Sleepwalking

What is sleepwalking?

Sleepwalking is a sleep disorder that causes you to move around or engage in unusual or unexpected activities while asleep. This condition often runs in families, and most people grow out of it.

The formal name for sleepwalking is somnambulism, which comes from Latin words that mean “sleep” and “walking.” Experts classify it as a sleep disorder (parasomnia).

How common is sleepwalking?

About 7% of people sleepwalk at least once in their lifetime. Sleepwalking usually starts in childhood, and most people grow out of it by the time they become adults. Within a year, about 5% to 15% of children — most often between ages 4 and 8 — and 1% to 1.5% of adults experience sleepwalking.

What are the symptoms of sleepwalking?

Like the name suggests, most people who sleepwalk stand up and walk around while asleep. But other activities during sleep are also possible. Sleepwalking usually involves several or all the following features:

• Partial waking: You become active but don’t fully wake up.
• Timing: It usually happens within the first two or three hours of falling asleep.
• Lack of coordination: Your movements are gangly, clumsy or awkward.
• Limited awareness: You aren’t fully aware of your physical surroundings or anything happening around you. Your eyes may be open, but you might not react to things in your field of vision.
• Lack of memory: You don’t remember what you did while sleepwalking.
• Limited complex abilities: An example of this would be not being able to unlock a door because you can’t access the problem-solving skills and coordination abilities you need.
• Dream-acting: You might act out behaviors that line up with a dream you’re having. Sometimes, people may pee (urinate) in unexpected places or talk in their sleep.
• Sleep eating: You may eat things you wouldn’t normally eat, like inedible items or foods high in carbs. You may find uncooked or partially cooked food in the kitchen or bed and may gain weight from the calories consumed during sleep.

While most people can’t do complex activities while sleepwalking, that’s not universal. In rare cases, people were even able to drive or cook while sleepwalking. And complex actions are more likely if you’re sleep-deprived (especially going more than 24 hours without sleep) before the sleepwalking episode.

What causes sleepwalking?

Experts aren’t sure why sleepwalking happens. The only possible sleepwalking cause that researchers can pinpoint with any certainty — at least for now — is genetics. Children of sleepwalkers are more likely to sleepwalk, too. If one parent has a history of sleepwalking, their child has a 47% chance of also doing it. That goes up to 62% if both parents have a history of sleepwalking. Research also links a specific gene mutation, HLA-DQB1*05, to a higher risk of sleepwalking in people who are white.

What are the risk factors for sleepwalking?

Several possible risk factors could make someone more likely to sleepwalk or trigger a sleepwalking episode, including:

• Sleep deprivation: People who sleepwalk are more likely to do it if they don’t get enough sleep. People with sleep deprivation are also able to do more complex tasks in their sleep.
• Other sleep disorders: Having another sleep disorder, like sleep apnea, may make sleepwalking more likely. This might be because of how those disorders affect your sleep cycle.
• Alcohol: Drinking alcohol before going to bed may affect how you sleep. That includes triggering a sleepwalking episode.
• Mental health: Research links anxiety, stress, childhood trauma and post-traumatic stress disorder (PTSD) to an increased risk of sleepwalking.
• Thyroid conditions: High thyroid activity (hyperthyroidism) can cause sleepwalking, though this isn’t common.
• Brain-related diseases: Degenerative brain conditions like Parkinson’s disease can cause sleepwalking when they affect your brainstem. Developmental conditions like Smith-Magenis syndrome (which is rare) can also cause sleepwalking.
• Environmental triggers if you’re at higher risk: Things like illness with or without fever, a full bladder or sounds that wake you up may trigger sleepwalking if you’re predisposed to it.

What medications can trigger sleepwalking?

Research indicates that several types of medication might trigger sleepwalking episodes. Some of the most likely medications include (but aren’t limited to) the following:

• Zolpidem (Ambien®).
• Quetiapine (Seroquel®).
• Metoprolol (Lopressor®).

If you think a medication might contribute to your sleepwalking (or sleepwalking in a loved one), it’s a good idea to talk to a healthcare provider. They can review medications and determine if there’s a risk.

How is sleepwalking diagnosed?

A healthcare provider can usually diagnose sleepwalking based on descriptions of what you did or how you acted while sleepwalking. Loved ones who witness sleepwalking can provide extremely helpful details that can lead to a sleepwalking diagnosis. Videos you take on your phone or on a security system can also be helpful, as sleepwalking doesn’t happen every night, so it can be hard to capture in a sleep study.

A full sleep study (polysomnography) is the best medical test to confirm sleepwalking. But these aren’t always necessary. Your healthcare provider (or your child’s provider) may recommend a sleep study if any of the following are true:

• They suspect that your sleepwalking symptoms are from a different condition. They may also want to distinguish between sleepwalking and sleep-related seizures or rapid eye movement behavior disorder.
• Sleepwalking leads to injury or sleepwalking behavior disrupts the sleep of others in your house.

In some cases, a healthcare provider might recommend other tests — like electromyography or electroencephalography — to rule out conditions that might relate to sleepwalking.

How is sleepwalking treated, and is there a cure?

Sleepwalking doesn’t usually need direct treatment. When it does, there are nonmedication approaches that your provider can recommend. They include:

• Relaxation and stress management techniques: Reducing stress levels may lower the chances of it triggering a sleepwalking episode.
• Treating the disorders causing arousal from sleep: Treating conditions like obstructive sleep apnea can reduce disordered arousals in people who sleepwalk.
• Mental health therapy (psychotherapy): Seeing a mental health provider can help reduce anxiety, stress and other factors that may contribute to sleepwalking episodes.
• Scheduled waking: Sleepwalking episodes often happen with predictable timing (usually within the first few hours of falling asleep). Scheduled waking 15 to 30 minutes before a sleepwalking episode should start (either for you or your child) can prevent sleepwalking from happening.

Medications for sleepwalking

There aren’t any U.S. Food and Drug (FDA)-approved drugs specifically for sleepwalking. In some cases, a provider might recommend medications that alter neurotransmitter levels, although there’s no evidence that they work. Neurotransmitters are chemicals your brain uses to send signals and control processes throughout your nervous system.

Medications that can affect neurotransmitters include:

• Gabapentin.
• Antidepressants.

Your healthcare provider may also prescribe a sedative so you’re less likely to be aroused during sleep.

Is sleepwalking preventable?

Sleepwalking happens unpredictably and for reasons experts don’t understand. That means you can’t stop it from occurring in the first place.

But you can take steps to reduce the risk of repeat sleepwalking episodes. You can:

• Set a schedule and routine for sleeping (experts call this good sleep hygiene).
• Make enough time for sleep and avoid sleep deprivation if possible.
• Avoid alcohol, caffeine or other things that might affect sleep quality.
• Manage your stress and anxiety.
• Get evaluated for common sleep disorders that might aggravate sleepwalking, like obstructive sleep apnea.

Your healthcare provider can recommend other things you might do to reduce the risk of sleepwalking episodes.

What can I expect if I sleepwalk?

Sleepwalking increases your risk of injury. You may slip and fall or do other things that you shouldn’t do unless you’re fully awake and attentive. Though it’s uncommon, some people who sleepwalk may do things to others that aren’t appropriate or safe. Examples include inappropriate sexual behaviors (also known as sexsomnia). Others may experience confusion and become agitated if woken up. For these reasons, it’s important to try to prevent sleepwalking episodes and take safety precautions.

How long does sleepwalking last?

Sleepwalking is usually something children grow out of once they reach puberty. Only about 1% of people who walked in their sleep as children are still sleepwalking as adults. If you don’t grow out of it, the episodes usually become less frequent as you get older.

What are the complications of sleepwalking?

Sleepwalking usually isn’t serious. But people who sleepwalk are at high risk for injury from things like falling down stairs, jumping out of windows, sleep driving, eating and cooking in sleep. There are even recorded instances where people became violent while sleepwalking. Fortunately, violent behavior is very rare.

How do I take care of myself?

There are several steps you can take to lower the chance of injury or harm, such as:

• Lock doors and windows. People who sleepwalk generally have trouble with problem-solving and more complicated actions. Locks and latches are excellent ways to limit how far a sleepwalker can go and prevent injuries.
• Remove breakable objects. That includes replacing windows and sliding door glass with other materials or break-resistant glass, or removing breakable items like lamps, decorations, etc.
• Use bells or other sound-producing, motion-sensitive items. These can potentially wake you if you’re the sleepwalker, or alert you to a sleepwalking loved one or child.
• Modify your home decorations and layout. Low furniture items or objects like tables, rugs, power cords, etc., can create a fall hazard. Remove them or at least move them out of the way to minimize the risk they pose. You can also use gate-type items to block stairs to prevent falls. Avoiding the use of bunk beds and only sleeping in ground-floor bedrooms may also help.
• Secure dangerous items. You should always secure any items that could cause injury — no matter how unlikely. This includes firearms, sharp objects like knives, tools, etc.

What questions should I ask my healthcare provider?

Some questions you can ask your or your child’s provider include:

• What could be causing sleepwalking to happen to me (or my child)?
• What are symptoms or behaviors to watch for that might indicate something more serious is behind sleepwalking?
• What can I do to prevent sleepwalking episodes?
• What are some signs that I should call my provider’s office or get medical attention?

Is it dangerous to wake a sleepwalker, and why?

People may be confused or disoriented if you wake them while they’re sleepwalking. In rare instances, they might respond out of fear or anger to whatever — or whomever — woke them up. If you have to wake a sleepwalker, do it gently and try not to scare or startle them. The safest thing to do with a sleepwalker is to guide them back to bed gently. In most cases, they’ll simply go back to sleep and won’t remember what happened.

What do sleepwalkers see?

People often have their eyes open while sleepwalking. But it’s usually clear that they aren’t fully awake. They usually don’t react to or seem aware of things that should be in their field of view. People who sleepwalk don’t remember it, so they can’t tell you what they see. There are no reports in the medical literature about what they see.