Sleepwalking

Sleepwalking usually occurs early in the night — often one to two hours after falling asleep. It's unlikely to occur during naps. A sleepwalking episode can occur rarely or often, and an episode generally lasts several minutes, but can last longer.

Someone who is sleepwalking may:

• Get out of bed and walk around
• Sit up in bed and open his or her eyes
• Have a glazed, glassy-eyed expression
• Not respond or communicate with others
• Be difficult to wake up during an episode
• Be disoriented or confused for a short time after being awakened
• Not remember the episode in the morning
• Have problems functioning during the day because of disturbed sleep
• Have sleep terrors in addition to sleepwalking

Sometimes, a person who is sleepwalking will:

• Do routine activities, such as getting dressed, talking or eating
• Leave the house
• Drive a car
• Engage in unusual behavior, such as urinating in a closet
• Engage in sexual activity without awareness
• Get injured, for example, by falling down the stairs or jumping out a window
• Become violent during the period of brief confusion immediately after waking or, occasionally, during sleepwalking

When to see a doctor

Occasional episodes of sleepwalking aren't usually a cause for concern and typically resolve on their own. You can simply mention the sleepwalking at a routine physical or well-child exam. However, consult your doctor if the sleepwalking episodes:

• Occur often — for example, more than one to two times a week or several times a night
• Lead to dangerous behavior or injury to the person who sleepwalks or to others
• Cause significant sleep disruption to household members or the person who sleepwalks
• Result in daytime symptoms of excessive sleepiness or problems functioning
• Start for the first time as an adult
• Continue into your child's teen years

Sleepwalking is classified as a parasomnia — an undesirable behavior or experience during sleep. Sleepwalking is a disorder of arousal, meaning it occurs during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Another NREM disorder is sleep terrors, which can occur together with sleepwalking.

Many factors can contribute to sleepwalking, including:

• Sleep deprivation
• Stress
• Fever
• Sleep schedule disruptions, travel or sleep interruptions

Sometimes sleepwalking can by triggered by underlying conditions that interfere with sleep, such as:

• Sleep-disordered breathing — a group of disorders featuring abnormal breathing patterns during sleep (for example, obstructive sleep apnea)
• Taking certain medications, such as hypnotics, sedatives or certain medications used for psychiatric disorders
• Substance use, such as alcohol
• Restless legs syndrome
• Gastroesophageal reflux disease (GERD)

Factors that may increase the risk of sleepwalking include:

• Genetics. Sleepwalking appears to run in families. It's more common if you have one parent who has a history of sleepwalking, and much more common if both parents have a history of the disorder.
• Age. Sleepwalking occurs more often in children than adults, and onset in adulthood is more likely related to other underlying conditions.

Sleepwalking itself isn't necessarily a concern, but a person who sleepwalks can:

• Hurt themselves — especially if they walk near furniture or stairs, wander outdoors, drive a car or eat something inappropriate during a sleepwalking episode
• Experience prolonged sleep disruption, which can lead to excessive daytime sleepiness and possible school or behavior issues
• Be embarrassed or experience problems with social relationships
• Disturb others' sleep
• Rarely, injure someone else nearby

To diagnose sleepwalking, your doctor reviews your medical history and your symptoms. Your evaluation may include:

• Physical exam. Your doctor may do a physical exam to identify any conditions that may be confused with sleepwalking, such as nighttime seizures, other sleep disorders or panic attacks.
• Discussion of your symptoms. Unless you live alone and are unaware of your sleepwalking, you'll likely be told by others that you sleepwalk. If your sleep partner comes with you to the appointment, your doctor may ask him or her whether you appear to sleepwalk. Your doctor may also ask you and your partner to fill out a questionnaire about your sleep behaviors. Tell your doctor if you have a family history of sleepwalking.
• Nocturnal sleep study (polysomnography). In some cases, your doctor may recommend an overnight study in a sleep lab. Sensors placed on your body will record and monitor your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements while you sleep. You may be videotaped to document your behavior during sleep cycles.

Treatment for occasional sleepwalking usually isn't necessary. In children who sleepwalk, it typically goes away by the teen years.

If sleepwalking leads to the potential for injury, is disruptive to family members, or results in embarrassment or sleep disruption for the person who sleepwalks, treatment may be needed. Treatment generally focuses on promoting safety and eliminating causes or triggers.

Treatment may include:

• Treating any underlying condition, if the sleepwalking is associated with sleep deprivation or an underlying sleep disorder or medical condition
• Adjusting medication, if it's thought that the sleepwalking results from a drug
• Anticipatory awakenings — waking the person who is sleepwalking about 15 minutes before he or she usually sleepwalks, then staying awake for a few minutes before falling asleep again
• Medication — such as benzodiazepines or certain antidepressants
• Learning self-hypnosis — when done by a trained professional who is familiar with parasomnias, people who are receptive to suggestions during hypnosis may benefit by achieving a deep state of relaxation through which a change in unwanted activities during sleep is promoted
• Therapy or counseling — a mental health professional can help with suggestions for improving sleep, stress-reduction techniques, self-hypnosis and relaxation

If sleepwalking is a problem for you or your child, try these suggestions.

• Make the environment safe. If sleepwalking has led to injuries or may do so, consider these precautions: Close and lock all windows and exterior doors before bedtime. You might even lock interior doors or place alarms or bells on the doors. Block doorways or stairways with a gate, and move electrical cords and other tripping hazards out of the way. Sleep in a ground-floor bedroom, if possible. Place sharp or fragile objects out of reach, and lock up all weapons. If your child sleepwalks, don't let him or her sleep in a bunk bed.
• Gently lead the person sleepwalking to bed. It's not necessary to wake up the person. Although it's not dangerous to the person to be awakened, it can be disruptive if he or she becomes confused and disoriented, and possibly agitated.
• Get adequate sleep. Fatigue can contribute to sleepwalking. If you're sleep deprived, try an earlier bedtime, a more regular sleep schedule or a short nap, especially for toddlers. If possible, avoid sleep-time noises or other stimuli that could interrupt sleep.
• Establish a regular, relaxing routine before bedtime. Do quiet, calming activities before bed, such as reading books, doing puzzles or soaking in a warm bath. Meditation or relaxation exercises may help, too. Make the bedroom comfortable and quiet for sleep.
• Put stress in its place. Identify the issues that cause stress and ways to handle the stress. Talk about what's bothering you. Or if your child sleepwalks and seems anxious or stressed, talk with him or her about any concerns. A mental health professional can help.
• Look for a pattern. For several nights, note — or have another person in your home note — how many minutes after bedtime a sleepwalking episode occurs. If the timing is fairly consistent, this information is useful in planning anticipatory awakenings.
• Avoid alcohol. Drinking alcohol can interfere with a good night's sleep and may be a trigger for sleepwalking.

If you sleepwalk and have concerns about safety or underlying conditions, see your doctor. Your doctor may refer you to a sleep specialist. You may want to bring a family member or friend along, if possible, to provide more information about your sleepwalking.

Keeping a sleep diary for two weeks before your appointment can help your doctor understand more about your sleep schedule, factors affecting your sleep and when sleepwalking occurs. In the morning, record as much as you know of bedtime rituals, quality of sleep and so on. At the end of the day, record behaviors that may affect sleep, such as sleep schedule disruptions, alcohol intake and any medications taken.

What you can do

Before your appointment, make a list of:

• Any symptoms experienced, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses or recent life changes
• All medications, vitamins, herbs or other supplements you're taking, and the dosages
• Questions to ask your doctor to help make the most of your time together

Some questions to ask your doctor include:

• What's likely causing the symptoms or condition?
• What are other possible causes?
• What kinds of tests are needed?
• Is the condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• Are there any restrictions that need to be followed?
• Is referral to a specialist needed?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you begin experiencing or noticing symptoms?
• Have you or your child had sleep problems in the past?
• Does anyone else in your family have sleep problems, especially sleepwalking or sleep terrors?
• What problems have you noticed related to the sleepwalking, such as waking up in unusual locations of the house?
• Are there symptoms of obstructive sleep apnea, such as loud snoring, witnessed breathing pauses during sleep, labored breathing during sleep, unrefreshing sleep, daytime sleepiness or behavioral changes?