An Overview of Sleepwalking

Sleepwalking involves walking or engaging in other complex behaviors while asleep. The condition is more common in children, but adults can also experience it. 

Sleepwalkers tend to remain in deep sleep during sleepwalking episodes. It may be difficult to wake the sleepwalker, and they likely will not recall the incident when awake. 

Sleepwalking has unique symptoms, causes, and risk factors. Treatment usually is not required. However, sometimes both medicinal and non-medicinal therapies are beneficial to cases that do require treatment.

Read on to learn more about sleepwalking and its symptoms, causes, and treatment options.

Prevalence 

It is estimated that 2% to 3% of adults sleepwalk, but that number is much higher in children. Up to 40% of children sleepwalk, and up to 3% sleepwalk multiple times per month. The onset or persistence of sleepwalking is quite common and generally not related to any mental health disorders or neurological problems.  

Symptoms 

Sleepwalking involves more than just walking around during sleep. It includes other activities while sleeping, with walking being the most obvious. Some people will sit up in bed, look around, or walk around their homes. Others may leave home or drive long distances.

Sleepwalking usually occurs during deep sleep stages 3 and 4, or within a few hours of falling asleep. The sleepwalker may look or behave as if they are partially awake during episodes. In addition to walking around, other symptoms of sleepwalking are: 

• Sleep talking
• No memory of the episode
• Inappropriate behavior, especially in children, such as urinating in a closet
• Screaming (if the person is also having a night terror)
• Behaving violently, especially to the person trying to wake them

Causes and Risk Factors

Sleepwalking is a type of sleep disorder called a parasomnia—a behavior carried out while asleep. 

Sleepwalking can also be triggered by health conditions or other factors, including:

• Substance abuse (including alcohol)
• Certain medications such as sedatives, hypnotics, and those used for treating psychiatric conditions
• Sleep apnea
• Restless legs syndrome—a nervous disorder that causes an uncontrollable urge to move the legs
• Gastroesophageal reflux disease, or GERD, which occurs when stomach acid frequently flows back into the esophagus (the tube connecting the mouth to the stomach)

Risk factors for sleepwalking include both genetics and age. Sleepwalking appears to run in families, and it's common in people with at least one parent who has a history of sleepwalking. The risk increases if both parents have a sleepwalking history. Sleepwalking is more common in children; adult-onset sleepwalking tends to be related to health and other sleep disorder conditions. 

Sleepwalking in young children may be associated with sleep apnea, a sleep disorder in which breathing is interrupted. The symptoms of sleep apnea in children are different than in adults. Sleep apnea in children causes snoring, daytime sleepiness, and breathing interruption for longer periods than with adults. Sleep apnea may also be associated with bedwetting and nightmares.  

Diagnosis and Treatment

Sleepwalking in children is common, and treatment usually is not needed. Parents simply need to keep a close eye on a child who sleepwalks to keep them safe from injury. An adult who sleepwalks, however, may have a greater risk of injury and should seek the advice of a healthcare professional who specializes in sleep disorders if the behavior is problematic.  

The doctor will want the sleepwalker to keep a sleep diary for at least two weeks to determine how sleep is affecting their life. Diagnostic tests usually are not necessary, but the doctor will look at medical history and present drug, alcohol, and medication use. The sleep doctor will then try to determine the cause of sleepwalking.

Sleepwalking in children usually goes away by the time they are teenagers. However, other sleep problems and concerns should be brought to the attention of a doctor. Treatment for sleep disorders, including sleep apnea, may resolve sleepwalking. 

Medications

If the sleepwalker is at risk of injury, if someone experiences significant daytime sleepiness, or if the sleepwalking is causing household disruption, conservative treatment, such as lifestyle change, is usually the first-line approach. 

Rarely, medications may be prescribed for sleepwalking if conservative treatment is unsuccessful. These may include estazolam, clonazepam, or trazodone. These medications usually need to be taken for only a few weeks. There may be cases in which sleepwalking returns after discontinuing medication, but the episodes are usually brief and end up resolving. 

Non-Medicinal Treatment Options

Non-medicinal options may also help for long-term treatment of sleepwalking. Relaxation techniques, mental imagery, and anticipatory awakening have all been proven to be effective.

Anticipatory awakening, for instance, involves a parent waking the child hours after the child has fallen asleep. The parent may wake the child again right before the usual time of the sleepwalking incidents. This method has been shown to be effective in several studies and could help to completely eradicate the sleepwalking episodes.

Prevention

The following measures can help prevent sleepwalking:

• Avoid alcohol and antidepressant medications. (Talk to your healthcare provider before stopping any prescription medicines.)
• Get plenty of rest to avoid insomnia or sleep deprivation, which can lead to sleepwalking.
• Try to reduce stress, anxiety, and conflict, which may exacerbate sleepwalking.

Summary

Sleepwalking is usually not a serious condition and can be resolved without treatment, especially in children. When treatment is necessary, the condition can be treated effectively. Drug treatment for sleepwalking may be needed when there is an underlying health condition or when sleepwalking is a safety concern for the sleepwalker or others. Non-medicinal treatment options are also available and are usually the first recommendation.