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Common Sleepwalking Myths

There are many myths about waking a person who is sleepwalking. A common one is that during sleep, the soul leaves the body, and when you wake someone up during a sleepwalking episode, they are left without a soul. In some cultures, it is considered bad luck to wake a sleepwalker.

Other myths about waking a sleepwalking person include health risks, such as heart attack, brain damage, coma, and even death. 

None of these myths are true. However, experts advise you shouldn’t wake a sleepwalker unless you must.

Scientific Explanation: Why Can't You Wake Up a Sleepwalker?

Experts advise against waking a sleepwalking patient unless necessary because it can trigger a stress response. When a person wakes up from a sleepwalking episode, they are typically confused and disoriented. Sudden or forceful awakening from an episode of sleepwalking can startle them and trigger fear and anxiety. As a result, they may become agitated and injure themselves or others. Patient disorientation is the reason why it can be dangerous to wake up a person who is sleepwalking.

How to Safely Manage Sleepwalking Episodes

The recommendation from sleep experts is to gently redirect a sleepwalking person back to bed without waking them up. 

If the person is in danger, it may be necessary to watch closely or wake them. In this case, avoid making forceful attempts by shaking or hitting them to awaken them because they are in deep sleep. Instead, gently wake them by calling their name. Most of the time, leading them back to bed is the best option.

Understanding Sleepwalking

What is Sleepwalking?

Sleepwalking (medical term: somnambulism) is a type of sleep disorder called parasomnia. It is an arousal disorder in which there is an undesirable or unusual physical event during sleep, such as moving around or walking.

Most sleepwalking episodes occur in the early sleep stages and last only a few minutes, typically around 10 minutes, although some can last longer, up to half an hour.

What Are the Risk Factors for Sleepwalking?

Anyone can experience sleepwalking. Experts estimate that approximately 7% of people have sleepwalked during their lifetime. Within the past year, 5%-15% of children (ages 4 to 8) and 1%-1.5% of adults report sleepwalking. 

Genetics

Sleepwalking runs in families. Children who have one parent with a history of sleepwalking have a 47% chance of also sleepwalking. The risk increases to 62% if both parents have a history of sleepwalking. A specific gene mutation has been linked to an increased risk of sleepwalking in Caucasians.

Age

Sleepwalking is more common in children compared to adults. Children between the ages of 4 and 8 years are most likely to sleepwalk. Most children grow out of sleepwalking by the time they become adults. 

What Causes Someone to Sleepwalk?

Research shows sleepwalkers are neither fully awake nor fully asleep but rather in an in-between state. Sleepwalking occurs when a person is aroused from sleep but is not fully conscious. As a result, their brain allows them to perform certain actions, such as walking that are usually done while awake, without being fully awake.

The Connection Between Sleepwalking and Sleep Stages

Does Sleepwalking Occur in Deep Sleep or Light Sleep?

Sleepwalking typically occurs in deep sleep. This is called stage 3 of the sleep cycle and is the deepest non-REM (non-rapid eye movement) phase, also known as N3 or stage 3 NREM sleep. You are likely to see someone sleepwalking usually within the first 90 minutes of going to bed. 

Does Sleepwalking Occur in Stage 3 Sleep?

Yes, as mentioned, most people sleepwalk during the first and longest cycle of non-REM sleep (deep, slow-wave sleep), stage 3 sleep. The normal sleep cycle has repeating stages of non-rapid eye movement (non-REM or NREM) sleep and rapid eye movement (REM) sleep. These stages are associated with different types of brain activity. 

What Triggers Sleepwalking Episodes?

Environmental and Lifestyle Factors

• Lack of sleep

• Disruptions in sleep schedule, for example, due to traveling

• Unexpected noises

• Stress

• Drinking alcohol before bedtime 

Health Conditions That Can Trigger Sleepwalking

• Fever

• Mental health conditions such as anxiety, stress, and post-traumatic stress disorder (PTSD)

• Substance use (alcohol or drug use)

• Obstructive sleep apnea

• Restless legs syndrome

• Gastroesophageal reflux disease (GERD)

• Hyperthyroidism (overactive thyroid gland)

• Parkinson’s disease

• Rare conditions such as Smith-Magenis syndrome

Medications That Can Cause Sleepwalking

The following prescription drugs may cause sleepwalking:

• Sedatives or hypnotics (commonly called “sleeping pills” or “tranquilizers) such as zolpidem (Ambien) (How Much Ambien Can I Take Safely?)

• Antipsychotics such as quetiapine (Seroquel)

• Beta-blockers such as metoprolol (Lopressor)

This is not a complete list. Not everyone who takes these medications or has these health conditions will sleepwalk. 

Check out our blog: Best Sleep Aids: Prescription Vs. Over-The-Counter.

Symptoms of Sleepwalking

How to Recognize a Sleepwalker?

Most sleepwalkers have an episode within the first couple of hours of falling asleep. A person who is sleepwalking: 

• Moves around without being completely awake or aware of their surroundings 

• Lacks coordination and has clumsy or awkward movements 

• Makes sounds or says words that sound like gibberish 

• Has open eyes that can appear glassy without actually “seeing” things around them. This can cause them to walk into furniture.

• Has reduced awareness of danger. For example, they may pick up sharp objects like kitchen knives. 

• Has a limited ability to perform complex tasks such as unlocking a door 

• Does not remember the next morning what they did while sleepwalking 

Activities During Sleepwalking

As the name suggests, most people walk around at night during sleepwalking episodes. Other activities that are also possible while sleepwalking include: 

• Acting out behaviors from a dream

• Urinating (peeing) in unexpected places, such as a closet

• Talking during sleep

• Eating inedible items or foods they wouldn’t normally eat

• Cooking

• Getting dressed

• Leaving the house

• Driving a motor vehicle

• Participating in sexual activity

Note: Complex actions during sleepwalking are more likely in people who are sleep-deprived, especially in the last 24 hours. 

Risks and Dangers of Sleepwalking

Sleepwalking itself isn't necessarily a problem, but it can cause problems indirectly. For example, a person who sleep-walks may:

• Injure themselves by walking into furniture, jumping out of a window, wandering outdoors, driving a car, or eating something inedible.

• Cause harm to others due to confusion and agitation.

• Be tired and sleepy during the day due to sleep disruptions at night.

• Be embarrassed about their activities.

When to See a Doctor for Sleepwalking

Occasional episodes of sleepwalking may not need to be treated. However, you should make an appointment to see a healthcare provider if you have: 

• New episodes of sleepwalking as an adult.

• Frequent episodes of sleepwalking (several times a night or more than once or twice a week). 

• Dangerous behaviors during sleepwalking.

• Tiredness during the day due to sleep disruptions. 

• Disturbance to other family members.

How to Make the Environment Safe for Sleepwalkers?

If you have a family member who sleepwalks, here are some precautions that will make the environment safer and prevent injuries and accidents.

• Use bells on doorways or motion-sensor technology to wake you up if a family member sleepwalks.

• Lock all doors and windows before going to bed. 

• Block stairways with a safety gate.

• Remove tripping hazards such as low furniture, rugs, and electrical cords. 

• Place breakable objects out of reach.

• Secure dangerous items such as weapons, tools, and sharp objects.

• Have the person sleep in a ground-floor bedroom. Avoid putting children who are sleepwalkers in bunk beds.

Prevention and Treatment of Sleepwalking

Tips for Preventing Sleepwalking Episodes

• Avoid sleep deprivation. Not getting enough sleep can lead to sleepwalking. 

• Practice good sleep hygiene. Sleep at regular times in a quiet, comfortable environment without noises that could cause sleep disruption.

• Develop a relaxing bedtime routine with calming activities such as a warm bath, meditation, and reading. 

• Avoid alcohol, especially for 3-4 hours before bedtime, as it can interfere with sleep.

• Manage stress. Seek care from a mental health professional if necessary.

• Keep a log of sleepwalking episodes. This can help you identify a pattern (for example, how soon after going to bed an episode occurs). 

Treatment for Sleepwalking

• Treatment of underlying medical conditions that can cause sleepwalking episodes

• Switching to other drugs or dosage adjustment of medications that may cause sleepwalking

• Anticipatory awakenings (setting an alarm to wake up 15-20 minutes before the usual sleepwalking time, staying awake for a few minutes, and then falling asleep again - this helps reset the sleep phases) 

• Medications such as benzodiazepines or antidepressants to treat insomnia, anxiety, and depression

• Therapy or counseling to reduce stress and improve sleep

• Self-hypnosis (this can be learned from a professional and helps to achieve deep relaxation)

References:

1. https://www.mayoclinic.org/diseases-conditions/sleepwalking/symptoms-causes/syc-20353506

2. https://my.clevelandclinic.org/health/diseases/14292-sleepwalking

3. https://www.sleepfoundation.org/parasomnias/sleepwalking

4. https://medlineplus.gov/ency/article/000808.htm

5. https://www.ncbi.nlm.nih.gov/books/NBK526132/#: