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Sleepwalking: Causes, Reasons, Risks, and Treatments

From childhood, we have been seen Hollywoods depiction of the phenomenon of The Sleepwalker, a.k.a. a somnambulist. In countless cartoons, movies, sitcoms, etc., a sleeping person (usually dressed in full pajamas and a sleeping cap, complete with tassel) calmly sits up in bed, pulls aside the covers, and puts their feet on the floor. But we then see that their eyes are closed and as they stand, they hold their arms straight out in front of their bodies, the dead giveaway that this person is sleepwalking….

The camera then follows the somnambulist as they tread unerringly through their house. They invariably avoid every obstacle, from sleeping dogs to hanging lights to inexplicably open trap doors. Sleepwalkers who make it outside invariably avoid pedestrians, speeding cars, bank robbers, traffic accidents, oncoming freight trains, even crashing airplanes. By the end of the film, they are back in bed, safe, sound only to be woken violently by their spouse dropping a pin on the floor.

In real life, sleepwalking almost never includes such precise comedic timing. It is a relatively rare sleep disorder that has been reported in ancient medicine from as far back as 2,500 years ago. In modern medicine, somnambulism is not seen as anything dangerous: a random, occasional thing that can happen to anyone with no ill effect.

Sleepwalking: Definition and Symptoms

Sleepwalking, also called somnambulism or noctambulism, is classified as a non-REM parasomnia. This is a group of sleep disorders that include sleep-talking, night terrors, sleep-related eating disorders, and confused arousals.

Typical symptoms of a sleepwalker include:

  • Open eyes, but with a glassy or staring appearance
  • Slow, nonsensical, or no response to questions
  • Typical movements may include sitting up in bed; walking; running; repetitive motions, as if stuck in a loop, etc.
  • Unusual movements include urinating, climbing, getting dressed, driving, etc.
  • No memory of having sleepwalked when awoken

On occasion, a sleepwalkers behavior may be virtually identical to their normal awake state, such as carrying on a conversation or preparing to leave the house. The only clue that they are actually sleepwalking may be the hour of night: for example, if a sleepwalker says they are going to school, but it is 1am.

Myths of Sleepwalking

There are two myths about sleepwalking that should immediately be dispelled.

Myth #1: Sleepwalkers walk with their arms out. Despite the classic Hollywood depictions of sleepwalkers, there is no evidence that somnambulists walking with their arms extended out, as if they are reaching for something. Sleepwalkers walk normally, arms down.

Myth #2: Never wake a sleepwalker. This myth is based on the fact that a sleepwalker is, in fact, in a very deep sleep, despite moving around the house. That is why somnambulists can be very difficult to wake up. In reality, it can be much more dangerous NOT to try and wake the sleepwalker. Unlike the movies, a sleepwalker can trip, stumble, fall, and hurt themselves.

What Causes Sleepwalking?

Medically speaking, sleepwalking is not a disease or ailment. It requires no lab tests or imaging, as there is no known specific physical or psychiatric source for somnambulism.

A sleepwalker was once thought to be acting out their dreams, or unconsciously indulging their secret desires (particularly if it ended in a midnight raiding of the refrigerator). While modern medicine still has been unable to pinpoint an actual cause for sleepwalking, it has been able to rule out wish fulfillment as a reason.

Analysis of the human sleep cycle has revealed that sleepwalking most often happens during stage 3 of the four-stage sleep cycle. A normal sleep cycle takes about an hour and a half, starting with 3 stages of non-REM (rapid eye movement) sleep and ending with the deep, dream-filled sleep of Stage 4 REM sleep.

Sometime during Stage 3 of their sleep cycle, the sleepwalkers brain triggers the body to rouse itself, despite being in a deep, non-REM sleep. During this part of the sleep cycle, brainwaves are slow, and the conscious brain (your cerebral cortex, also known as grey matter) is quiet and inactive literally your waking mind is still asleep. During this time the body is most likely to toss and turn, and in as many as 15% of sleepers, will translate into full-on sleepwalking.

Many factors can increase the likelihood of a somnambulant episode:

  • Sleep deprivation and inconsistent sleep schedules
  • Medical conditions, including pregnancy, menstruation, obstructive sleep apnea, and acid relux
  • Illness such as fevers, asthma, allergies, magnesium deficiency, and any stress-induced conditions
  • Medications, particularly psychoactive drugs that affect ones level of consciousness (sedatives, hypnotics, tranquilizers, stimulants, antihistamines, and neuroleptics for psychosis)
  • Drugs, particularly alcohol
  • There may be a genetic component to this sleep disorder. Sleepwalking can run in families: if a close relative sleepwalks, you are ten times more likely to do it, too.

Which People Are Most Susceptible to Sleepwalking?

An estimated three million cases of sleepwalking are reported in the United States every year less than a one in a hundred of the country’s approximate population of 350 million.

Children between the ages of four and eight are the most likely group to sleepwalk, particularly if they
suffered from night terrors as infants, or have other sleep disorders such as sleep apnea and bedwetting. Most cases of sleepwalking end by the time the child reaches age 12.

Only about four percent of adults in the United States are sleepwalkers, with only a very few cases that will require any sort of intervention.

Is Sleepwalking Dangerous?

By itself, sleepwalking is not considered to be dangerous. It does not seem to indicate an underlying psychological problem, nor does it seem to accompany any specific health hazard. Most sleepwalkers return to bed without any memory of the event, and without any injury to themselves or others.

However, sleepwalking may indicate the presence of another, more serious sleep disorder. For example, obstructive sleep apnea is a condition in which ones breathing is interrupted repeatedly during sleep, sometimes resulting in an inability to achieve Stage 4 REM sleep and poor quality sleep overall. Such conditions may cause sleepwalking to occur.

The most dangerous consequences of sleepwalking comes from extreme cases, in which the somnambulist actually leaves their home and performs actions that put themselves in harms way. These are rare occurrences, but they include episodes like climbing out of windows; running in the streets; and most dangerous of all, sleep-driving.

How Is Sleepwalking Treated?

As sleepwalking is usually caused by waking issues, the treatment of those issues generally alleviate the instances of sleepwalking. Such issues include a lack of sleep, intensely emotional problems, and working or living in a high stress environment.

Simple do-it-yourself treatments may be sufficient to protect a sleepwalker, such as the following:

  • Ensuring a full nights sleep of 68 hours minimum each night
  • Use of meditation, relaxation, calming exercises
  • Cutting off high-stimulus activities well before bedtime, including TV, computer usage, mobile devices, etc.
  • Removing any sharp or potentially dangerous objects from the sleeping area
  • Shutting and locking doors and windows

If a sleepwalker is having frequent or increased episodes or has injured themselves or shown violent behaviors while sleepwalking, it may be prudent to consult a sleep specialist. No specific medical exams or test is usually needed, but medical and psychological evaluations may be helpful in understanding and identifying any underlying causes.

Short regimens of medications, such as benzodiazepines and antidepressants, have proven useful in controlling excessive somnambulism. A few weeks of pills appears to be effective.

Hypnotism and behavioral therapy are other excellent treatment options for sleepwalkers whose nightly strolls are causing problems for themselves and their families.

In most cases, instances of somnambulism end on their own.

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