Sleepwalking

*Nothing in this article is intended as medical advice. Seek guidance from a physician if you have any questions.*

Sleepwalking often appears as a funny trope in comedy movies. The main character accidentally walks out of the house or does something else that they cannot remember the next day. However funny sleepwalking may seem on the big screen, it is a real condition that can have very serious consequences if left untreated. Today, let’s take a deeper look into what exactly sleepwalking is.

Signs of Sleepwalking

Sleepwalking, medically referred to as somnambulism, is a somewhat common condition that affects up to 4% of Americans each year. While the condition usually affects children and teens, many adults can experience bouts of sleepwalking, too. Simply put, sleepwalking is a condition whereby an individual gets up, walks around, and performs otherwise complicated tasks, all while still asleep. First, the list of things that a sleepwalking individual may do is rather extensive:

• Get out of bed and walk around
• Leave the house
• Participate in “normal” activities like making food, eating, talking, or getting dressed
• Drive a car
• Not remember the episode in the morning
• Have difficulty functioning during the day due to disturbed sleep
• Engage in sexual activity without awareness
• Injury themselves, often by falling down steps or climbing out of windows
• Become violent immediately after waking or, occasionally, during sleepwalking

 Beyond these signs and indications of sleepwalking, a partner or other house member may realize that an individual is sleepwalking. This will usually be fairly obvious as a sleepwalking person can be very difficult to wake, even though they appear to be conscious and alert. A person who is actively sleepwalking may exhibit some or all of the following characteristics:

• If the affected person does not actively get out of bed, they may simply just sit up. They will appear to be conscious, but typically will not respond to stimuli or move much.
• If the affected person is up and walking around, they may appear glassy-eyed and expressionless
• The person will likely not respond to either vocal or physical stimuli immediately
• They will likely be very difficult to wake
• If they are awoken, they seem dazed, confused, or disoriented immediately after the episode

Causes of Sleepwalking

Sleepwalking is classified as a type of Parasomnia - a suite of conditions that affect individuals while they are sleeping. When a person is sleepwalking, they are currently experiencing delta sleep or slow-wave sleep, usually abbreviated as N3 sleep. This is a type of non-rapid eye movement (NREM) sleep. This is coincidentally the same type of sleep that is occurring when individuals experience night terrors. Often, when adults experience bouts of sleepwalking, they are very short-lived. Even so, there are signs to look out for that may indicate you or a loved one should see a physician. Consider consulting a sleep doctor if any of the following is occurring

• Sleepwalking occurs often, i.e. more than a few times a week or multiple times in a single night
• Bouts of sleepwalking last more than ~15 minutes
• You or a loved one participates in dangerous activities while sleepwalking, like using the steps, driving a car, or leaving the house
• An individual never experienced sleepwalking as a child but has developed the condition as an adult

Often, the root cause of sleepwalking is relatively transient in nature. Any of the following may cause sleepwalking in an otherwise healthy adult:

• Stress
• Sleep deprivation
• Fever
• Disruption of regular sleep patterns, travel or sleep interruptions occurring throughout the night
• Alcohol or drug use

Additionally, sleepwalking can also present as a symptom of an underlying condition. Included among those conditions are:

• Obstructive sleep apnea. OSA is a disorder whereby “a person’s breathing starts and stops during the course of a night’s sleep.” This disorder has several different root causes, but sleepwalking can manifest as a symptom regardless of the root OSA cause.
• Gastroesophageal reflux disease. GERD is a common disorder that affects roughly 20% of the adult population in America. Like OSA, GERD can cause an individual to continuously wake up over the course of a single night, contributing to the prevalence of sleepwalking.
• Certain psychiatric medications. For complex - and in some cases, unknown - reasons, certain types of psychiatric medications are more likely to cause sleepwalking. Consult your physician if you have any concerns about this possibility.

Sleepwalking Treatments

Treatment for children who experience sleepwalking is relatively rare. More often than not, children will outgrow bouts of sleepwalking by the time they hit puberty or shortly after. In and of itself, sleepwalking is typically not a large detractor from quality of life. That being said, it can be dangerous, disruptive, and annoying to both the patient and their loved ones. Treatment for adults who sleepwalk often falls into one of a few different categories:

• Treatment of underlying conditions. As discussed previously, OSA, GERD, and a variety of other conditions can make an individual more prone to sleepwalking. Due to this, the first step by a sleep doctor will often be to recommend getting the other condition under control.
• Adjustments to lifestyle and routine. Sometimes, changes to diet, exercise, and sleep schedule can be enough to break a cycle of sleepwalking. A doctor may recommend changing your sleep schedule by an hour, changing when you exercise or changing what you eat before bed.
• Anticipatory awakenings. For many people who experience sleepwalking, the event often occurs around the exact same time every night. To break a cycle, some individuals will need to wake up shortly before the typical sleepwalking time and stay awake for a few minutes. This changes the sleep cycle and alters when N3 sleep occurs. This, too, can be enough to break a bout of sleepwalking.
• Counseling and therapy. If a cycle still persists, your doctor may suggest counseling or therapy. These are often aimed at reducing stress and anxiety that may be triggers for sleep patterns that are more prone to induce sleepwalking. Additionally, some Somnologists may prescribe medications or self-hypnosis.

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Written by: Patrick O'Hare