sleepwalking in some cases.

Other helpful ways you might be able to reduce your child’s sleepwalking events:

• Have your child relax at bedtime by listening to soft music or relaxation tapes or CDs.
• Establish regular nap and sleep schedules and stick with them – both nighttime and wake-up times. Naps are important in the younger child. This will eliminate sleep deprivation, a known trigger for sleepwalking.
• Cut back on the amount of liquids your child consumes in the evening and make sure he or she goes to the bathroom before bedtime (a full bladder contributes to sleepwalking).
• Avoid caffeine near bedtime (caffeinated products include coffee, tea, colas, some non-cola pops, energy drinks and chocolates).
• Make sure your child’s bedroom is quiet, calm, comfortable (< 75° F), and sufficiently dark.

If stress is thought to contribute to the problem, counseling may help. Hypnosis or biofeedback may also be looked into.

On rare occasions, doctors may prescribe a medication to help your child sleep.

When To Contact A Medical Help
Occasional episodes of sleepwalking aren't usually a cause for concern. You can simply mention the sleepwalking at a routine physical or well-child exam. However, consult your doctor if the sleepwalking episodes:

• Occur often, for example, more than one to two times a week
• Lead to dangerous behavior or injury to the person who sleepwalks (which may occur, for example, after leaving the house) or to others
• Cause significant sleep disruption to household members or embarrassment to the person who sleepwalks
• Start for the first time in an adult
• Continue into your child's teen years

Coping

As sleep deprivation often contributes to sleepwalking, increasing the amount of time scheduled for sleep can be helpful. Other possible triggers for sleepwalking include alcohol and certain medications. Also, experts recommend establishing a regular, relaxing routine prior to bedtime to cope with sleepwalking.

Prevention

It's important to keep the areas of your home where a person may sleepwalk free of breakable or potentially harmful objects, and to remove any items they could trip over. It's also a good idea to keep windows and doors locked.

If your child sleepwalks, don't let them sleep on the top bed of a bunk bed. You may also want to fit safety gates at the top of the stairs.