Definition

Sleepwalking is a disorder that occurs when people walk or do other activity while they are still asleep.

Alternative Names

Walking during sleep; Somnambulism

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 (called N3 sleep) early in the night.

Sleepwalking is much more common in children and young adults than in older adults. This is because as people age, they have less N3 sleep. Sleepwalking tends to run in families.

Fatigue, lack of sleep, and anxiety are all associated with sleepwalking. In adults, sleepwalking may occur due to:

• Alcohol, sedatives, or other medicines, such as some sleeping pills
• Medical conditions, such as seizures
• Mental disorders

In older adults, sleepwalking may be a symptom of a medical problem that causes decreased mental function neurocognitive disorder.

Symptoms

When people sleepwalk, they may sit up and look as though they are awake when they are actually asleep. They may get up and walk around. Or they may do complex activities such as moving furniture, going to the bathroom, and dressing or undressing. Some people even drive a car while they are asleep.

The episode can be very brief (a few seconds or minutes) or it can last for 30 minutes or longer. Most episodes last for less than 10 minutes. If they are not disturbed, sleepwalkers will go back to sleep. But they may fall asleep in a different or even unusual place.

Symptoms of sleepwalking include:

• Acting confused or disoriented when the person wakes up
• Aggressive behavior when woken up by someone else
• Having a blank look on the face
• Opening eyes during sleep
• Not remembering the sleep walking episode when they wake up
• Performing detailed activity of any type during sleep
• Sitting up and appearing awake during sleep
• Talking during sleep and saying things that do not make sense
• Walking during sleep

Exams and Tests

Usually, examinations and testing are not needed. If the sleepwalking occurs often, your health care provider may do an exam or tests to rule out other disorders (such as seizures).

If the person has a history of emotional problems, they also may need to have a mental health evaluation to look for causes such as excessive anxiety or stress.

Treatment

Most people do not need specific treatment for sleepwalking. Hypnosis and timed awakenings may help some people.

In some cases, medicines such as short-acting tranquilizers are helpful in reducing sleepwalking episodes. However, some of these medicines can also cause sleep walking.

Some people mistakenly believe that a sleepwalker should not be awakened. It is not dangerous to awaken a sleepwalker, although it is common for the person to be confused or disoriented for a short time when they wake up.

Another misconception is that a person cannot be injured while sleepwalking. Sleepwalkers are commonly injured when they trip and lose their balance.

Safety measures may be needed to prevent injury. This may include moving objects such as electrical cords or furniture to reduce the chance of tripping and falling. Stairways may need to be blocked with a gate.

Outlook (Prognosis)

Sleepwalking usually decreases as children get older. It usually does not indicate a serious disorder, although it can be a symptom of other disorders.

It is unusual for sleepwalkers to perform activities that are dangerous. But precautions should be taken to prevent injuries such as falling down stairs or climbing out of a window.

When to Contact a Medical Professional

You probably do not need to visit your provider. Discuss your condition with your provider if:

• You also have other symptoms
• Sleepwalking is frequent or persistent
• You do dangerous activities (such as driving) while sleepwalking

Prevention

Sleepwalking may be prevented by the following:

• Do not use alcohol or anti-depressant medicines if you sleepwalk.
• Avoid sleep deprivation, and try to prevent insomnia, because these can trigger sleepwalking.
• Avoid or minimize stress, anxiety, and conflict, which can worsen the condition.

References

Avidan AY. Disorders of arousal. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 116.

Avidan AY. Sleep and its disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley's and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 101.