Sleepwalking

Sleepwalking, also known as somnambulism, is when people get up and walk around while asleep. It's more common in children than adults. Children usually outgrow sleepwalking by the teen years. Sleepwalking that happens once in a while often isn't a serious problem and doesn't need treatment. But sleepwalking that happens a lot may suggest an underlying sleep disorder.

Sleepwalking in adults is more likely to be confused with, or happen as part of, other sleep disorders. Medical conditions also can cause people to walk in their sleep.

If people in your household sleepwalk, it's important to take steps to help prevent them from getting injured while sleepwalking.

Sleepwalking usually occurs early in the night — often 1 to 2 hours after falling asleep. It isn't likely to happen during naps, but it is possible. A bout of sleepwalking can occur rarely or often. A bout generally lasts several minutes, but it can last longer.

People who sleepwalk may:

• Get out of bed and walk around.
• Sit up in bed and open their eyes.
• Have a glazed, glassy-eyed expression.
• Not respond or talk to others.
• Be hard to wake up.
• Be confused for a short time after waking up.
• Not remember in the morning that they sleepwalked.
• Have problems functioning during the day because of disturbed sleep.
• Also have sleep terrors that cause screaming and waving of arms and legs.

Sometimes, people who sleepwalk will:

• Do routine activities, such as getting dressed, talking or eating.
• Leave the house.
• Drive a car.
• Take part in unusual behavior, such as passing urine in a closet.
• Take part in sexual activity without being aware of it.
• Get injured, such as by falling down the stairs or jumping out a window.
• Become violent while briefly confused after waking up or once in a while sleepwalking.

When to see a doctor

Occasional bouts of sleepwalking aren't usually a cause for concern. They usually go away on their own. You can simply mention the sleepwalking at a routine physical or well-child exam.

See your healthcare professional if the bouts of sleepwalking:

• Happen often — for example, more than 1 to 2 times a week or several times a night.
• Lead to dangerous behavior or injuries to those who sleepwalk or others.
• Disturb the sleep of household members or those who sleepwalk.
• Lead to being very tired during the day or causing problems in daily life activities, such as at school or work.
• Continue into your child's teen years or start for the first time as an adult.

Sleepwalking is classified as a parasomnia — an undesirable behavior or event during sleep. Sleepwalking is a disorder of arousal. This means it occurs during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Another NREM disorder is sleep terrors, which can occur with sleepwalking.

Many factors can lead to sleepwalking, including:

• Not getting enough sleep.
• Stress.
• Fever.
• Sleep schedule disruptions, travel or sleep interruptions.

Sometimes underlying conditions that affect sleep can cause sleepwalking, such as:

• Sleep-disordered breathing — a group of disorders featuring unusual breathing patterns during sleep, such as obstructive sleep apnea.
• Taking certain medicines, such as hypnotics, sedatives or some medicines used for mental health conditions.
• Substance use, such as alcohol.
• Restless legs syndrome.
• Gastroesophageal reflux disease (GERD).

Factors that may raise the risk of sleepwalking include:

• Genetics. Sleepwalking appears to run in families. It's more common if one parent has a history of sleepwalking, and much more common if both parents have a history of the sleep disorder.
• Age. Sleepwalking occurs more often in children than adults. When it starts in an adult, it's more likely related to other underlying conditions.

Sleepwalking itself isn't necessarily a concern, but people who sleepwalk can:

• Get hurt, especially if they walk near furniture or stairs, wander outdoors, drive a car, or eat something that shouldn't be eaten while sleepwalking.
• Have a sleep disruption that lasts a long time, which can lead to being very tired during the day and possible school or behavioral issues.
• Be very embarrassed about their actions.
• Disturb others' sleep.

Rarely, people who sleepwalk can injure someone else nearby.

To diagnose sleepwalking, your healthcare professional reviews your medical history and symptoms. Your evaluation may include:

• Physical exam. Your healthcare professional may do a physical exam to identify any conditions that may be confused with sleepwalking, such as nighttime seizures, other sleep disorders or panic attacks.
• Discussion of your symptoms. Unless you live alone and aren't aware of your sleepwalking, you'll likely be told by others that you sleepwalk. If your sleep partner comes with you to the appointment, your healthcare professional may ask your sleep partner whether you appear to sleepwalk. Your healthcare professional also may ask you and your sleep partner to fill out a questionnaire about your sleep behaviors. Tell your healthcare professional if you have a family history of sleepwalking.
• Sleep study. In some cases, your healthcare professional may recommend an overnight study in a sleep lab. This sleep study is called a polysomnography. Sensors placed on your body will record and keep track of your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements, while you sleep. You may be videotaped to document your behavior during sleep cycles.

Occasional sleepwalking usually does not need to be treated. In children who sleepwalk, it usually goes away by the teen years.

If sleepwalking could lead to injury, disrupts family members, or results in embarrassment or sleep disruption for the people who sleepwalk, treatment may be needed. Treatment generally focuses on promoting safety and stopping what's causing the sleepwalking.

Treatment may include:

• Treating any underlying condition, if the sleepwalking is related to not getting enough sleep or an underlying sleep disorder or medical condition.
• Adjusting medicine, if it's thought that the sleepwalking is due to a drug.
• Anticipatory awakenings, which involves waking people up about 15 minutes before they usually sleepwalk, then staying awake for a few minutes before falling asleep again.
• Medicine such as benzodiazepines, which slow down activity in the nervous system, or certain antidepressants.
• Learning self-hypnosis from a trained professional who is familiar with parasomnias. People who are open to suggestions during hypnosis may achieve a deep state of relaxation that could change unwanted activities during sleep.
• Therapy or counseling, where a mental health professional can suggest ways to improve sleep and reduce stress, as well as teach techniques on self-hypnosis and relaxation.

If sleepwalking is a problem for you or your child, try to:

• Make the environment safe. If sleepwalking has led to injuries or may do so, take precautions. Close and lock all windows and exterior doors before bedtime. You might even lock interior doors or place alarms or bells on the doors. Block doorways or stairways with a gate. Move electrical cords and other tripping hazards out of the way. Sleep in a ground-floor bedroom, if possible. Place sharp or fragile objects out of reach, and lock up all weapons. If your child sleepwalks, avoid bunk beds for sleeping.
• Gently lead people who sleepwalk to bed. You don't need to wake them up. Although it isn't dangerous to be awakened, it can be disruptive if they become confused and possibly agitated.
• Get enough sleep. Being very tired can lead to sleepwalking. If you don't get enough sleep — at least seven hours each night — try to go to bed earlier or take up a more regular sleep schedule. Or take a short nap, which is especially helpful for toddlers. If possible, avoid noises while sleeping or anything else that could interrupt sleep.
• Have a regular, relaxing routine before bedtime. Do quiet, calming activities before bed, such as reading books, doing puzzles or soaking in a warm bath. Meditation or relaxation exercises may help too. Make the bedroom comfortable and quiet for sleep.
• Put stress in its place. Identify the issues that cause stress and ways to handle the stress. Talk about what's bothering you. Or if your child sleepwalks and seems anxious or stressed, talk with your child about any concerns. A mental health professional can help.
• Look for a pattern. For several nights, note ― or have another person in your home note ― how many minutes after bedtime a bout of sleepwalking occurs. If the timing is fairly consistent, this information could help plan anticipatory awakenings.
• Stay away from alcohol. Drinking alcohol can interfere with a good night's sleep and may cause sleepwalking.

If you sleepwalk and have concerns about safety or underlying conditions, see your healthcare professional. You may want to bring a family member or friend along, if possible, to provide more information about your sleepwalking. Your healthcare professional may refer you to a sleep specialist.

You may want to keep a sleep diary for two weeks before your appointment and bring the diary to your appointment. The information can help your healthcare professional understand more about your sleep schedule, what affects your sleep and when sleepwalking occurs. In the morning, record bedtime routines, quality of sleep and so on. At the end of the day, record behaviors that may affect sleep, such as sleep schedule changes, alcohol consumed and any medicines taken.

What you can do

Before your appointment, make a list of:

• Any symptoms, including any that don't seem to be related to the appointment.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbs or other supplements you're taking, and the doses.
• Questions to ask your healthcare professional to make the most of your time together.

Some questions to ask your healthcare professional include:

• What could cause the symptoms or condition?
• What kinds of tests are needed?
• Is this likely a short- or long-term condition?
• What's the best course of action?
• What are the options to the main approach you're suggesting?
• Are there any guidelines that need to be followed?
• Do I need to see a specialist?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional likely will ask you several questions. Be ready to answer them to make sure you have time to go over any points you want to focus on.

Your healthcare professional may ask:

• When did you begin having symptoms?
• Have you or your child had sleep problems in the past?
• Does anyone else in your family have sleep problems, especially sleepwalking or sleep terrors?
• What problems have you noticed related to the sleepwalking, such as waking up in unusual locations of the house?
• Are there symptoms of obstructive sleep apnea, such as loud snoring, witnessed breathing pauses during sleep, labored breathing during sleep, sleep that's not refreshing, daytime sleepiness or behavioral changes?