Sleepwalking

Definition

Sleepwalking — also known as somnambulism — usually involves getting up and walking around while asleep. Most common in children between the ages of 4 and 8, sleepwalking often is a random event that doesn't signal any serious problems or require treatment.

However, sleepwalking can occur at any age and may involve unusual, even dangerous behaviors, such as climbing out a window or urinating in closets or trash cans.

If anyone in your household sleepwalks, it's important to protect him or her from sleepwalking injuries.

Symptoms

Sleepwalking is classified as a parasomnia — an undesirable behavior or experience during sleep. Sleepwalking is a parasomnia of arousal, meaning it occurs during deep, dreamless (non-rapid eye movement, or NREM) sleep. Someone who is sleepwalking may:

• Sit up in bed and open his or her eyes
• Have a glazed, glassy-eyed expression
• Roam around the house, perhaps opening and closing doors or turning lights on and off
• Do routine activities, such as getting dressed or making a snack — even driving a car
• Speak or move in a clumsy manner
• Scream, especially if also experiencing night terrors, another parasomnia in which you are likely to sit up, scream, talk, thrash and kick
• Be difficult to wake up during an episode

Sleepwalking usually occurs during deep sleep, early in the night — often one to two hours after falling asleep. Sleepwalking is unlikely to occur during naps. The sleepwalker won't remember the episode in the morning.

Sleepwalking episodes can occur rarely or often, including multiple times a night for a few consecutive nights.

Sleepwalking is common in children, who typically outgrow the behavior by their teens, as the amount of deep sleep they get decreases.

When to see a doctor
Occasional episodes of sleepwalking aren't usually a cause for concern. You can simply mention the sleepwalking at a routine physical or well-child exam. However, consult your doctor if the sleepwalking episodes:

• Become more frequent
• Lead to dangerous behavior or injury
• Are accompanied by other signs or symptoms
• Continue into your child's teens

Causes

Many factors can contribute to sleepwalking, including:

• Sleep deprivation
• Fatigue
• Stress
• Anxiety
• Fever
• Sleeping in unfamiliar surroundings
• Some medications, such as zolpidem (Ambien, Edluar)

Sleepwalking is sometimes associated with underlying conditions that affect sleep, such as:

• Sleep-disordered breathing — a group of disorders characterized by abnormal breathing patterns during sleep, the most common of which is obstructive sleep apnea
• Restless legs syndrome (RLS)
• Migraines
• Head injuries

In other cases, use of alcohol, illegal drugs or certain medications — including some, antihistamines, sedatives and sleeping pills — can trigger sleepwalking episodes.

Risk factors

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.

Complications

Sleepwalking itself isn't necessarily a concern, but sleepwalkers can easily hurt themselves — especially if they wander outdoors or drive a car during a sleepwalking episode. Prolonged sleep disruption can lead to excessive daytime sleepiness and possible school or behavior issues. Also, sleepwalkers usually disturb others' sleep.

Preparing for your appointment

For children, sleepwalking episodes tend to go away by the time they're adolescents. However, if you have concerns about safety or underlying conditions, you may want to see your doctor. Your doctor may refer you to a sleep specialist.

It's a good idea to prepare for your appointment. Here's some information to help you.

What you can do

• Keep a sleep diary. Keeping a sleep diary for two weeks before your appointment can help your doctor understand what's causing your sleepwalking. In the morning, you record as much as you know of your or the sleepwalker's bedtime ritual, quality of sleep, and so on. At the end of the day, you record behaviors that may affect your or your child's sleep, such as caffeine consumption and any medications taken.
•  Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you're taking.
• Bring a family member or friend along, if possible. Someone who accompanies you can help you remember what the doctor says.
• Write down questions to ask your doctor.

Preparing a list of questions for your doctor will help you make the most of your time together. For sleepwalking some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

Don't hesitate to ask other questions that occur to you.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:

• When did you begin experiencing symptoms?
• Have you had sleep problems in the past?
• Does anyone else in your family have sleep problems?

Tests and diagnosis

Unless you live alone and are completely unaware of your sleepwalking, chances are you'll make the diagnosis of sleepwalking for yourself. If your child sleepwalks, you'll know it.

Your doctor may do a physical or psychological exam to identify any conditions that may be confused with sleepwalking, such as a seizure disorder or panic attacks. In some cases, a sleep study in an overnight sleep lab may be recommended.

Sleep studies
To participate in a sleep study, also known as a polysomnogram, you'll likely spend the night in a sleep lab. Sensors that send electrical signals will be placed on various parts of your body, and a chip will be attached to your finger. In some studies, a video camera will record your sleep. Throughout the night, the sensors will record your:

• Heartbeat
• Brain waves
• Breathing
• Eye movements
• Leg movements
• Muscle tension
• Oxygen in your blood

Your doctor will review the information to determine whether you have any sleep disorders.

Treatments and drugs

Treatment for sleepwalking isn't usually necessary. If you notice your child or anyone else in your household sleepwalking, gently lead him or her back to bed. It's not dangerous to the sleepwalker to wake him or her, but it can be disruptive. The person may be confused and disoriented if awakened. Adults, in particular, might attack the awakener.

Treatment for adults who sleepwalk may include hypnosis. Rarely, sleepwalking may result from a drug, so a change of medication may be required.

If the sleepwalking leads to excessive daytime sleepiness or poses a risk of serious injury, your doctor may recommend medication. Sometimes use of benzodiazepines or certain antidepressants may stop sleepwalking episodes.

If the sleepwalking is associated with an underlying medical or mental health condition, treatment is aimed at the underlying problem. For example, if the sleepwalking is due to another sleep disorder, such as obstructive sleep apnea, using continuous positive airway pressure (CPAP), a machine that delivers air pressure through a mask placed over your nose while you sleep, keeps your upper airway passages open.

Lifestyle and home remedies

If sleepwalking is a problem for you or your child, here are some things to try:

• Make the environment safe for sleepwalking. To help prevent injury, close and lock all windows and exterior doors at night. 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 or other objects that pose a tripping hazard. If your child sleepwalks, don't let him or her sleep in a bunk bed. Place any sharp or fragile objects out of reach.
• Get more sleep. Fatigue can contribute to sleepwalking. Try an earlier bedtime or a more regular sleep schedule.
• Establish a regular, relaxing routine before bedtime. Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed. Meditation or relaxation exercises may help, too.
• Put stress in its place. Identify the things that stress you out, and brainstorm possible ways to handle the stress. If your child seems anxious or stressed, talk about what's bothering him or her.
• Look for a pattern. If your child is sleepwalking, keep a sleep diary. For several nights, note how many minutes after bedtime a sleepwalking episode occurs. If the timing is fairly consistent, wake your child about 15 minutes before you expect a sleepwalking episode. Keep your child awake for five minutes, and then let him or her fall asleep again.

Above all, be positive. However disruptive, sleepwalking usually isn't a serious condition — and it usually goes away on its own.