Sleepwalking

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Sleepwalking, also called somnambulism, is a condition in which an individual walks around or performs other activities while asleep. It is considered a parasomnia (1), an unconscious behavior that occurs during partial sleep. Similar sleep-related disorders that hold this classification include night terrors, nightmares, rapid eye movement sleep behavior disorder, and sleep-related leg cramps.

Most sleepwalking episodes occur within the first few hours after falling asleep (2). They are typically short, but some episodes may last for more than 30 minutes. The condition is more common in childhood, and is believed to affect approximately 5% of children versus 1.5% of adults (3). Children often grow out of sleepwalking, but some people only start sleepwalking once they have entered adulthood.

For many, sleepwalking is merely an inconvenience. However, some individuals with frequent, severe, or dangerous episodes may require medical treatment.

Causes and Risk Factors of Sleepwalking

Sleepwalking represents an incomplete arousal from deep sleep, therefore potential triggers (4) tend to consist of factors that increase deep sleep or interfere with the awakening process. It is not always clear what causes sleepwalking, as some risk factors could be associated with the condition without actively triggering it. Common reasons why people sleepwalk may include:

  • Sleep Deprivation: Sleep deprivation (5) may contribute to sleepwalking episodes.
  • Alcohol: Alcohol affects sleep quality (6). Although there is insufficient evidence to determine whether it triggers sleepwalking, this theory has been used as a legal defense in criminal cases (7).
  • Irregular Work Schedule: Parasomnias like sleepwalking are more common in shift workers (8), who have irregular sleep schedules.
  • Jet Lag: Incidental cases suggest that sleep deprivation from jet lag (9) may lead to sleepwalking.
  • Parental History and Genetics: Sleepwalking may run in the family. One study found that children were twice as likely to sleepwalk if at least one of their parents sleepwalked. The probability rose even higher if both parents sleepwalked (10). The researchers concluded sleepwalking may have a genetic component.
  • Encephalitis: Encephalitis (11), or swelling of the brain, may contribute to sleepwalking.
  • Fever: During sickness, sleepwalking may be provoked by a fever.
  • Headaches: Migraines and other headaches (12) are common in people who sleepwalk, suggesting there may be a link between these conditions.
  • Obstructive Sleep Apnea: Obstructive sleep apnea causes lapses in breathing that interfere with sleep. In one study, participants who had severe obstructive sleep apnea (13) were more likely to sleepwalk.
  • Neurological Disease: Some neurological disorders, including Parkinson’s disease (14), may increase the likelihood of sleepwalking.
  • Stress: Many sleepwalkers report that stress (15) tends to trigger episodes.
  • Medication: Several medications (16) may heighten the risk of sleepwalking. Speak to your doctor if you have concerns about the potential side effects of a specific medication.
  • Full Bladder: Needing to go to the bathroom may lead to a semi-arousal from deep sleep that triggers sleepwalking.
  • Noise or Light: Sleepwalking episodes may also be provoked by outside stimuli such as noise or light.

Symptoms of Sleepwalking

While some individuals who sleepwalk have a vague recollection of what they did during their sleep, many have no memory of the incident. If you live with your family, partner, or roommates, they may be able to confirm that you sleepwalk. However, if you live alone, the following signs may point towards this condition:

  • Waking up confused
  • Sustaining injuries you do not remember
  • Finding evidence of nighttime activities that you do not remember
  • Daytime tiredness (17)

It is important to note that somnambulism is not restricted to just walking during sleep. An individual may also engage in other activities, including performing routine tasks, talking, urinating, engaging in sexual behavior (18), driving (19), or becoming violent (20).

Onlookers may notice a sleepwalker has open eyes with a glassy stare, ignores questions or is slow to respond, and does not respond in a normal way when people attempt to intervene.

Dangers of Sleepwalking

Since sleepwalkers lack the decision-making and problem-solving skills they have during waking hours, they might engage in hazardous behaviors.

Potential dangers of sleepwalking include self-injury or harm to a bed partner, or others in the household. Sleep disruption from sleepwalking may also contribute to fatigue, excessive daytime sleepiness, psychological distress, and a reduced quality of life.

How to Stop Sleepwalking

If you suspect you sleepwalk, talk to your doctor to discuss the best course of action. In cases of infrequent episodes with relatively mundane and benign behavior, treatment may not be necessary. However, if you are concerned about your sleepwalking, there may be steps you can take to help reduce incidents and make your home safer if sleepwalking does occur.

Good Sleep Hygiene

Good sleep hygiene practices such as avoiding caffeine before bedtime can help you sleep more soundly and lower your chances of sleepwalking. You should also visit a qualified medical professional to help you treat sleep disorders or other medical conditions that interfere with sleep.

Scheduled Waking

If the sleepwalker has episodes around the same time each night, waking them 15 to 30 minutes beforehand might prevent somnambulism. These scheduled awakenings should be performed every day for at least a couple of weeks.

Hypnosis

Evidence suggests that hypnosis may be helpful for coaching adult sleepwalkers to wake up if they get out of bed. Psychotherapy (21) may also help reduce anxiety and insomnia, with accompanying benefits for sleepwalking.

Medications

Although the U.S. Food and Drug Administration (FDA) has not approved any medication for sleepwalking, doctors may sometimes prescribe medications that target GABA receptors. Addressing your concerns with your doctor can help you determine the best course of treatment.

Prevention of Safety Risks

Sleepwalking can occur without warning, so it is helpful to take additional safety measures before you go to sleep. This may involve:

  • Removing tripping hazards and breakable objects
  • Keeping weapons and sharp objects locked away
  • Securing doors and windows
  • Putting lights on a motion sensor
  • Placing your car keys in a secure location that is not too easy to access
  • Installing gates for stairways
  • Installing door alarms
  • Sleeping in a lower bed

When you see a loved one sleepwalking, there is generally no need to wake them up. If possible, try to steer them gently back to bed, taking care not to frighten them.

References

+ 21 Sources
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  2. 2. Accessed on August 23, 2021. https://aasm.org
  3. 3. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/32644427/
  4. 4. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/17208473/
  5. 5. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/26241047/
  6. 6. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/26634095/
  7. 7. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/17542950/
  8. 8. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/34107833/
  9. 9. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/22767364/
  10. 10. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/25938617/
  11. 11. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/17931980/
  12. 12. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/25902807/
  13. 13. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/30026716/
  14. 14. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/33847749/
  15. 15. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/24597508/
  16. 16. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/28363449/
  17. 17. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/23450499/
  18. 18. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/16564199/
  19. 19. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/21367628/
  20. 20. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/28446961/
  21. 21. Accessed on August 23, 2021. https://pubmed.ncbi.nlm.nih.gov/26874839

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