Sleepwalking, also known as somnambulism, is a type of parasomnia, a sleep disorder characterized by unusual behavior, vocalization, or movement during sleep. Sleepwalking occurs during the deepest stage of sleep, known as N3 sleep, which predominates during the early hours of the night. More than 8 million Americans sleepwalk, or nearly 7% of the population. (1)
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
Symptoms of sleepwalking often appear in childhood. Though the disorder typically affects children and resolves on its own in late childhood or adolescence, it affects a significant number of adults. (2)
Sleepwalking usually occurs during deep sleep but can also take place during the lighter sleep stages. Contrary to its name, sleepwalking may involve more than just walking during sleep. Signs and symptoms of the disorder include:
- Sitting up in bed
- Walking around
- Not responding to a voice or touch
- Leaving the home
- Attempting to drive or engage in other activities that could be dangerous while asleep
- Appearing dazed
- Repeating certain movements such as rubbing the eyes
Children may urinate in inappropriate places during sleepwalking episodes, or scream and appear frightened if sleepwalking occurs during a night terror. (3) People who sleepwalk can also experience other parasomnias, such as eating while asleep or confusional arousals.
People who suffer from sleepwalking may injure themselves while they are asleep and not realize it until the next day. In some cases, sleepwalkers may become violent or act out sexually during episodes. Sleepwalkers are usually difficult to awaken and rarely have a memory of their actions. (4)
Sleepwalking tends to occur more often in children whose parents sleepwalked as children, pointing to a genetic link. The sleep and wake system is less mature in children, which may contribute to sleepwalking episodes. (5) Other potential causes include:
- Sleep deprivation
- Fever or illness
- Jet lag or other disruptions to the circadian rhythm
- Gastroesophageal reflux disease (GERD)
- Other sleep disorders, such as restless legs syndrome and obstructive sleep apnea
- Use of alcohol, recreational drugs, and certain medications, particularly prescription sleep medications and sedatives
Stress and major life changes such as a move or loss of a family member are common triggers for sleepwalking. There may also be a connection between sleepwalking and mental and mood disorders. (6) Most cases of sleepwalking occur only occasionally and are not an indication of an underlying disorder.
In most cases of sleepwalking, treatment isn’t necessary. For children and adults who sleepwalk frequently or endanger themselves, however, medication or another type of intervention may help. (8) Treatment may also be warranted in cases that involve the following:
- Another parasomnia, such as night terrors or bedwetting
- Another sleep disorder, such as sleep apnea or narcolepsy
- Significant awakenings during the night that result in daytime sleepiness, impaired function, or behavioral issues
Treating underlying medical or sleep issues can help reduce the tendency to sleepwalk and improve the quality of sleep as a whole. Hypnosis may also be an option for some people who sleepwalk chronically.
Scheduled awakenings can be effective in reducing sleepwalking episodes, particularly in children who sleepwalk frequently and at a consistent time of night. (7) The goal of this treatment is to prevent sleepwalking by waking the sufferer about thirty minutes before their usual episode occurs. Scheduled awakenings can also help prevent night terrors, a parasomnia characterized by overwhelming fear and physical symptoms, such as sweating and dilated pupils.
Medications are not typically prescribed for sleepwalking unless the disorder presents a persistent danger or interferes with daily life. Medications for sleepwalking include antidepressants and benzodiazepines, such as:
- Clonazepam (Klonopin)
All of these medications may cause side effects like drowsiness and dizziness. Because benzodiazepines can cause dependency and protracted withdrawal symptoms, they are rarely suggested for long-term use.
Tips for Parents and Caregivers
Parents and caregivers may not be able to completely stop sleepwalking episodes, but they can help keep a child or adult safe. To lower the risk of injury, consider the following tips:
- Make sure front and back doors are locked at night
- Install childproof locks on windows
- Don’t allow a child who sleepwalks to sleep in a top bunk bed
- Put heavy, sharp, or dangerous objects out of reach
- Hide keys if the sleepwalker has ever attempted to drive
- To prevent falls, install gates on stairways
- If episodes continue, see your healthcare provider for professional diagnosis and advice
Following good sleep hygiene can also help decrease episodes of sleepwalking. Sleep hygiene basics include consistent sleep and wake times, turning off electronics such as phones and televisions at least an hour before bed, eliminating consumption of caffeine and alcohol at night, and reducing anxiety and stress to help deactivate the nervous system.
Other sleep hygiene basics include:
- Keeping the bedroom cool, dark, and quiet. An environment that is conducive to sleep is less likely to result in partial awakenings that can cause sleepwalking
- Exercise regularly. Consistent exercise helps to relax muscles, reduce anxiety, and regulate the circadian rhythm
- Avoid eating or feeding children heavy meals close to bedtime. Like sleep, digestion is controlled by the circadian rhythm, and can disrupt sleep and wake cycles
- Reduce stimulation of all kinds before bed to help the brain and body prepare for sleep
Last Word From Sleepopolis
Many people know about sleepwalking through movies and novels, and never experience it themselves. The disorder is fairly common, however, particularly in children. Occasional sleepwalking rarely requires treatment, and usually goes away by adolescence.
Chronic sleepwalking or sleepwalking that results in injury may require treatment. Medication is an option in some cases, but is rarely necessary. Good sleep hygiene and scheduled awakenings are often sufficient to decrease the effects of sleepwalking and promote healthy sleep.
What is a confusional arousal?
A type of parasomnia characterized by confusion, disorientation, and difficulty waking up.
Why doesn't sleepwalking occur during REM sleep?
The muscles are paralyzed during REM sleep, preventing walking or any other movement.
Do people dream while they sleepwalk?
Though sleepwalking does not occur during REM sleep when most dreaming takes place, some people dream or hallucinate when they sleepwalk.
- Stallman HM, Kohler M., Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis, Plos One, November 10th, 2016
- Christian Guilleminault, Adult chronic sleepwalking and its treatment based on polysomnography, Brain, May, 2005
- Mary Grace Umlauf, Bedwetting—Not Always What It Seems: A Sign of Sleep‐Disordered Breathing in Children, Pediatric Nursing, February 22, 2007
- Popat S, Winslade W., While You Were Sleepwalking: Science and Neurobiology of Sleep Disorders & the Enigma of Legal Responsibility of Violence During Parasomnia, Neuroethics, April 2015
- Christian Guilleminault, Non-REM-sleep instability in recurrent sleepwalking in pre-pubertal children, Sleep Medicine, November 2005
- Elana R. Bloomfield BA, Parasomnias and Movement Disorders in Children and Adolescents, Child and Adolescent Psychiatric Clinics of North America, October 2009
- Frank NC, Spirito A, Stark L, Owens-Stively J., The use of scheduled awakenings to eliminate childhood sleepwalking, Journal of pediatric psychology, June 1997
- Bharadwaj R, Kumar S., Somnambulism: Diagnosis and treatment, Indian journal of psychiatry, April-June 2007