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Sleepwalking: Symptoms, Causes, and Treatment
Oct 08, 2024
Fact Checked
Learn how sleepwalking can affect you, and the steps to take for treatment
Key Takeaways
- Sleepwalking is a type of sleep disorder where someone gets out of bed and can walk, talk, and do other activities while still asleep.
- About 4% of adults in the United States sleepwalk, but the condition is more common in children.
- Approximately 80% of sleepwalkers have a family history of sleepwalking.
- Sleepwalking most often happens in the deep non-REM part of the sleep cycle.
When you see sleepwalking in the movies, it often looks like people in pajamas with their arms outstretched in front of them and their eyes closed. They may get into mischief, and the entire scene is supposed to make people laugh. While Hollywood tends to portray inaccurate views of sleepwalking, there are some truths. For example, people who sleepwalk can get out of bed, walk around, talk, and eat while asleep. Less often, they may even drive a car or cook.
We spoke with sleep experts to get the most accurate information about sleepwalking, including why it happens and its symptoms.
What is sleepwalking?
Sleepwalking, formerly called somnambulism, is a type of parasomnia—an unusual behavior that happens while you sleep. What makes parasomnias unusual is they can occur in the period between being asleep and being awake. “When you sleepwalk, you can physically walk or move around your home despite being asleep,” explained Camilo Ruiz, DO, a doctor and sleep medicine expert at Sleep and Internal Medicine Specialists in Fort Lauderdale, Florida.
“When people sleepwalk, they may act as if they are awake by sitting up, picking up items—even moving furniture,” said Ruiz. He added that their eyes may be open, but they may not recognize someone who tries to talk to them. And if they speak, their words may not make sense.
According to Bijoy John, MD, a sleep specialist and founder of Sleep Fix Academy in Tennessee, sleepwalking usually happens during the first couple hours of sleep.
Sleepwalking affects up to 4% of adults in the United States, according to the American Academy of Sleep Medicine. It is less common in older adults because non-REM sleep, which happens early in the sleep cycle, decreases with age. Non-REM stands for non-rapid eye movement; sleepwalking usually happens during this stage.
Symptoms of sleepwalking
Sleepwalking symptoms can look different for everyone. “Sleepwalking can cause you to wake up suddenly with a panicked look and can cause behaviors such as arranging pillows or fixing bed sheets,” explained John. “The movements are usually purposeless.”
Sleepwalking symptoms can look different for everyone. “Sleepwalking can cause you to wake up suddenly with a panicked look and can cause behaviors such as arranging pillows or fixing bed sheets,” explained John. “The movements are usually purposeless.”
Sleepwalking behaviors
Sleepwalking might be alarming to someone watching the behaviors. “People can bump into furniture or push objects down, but sometimes they can have complex behaviors like cooking, eating food, and driving a car,” John said.
According to Mayo Clinic, some common behaviors of someone who sleepwalks might be:
- Walking around during sleep
- Opening their eyes and sitting up in bed
- Not responding when others talk to them
- Confusion when waking up
- Not waking up when prompted
- Being unable to remember what happened in the morning
- Feeling tired during the day
Less often, there might be more dangerous activities you might do while sleepwalking. Mayo Clinic says these might involve:
- Leaving the house
- Driving a car
- Unusual behaviors, such as urinating somewhere outside the bathroom
- Sexual activity
- Injuries from falling
- Violence during sleepwalking or immediately upon waking up
Physical signs
During sleepwalking, you might show physical signs, such as:
- Clumsy and awkward movements
- Opening your eyes and having a glazed look on your face
- An inability to do simple activities such as unlocking a door because the thinking part of your brain isn’t fully working
- Eating or preparing foods you wouldn’t normally eat, which can result in gaining weight over time from the extra calories you eat while sleepwalking
Causes of sleepwalking
There can be several different causes for sleepwalking—some of which you may have control over and some you may not, such as genetics.
Genetics
According to sleep specialist John, genetics or your family history can play a major role in whether you sleepwalk or not. Eight out of 10 people who sleepwalk have an immediate family member, such as a parent or sibling, who also sleepwalks or did in the past.
A study published in 2015 found about 47% of children who sleepwalk have a parent with a history of sleepwalking. If both parents have a history of sleepwalking, the number rises to more than 61%.
Sleepwalking is also common in twins, especially identical twins, and can be found in extended family members such as aunts, uncles, and cousins, according to John.
Sleep deprivation
Sleep deprivation can cause you to sleepwalk. “During the three stages of the non-REM sleep cycle, the body’s muscles relax, heart rate lowers, and blood pressure drops,” said sleep medicine expert Ruiz. This plays an important role in helping the body repair itself.
Sleepwalking is more likely to happen during deep, non-REM sleep. As you get older, your body needs less of this deep non-REM sleep. But if you’re sleep-deprived, your body spends more time in this stage of sleep, making sleepwalking more likely to happen.
Mental health conditions
Feeling stressed can make it harder to fall asleep. If stressors such as work, finances, or relationships are keeping you up at night, you can become sleep-deprived, which can trigger sleepwalking.
Some mental health conditions can also increase your risk for sleepwalking, such as:
- Anxiety
- Post-traumatic stress disorder (PTSD)
- Childhood trauma
Certain medications
Some medications can make you more likely to sleepwalk. Although sleepwalking is most common in childhood and usually goes away on its own, according to Ruiz, it’s usually due to certain medications when it happens in adults.
Ruiz explained that zolpidem (Ambien), a medication used to treat insomnia, can increase the risk of sleepwalking. Insomnia is a condition that makes it hard to fall asleep or stay asleep.
Other medications that might increase the risk of sleepwalking include:
- Sodium oxybate, a medication used to treat narcolepsy
- Some medications to treat insomnia, including benzodiazepine receptor agonists
- Antidepressants or medications used to treat symptoms of depression
- Medications used to treat psychiatric conditions, such as Seroquel
- Beta blockers, such as metoprolol, that help treat high blood pressure and heart conditions
Alcohol
Alcohol changes how you progress through the different sleep cycles and can disrupt you from getting quality sleep. It may also increase the risk of sleepwalking, although more research is needed to verify the connection.
Medical conditions
Some brain conditions, such as Parkinson’s disease, might cause sleepwalking. Restless leg syndrome (RLS) might also put you at higher risk for sleepwalking, according to a study on RLS in children published in 2019.
“Sometimes respiratory conditions, such as sleep apnea—a sleep-related breathing disorder—can trigger it as well,” explained Ruiz. A study published in 2018 found that those with more severe sleep apnea were more likely to sleepwalk than those with a milder form.
Diagnosing sleepwalking
According to Mayo Clinic, your health care provider may diagnose sleepwalking by asking questions about your medical and family history. The health care provider may then perform a physical exam to make sure your sleepwalking isn’t caused by another medical condition, such as seizures, panic attacks, or other sleep conditions.
If someone you live with has told you that you sleepwalk, you may want to take them to your appointment so they can provide your health care provider with information about how you look and act while sleepwalking. They may also ask whether anyone else in your family has a history of sleepwalking.
Your health care provider may recommend a sleep study, but they aren’t always needed. Sleep studies are typically for more severe and dangerous forms of sleepwalking or when health care providers want to rule out sleep conditions with similar symptoms to sleepwalking. Sleep studies are usually done at night in a sleep lab.
Sleepwalking treatment options
Sleepwalking doesn’t always require treatment. Sometimes, lifestyle adjustments are enough. But there are things you can do to help reduce the number of times you sleepwalk or treat the underlying problem so you no longer sleepwalk.
Lifestyle changes
Here are some ways to lower your chances of sleepwalking:
- Improve your sleep hygiene. Sleep hygiene is important to getting good sleep, which impacts your overall health. Try to get between seven and nine hours of sleep a night. Your mattress can make a big difference in your quality of sleep, so make sure you have the right mattress that meets your sleep needs, whether you’re a back, stomach, or side sleeper. A good mattress is especially important if you’re dealing with back pain that can keep you tossing and turning. John recommends cooling features in a mattress to help you sleep better, adding the importance of a mattress set to a lower level to prevent falls when trying to get out of bed.
- Establish a regular sleep schedule. “Sleep deprivation is a common trigger for sleepwalking,” said John. “Make sure you have enough hours of sleep and avoid sleeping pills.” Try to go to bed and wake up at the same time every day. Avoid alcohol and caffeinated beverages in the evening that can keep you awake. Use your bed only for sleeping and sex and not for eating or working.
- Reduce stress. Manage stress through relaxation techniques such as meditation and deep breathing exercises. Lowering your levels of stress can help you sleep better.
- Get regular exercise. Aim to exercise at least 30 minutes daily, but avoid working out within two hours of going to bed. Exercising too close to bed can increase your heart rate and increase your body temperature, making it harder to relax before bed.
Safety measures
“Sleepwalking is not generally dangerous. But it does require some precautions in order to prevent injury,” said Ruiz. He offered some ideas to help you stay safe if you sleepwalk, such as:
- Locking doors and windows
- Removing dangerous objects from the bedroom
- Keeping walkways clear of clutter
- Installing gates at the tops of stairs
- Using bells or alarms to help wake you or alert your partner
Medical interventions
Unfortunately, the Food and Drug Administration hasn’t approved any medication to treat sleepwalking. But health care providers sometimes prescribe medications to help.
“Benzodiazepines can be effective in controlling sleepwalking behavior since they cause muscle relaxation during sleep,” explained Ruiz. Benzodiazepines are a class of medication known as depressants that cause sedation and relaxation. “If sleepwalking becomes a frequent occurrence and if it becomes a risk of injury, medication is recommended,” said Ruiz.
If sleepwalking is caused by another health condition, such as sleep apnea, your health care provider will want to diagnose and treat the underlying cause. If sleepwalking is caused by a medication you’re taking, the medication will likely be stopped or the dose adjusted.
Therapies
Cognitive behavioral therapy (CBT) can help if you have a sleep condition. This type of therapy helps you figure out what might be causing your sleep problems, such as insomnia, and helps you learn healthier sleep habits, such as changing your bedtime routine or using relaxation techniques.
Talking with a therapist can help you if you are struggling with anxious thoughts, stress, or sleep deprivation that can make you more likely to sleepwalk.
Bottom line
Sleepwalking in adults isn’t as common as sleepwalking in children. In adults, sleepwalking is often related to medication or an underlying health condition. So it’s important to find the cause.
Sleepwalking might be a rare occurrence, or it can happen regularly with potentially dangerous consequences. With treatment, sleepwalking can often be resolved on its own.
If sleepwalking is damaging your sleep, relationships, or overall life, you may want to consider talking with your health care provider about options for treatment.
Have questions about this article? Email us at reviewsteam@ncoa.org.
Sources
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