Why do People Sleepwalk?

It is thought that sleepwalking may affect up to 15% of the population and is most common in children who are between the ages of 4 and 8 years old.

There are many factors that can affect the quality of the sleep that we get, including genetic and environmental factors. While sleeping, some people find that they experience disruptive sleep disorders or parasomnia. Parasomnia can occur as a one-off incident, an occasional occurrence or, for some people, can mean they frequently exhibit abnormal sleep behaviour.

Lack of sleep affects our ability to process and remember information. Not getting an adequate amount of rest can compromise the immune system and increase the risk of illness and infection.

People who experience frequent episodes of parasomnia may require some intervention or treatment to help them try to get a healthy sleeping routine going. Sleepwalking is amongst the most common parasomnias that people experience.

What is sleepwalking?

Sleepwalking or somnambulism is a sleep disorder that affects a relatively small percentage of the population. During instances of sleepwalking people may get out of bed, move around or try to perform their routine, day-to-day activities whilst not being fully awake.

Scientists have learned that sleep happens in stages. Sleepwalking is a type of parasomnia which usually happens during periods of deep sleep.

Other common parasomnias that can affect the quality and duration of sleep include:

• Night terrors/sleep terrors.
• Sleep paralysis.
• Sleep apnoea/obstructive sleep apnoea (OST) – when breathing stops and starts during sleep.
• Restless leg syndrome.

Most episodes of sleepwalking last for around ten minutes but some can be significantly longer. At the end of their sleepwalking episode some people will wake up and others will return to bed and continue to sleep.

Why do people sleepwalk?

Episodes of sleepwalking usually occur during the first few hours of sleep.

Sleep occurs in two stages:

• Non-rapid eye movement (NREM).
• Rapid eye movement (REM).

The first stage, NREM, is made of four phases N1–N4. Once you have gone through all four phases of NREM you enter REM sleep. Assuming you get the recommended eight hours of sleep a night, you probably experience five or six of these sleep cycles.

If you are going to sleepwalk, you can expect this to happen during the first couple of cycles of sleep and during deep sleep (within N3 or N4). This is why most instances of sleepwalking happen just a few hours after going to bed.

Although sleepwalking is more common in children, it can start at any age. People may wake suddenly and move around or try to perform activities as if they are awake when they are not awake.

What causes sleepwalking?

Although the exact cause of sleepwalking is hard to pinpoint, it is thought to be a hereditary condition that runs in families. This means that if other close family members have experienced parasomnias such as sleepwalking or night terrors, you have a higher chance of experiencing them too.

Some other factors that can increase the risk of sleepwalking include:

• Lack of sleep/being overtired.
• Stress.
• Depression or anxiety.
• Alcohol or drugs.
• Certain medications (especially sedatives/sleeping pills).
• A full bladder/waking suddenly due to needing to urinate.
• Environmental changes (moving house, sleeping in a new location such as a hotel).
• Being awoken suddenly due to loud noise or unexpected touches.
• Head injuries.

Stress and anxiety can trigger episodes of sleepwalking. Being overtired can make you more stressed. A lack of sleep might mean you are more prone to sleepwalking. Parasomnias (sleep disorders or disturbances) will also cause you to be overtired, leaving you caught in a vicious cycle.

A relaxed, regular bedtime routine can help to mitigate some of the triggers of a sleepwalking episode. Taking frequent exercise, staying hydrated, eating a balanced diet and making sure you are getting your recommended daily amount of vitamins and minerals can also help to maintain a healthy sleep cycle.

• Try to limit stress (especially around bedtime).
• Avoid using electronics just before bed including smartphones, tablets, laptops, e-readers etc as they give off blue light which can suppress the hormone melatonin, essentially tricking the body into believing we are not sleepy.
• Read a book before bed or have a warm bath/shower.
• If you struggle to relax, try a night-time yoga routine, mediation or deep breathing exercises.
• Make sure you visit the bathroom before you go to bed to limit a full bladder waking you up.
• Your sleeping area should ideally be calm, quiet, dark, organised and safe.
• Find alternatives to caffeinated drinks and snacks in the evenings (camomile tea is thought to be very relaxing, but avoid any large drinks just before bed).
• Reduce your alcohol intake and be careful not to mix alcohol with certain medication (always read the enclosed leaflet for guidance).

What happens when a person sleepwalks?

People experience sleepwalking in different forms. Not every sleepwalker actually gets out of bed and walks around; some may simply sit up in bed and look around confused.

In some instances, people may try to do their usual activities such as opening cupboards, cooking and eating while sleepwalking.

They may also attempt to actually leave their house, either by a door or window, and some sleepwalkers have even managed to start up and drive a car.

Often, the sleepwalker will have little memory of what happened in the morning.

Can sleepwalking be dangerous?

During the episode, sleepwalking can be dangerous if:

• The person tries to leave their house as they will not have any perception of hazards around them, moving cars etc.
• The person tries to drive as this could lead to injury, destroyed property and even death.
• The sleepwalker tries to perform a function that during waking would need an awareness of safety (such as chopping food up with a sharp knife, lighting a gas hob).
• There are open or unlocked windows that the sleepwalker could fall out of.
• Others in the residence are not aware of the possibility of sleepwalking occurring, or what to do if it happens, so they react inappropriately (such as grabbing or restraining the sleepwalker and causing them to react violently).
• Sleepwalkers engage in any risky behaviour.

There can also be implications for anyone who experiences parasomnia if it starts to affect how they feel and behave the following day.

Lack of sleep or disrupted, poor quality sleep can have a detrimental effect on a person’s life. If you are waking up groggy and irritable, unable to perform day-to-day functions as you should, this is a sign that you are not getting a healthy amount of sleep or that something is impairing the quality of sleep you are getting.

Being overtired can also cause an increased risk of accident or injury especially if you are operating heavy machinery or a car. Tiredness makes you less alert and can cause slower reaction times, lapses in concentration and even the risk of falling asleep accidentally and causing a serious incident.

A study by IAM RoadSmart released last year suggested that one in ten UK drivers had momentarily closed their eyes behind the wheel due to tiredness.

As with any type of parasomnia, if it is affecting your life in a negative way, either during the episodes or from the after-effects, it is worth exploring ways to improve or treat the condition.

What are the symptoms of sleepwalking?

Sleepwalkers do not necessarily get up out of bed and walk around (although this does often happen). Sometimes people sit up in bed and look around with confusion for a brief time then go back to sleep. They may also perform repetitive movements such as eye rubbing or tugging at their pyjamas.

Other symptoms seen in sleepwalkers can include:

• Not responding to questions when being spoken to, or giving nonsensical answers.
• Urinating in random, inappropriate places such as the wardrobe or washing basket.
• Bedwetting (especially common in children who sleepwalk).
• Open but glazed-over eyes – the sleepwalker can see but not as well as they would during their waking hours.
• Trying to perform day-to-day functions such as getting dressed, eating or even driving in the middle of the night (seemingly for no reason).
• Sleep talking.
• Clumsy or awkward behaviour (falling over things, knocking items off the side etc).
• Trying to exit the house via a door or window or to find keys.

How to know if someone is sleepwalking

Sleepwalking might look different to the way you expect. Sleepwalkers will not typically move around with their arms outstretched in a kind of hypnotic state the way you might have seen on TV shows.

• Sleepwalkers may move around for several minutes or they may simply sit up in bed and behaved confused or demonstrate odd, repetitive behaviours.
• Sleepwalkers may have their eyes open but they can appear glazed or as if the person is ‘not quite there’.
• They may not respond to being spoken to or may give responses that are random or make no sense.
• Sleepwalkers sometimes try to perform their usual day-to-day functions – if you suspect someone is doing so, ask yourself if the situation feels ‘quite right’ such as trying to exit the house in pyjamas, starting cooking in the middle of the night etc. If the situation feels unnatural, the person may be sleepwalking.
• Grabbing them or making sudden movements might get a volatile response.
• Sleep talking is often associated with sleepwalking (although it can occur by itself).

If you suspect someone of sleepwalking because they have roused unexpectedly from sleeping and are behaving unnaturally and not responding as you would expect, try to guide them gently back to bed. Gentle affirmations such as ‘You are safe’ or ‘Don’t worry you are in your own bed’ will help.

Remove any items or obstacles that may injure them.

• Do not shake, shout at or try to suddenly wake a sleepwalker – they may become volatile due to the unexpected situation and may lash out.
• Do not just ignore a sleepwalker and wait for them to make their way back to bed if there is any chance of them hurting themselves or someone else or causing damage.
• In the morning, there is no reason to mock a person for sleepwalking. It is often a condition beyond their control. Be supportive and help them to look for solutions.

Sleepwalking in children

Sleepwalking is most common in children. It is thought that one in five will experience it at least once, although most children grow out of it by the time they reach their teens.

If you find your child sleepwalking, follow the general advice such as gently guiding them back to bed and reassuring them.

To reduce the chances of your child becoming injured if they sleepwalk, you should consider:

• Not putting them in the top bunk of bunk beds.
• Moving them to sleep somewhere on the ground floor.
• Installing a stair gate at the top of the stairs.
• Ensuring windows and doors are locked.
• Keeping sharp or dangerous objects out of reach.
• Keeping their environment (especially their bedroom) organised with the floor free from clutter.
• Not panicking or trying to shake them awake.

To reduce the chances of your child sleepwalking, try to:

• Get into a relaxing bedtime routine (warm bath, story time and going to bed around the same time each day).
• Not allow your child to have any screen time just before bed.
• Avoid large drinks at bedtime and encourage them to use the toilet before they get into bed.
• Stick to sleeping and napping schedules (especially for very young children) as being overtired can be a trigger for sleepwalking.
• Make bedtimes calm, quiet and as stress-free as possible.
• Keep the temperature in their room fairly cool (22-23°C max). A dark space may help with sleep (consider blackout curtains for spring/summer nights).

Try not to worry if your child sleepwalks occasionally. If your child is getting injured during episodes of sleepwalking, is overtired or anxious the following day or if they continue to sleepwalk after their teenage years, you may want to book an appointment with your doctor to discuss the problem.

Your doctor may suggest that you try a technique called ‘scheduled wakening’. This requires you to take note of the time your child usually starts to sleepwalk then try waking them (you don’t have to fully awaken them, just gently rouse them) 15-30 minutes before the expected time they will sleepwalk.

If you do this for a few nights in a row it may disrupt their usual sleep cycle, causing it to change and the sleepwalking events to stop.

How is sleepwalking treated?

At the moment, there isn’t a specific treatment for sleepwalking. If you talk to your doctor about sleepwalking, they will assess you based on your family history, any medication you are currently taking and any conditions you have a prior diagnosis for.

In many instances, you might be able to stop the sleepwalking episodes by identifying and treating the underlying cause. If you are taking certain medication that may be triggering sleepwalking episodes, your doctor may change your dosage or prescribe an alternative.

It is rare for medicine to be prescribed to target sleepwalking although occasionally certain antidepressants or benzodiazepines might be considered, especially if there is a significant risk of injury associated with sleepwalking. As an alternative to medication, hypnotherapy or cognitive behavioural therapy (CBT) may help.

Your doctor might also want to rule out an underlying condition that may be associated with your sleepwalking episodes.

Underlying conditions that can sometimes trigger sleepwalking include:

• Sleep apnoea.
• Post-traumatic stress disorder (PTSD).
• Drug or alcohol dependency.
• Arrhythmias (abnormal rhythms of the heart).
• Asthma.
• Narcolepsy (a long-term brain condition where the brain is unable to regulate standard sleeping and waking patterns).
• Fever/very high temperature (usually caused by an infection).

If your sleepwalking is found to be associated with other conditions such as sleep apnoea or is causing you a lot of distress you may be referred to a sleep clinic by your GP. If you have the funds, you can also opt to attend a private sleep clinic.

During a sleep study, you will usually be observed overnight by doctors in a clinical setting whilst you sleep. Private patients can sometimes opt to take part in an outpatient study in their own homes.

The studies might include observing and recording what happens while you sleep as well as using machines to check your breathing and heart rate.

It can be extremely scary for people to know that they have been sleepwalking as it taps into a primal fear of not being in control of your own body. As we know that stress can increase the chance of sleep disorders, it is important to try not to worry too much as this is going to make the situation worse.

Learning the triggers for your sleepwalking episodes and how to avoid them might help you to feel you have some control over the condition. It is also important to have support from others in your household who might also be affected by your sleepwalking.