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Sleepwalking

Definition

Sleepwalking is a disorder that occurs when a person walks or does another activity while they are still asleep.

Alternative Names

Walking during sleep; Somnambulism

Causes, incidence, and risk factors

The normal sleep cycle has distinct stages, from light drowsiness to deep sleep. During 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 (stage 3 or stage 4 sleep) early in the night. If it occurs during REM sleep, it is part of REM behavior disorder and tends to happen near morning.

The cause of sleepwalking in children is usually unknown. Fatigue, lack of sleep, and anxiety are all associated with sleepwalking. In adults, sleepwalking may be associated with:

• Mental disorders
• Reactions to drugs and alcohol
• Medical conditions such as partial complex seizures

In the elderly, sleepwalking may be a symptom of an organic brain syndrome or REM behavior disorders.

Sleepwalking can occur at any age, but it happens most often in children aged 4 - 8. It appears to run in families.

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 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. If they are not disturbed, sleepwalkers will go back to sleep. However, they may fall asleep in a different or even unusual place.

Symptoms of sleepwalking include:

• Eyes open during sleep
• May have blank look on face
• May sit up and appear awake during sleep
• Walking during sleep
• Performing other detailed activity of any type during sleep
• Not remembering the sleep walking episode when they wake up
• Acting confused or disoriented when they wake up
• Rarely, aggressive behavior when they are awakened by someone else
• Sleep talking that does not make sense

Signs and tests

Usually, people do not need further examinations and testing. If the sleepwalking occurs often, the doctor may do an exam or tests to rule out other disorders (such as partial complex seizures).

If you have a history of emotional problems, you also may need to have a psychological evaluation to look for causes such as excessive anxiety or stress.

Treatment

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.

Most people don't need any specific treatment for sleepwalking.

Safety measures may be needed to prevent injury. This may include moving objects such as electrical cords or furniture to reduce the chances of tripping and falling. You may need to block off stairways with a gate.

In some cases, short-acting tranquilizers have been helpful in reducing sleepwalking episodes.

Support Groups

Expectations (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. However, you may need to take care to prevent injuries such as falling down stairs or climbing out of a window.

Complications

The main complication is getting injured while sleepwalking.

Calling your health care provider

You probably won't need to visit your health care provider if you are sleepwalking. However, discuss the condition with your doctor if:

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

Prevention

• Avoid the use of alcohol or central nervous system depressants if you sleepwalk.
• Avoid getting too tired and try to prevent insomnia, because this can trigger a sleepwalking episode.
• Avoid or minimize stress, anxiety, and conflict, which can worsen the condition.

References

Mahowald MW. Disorders of sleep. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 429.

Plante DT, Winkelman JW. Parasomnias. Psychiatr Clin North Am. 2006;29:969-987.