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Sleepwalking

Definition

Sleepwalking is a disorder that occurs when people walk or do other activity while they are still asleep.

Alternative Names

Walking during sleep; Somnambulism

Causes

The normal sleep cycle has stages, from light drowsiness to deep sleep. During the stage called 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 occur due to:

  • Alcohol, sedatives, or other medication
  • Medical conditions, such as partial complex seizures
  • Mental disorders

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 ages 5 through 12. 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 they 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. Most episodes last for less than 10 minutes. If they are not disturbed, sleepwalkers will go back to sleep. But they may fall asleep in a different or even unusual place.

Symptoms of sleepwalking include:

  • Acting confused or disoriented when the person wakes up
  • Aggressive behavior when woken uip by someone else
  • Having a blank look on the face
  • Opening eyes during sleep
  • Not remembering the sleep walking episode when they wake up
  • Performing detailed activity of any type during sleep
  • Sitting up and appearing awake during sleep
  • Taking in sleep and saying things that do not make sense
  • Walking during sleep

Exams and Tests

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

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

Treatment

Most persons do not need specific treatment for sleepwalking.

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

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.

Safety measures may be needed to prevent injury. This may include moving objects such as electrical cords or furniture to reduce the chance of tripping and falling. Stairways may need to be blocked with a gate.

Outlook (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. But precautions should be taken to prevent injuries such as falling down stairs or climbing out of a window.

When to Contact a Medical Professional

You probably do not need to visit your health care provider. But discuss your condition with your doctor if:

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

Prevention

  • Do not use alcohol or anti-depressant medicines if you sleepwalk.
  • Avoid getting too tired and try to prevent insomnia, because this can trigger sleepwalking.
  • Avoid or minimize stress, anxiety, and conflict, which can worsen the condition.

References

Attarian H. Treatment options for parasomnias. Neurol Clin. 2010;28:1089–1106.           

Chokroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Elsevier Saunders; 2012:chap 68.

Mahowald MW. Disorders of sleep. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 412.


Review Date: 4/14/2013
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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