“Sleepwalking is probably the most fascinating thing about sleep medicine,” says Dr. Joshua Lennon, a board-certified sleep specialist, assistant professor of neurology at the University of Tennessee Health Science Center, and host of the podcast Well Rested.
Researchers are still parsing out the details of why it happens. And figuring out what’s at the root of individual cases and how to treat them can look a lot like detective work, says Dr. Alon Y. Avidan, a professor of neurology and director of the UCLA Sleep Disorders Center.
Often, we boil down weird nighttime incidents like peeing in the closet to simply being a kid, and the occasional sleepwalking episode in children is nothing to worry about. But sleepwalking is a genuine medical condition that can be dangerous, especially for adults.
If you or someone you know has a sleepwalking habit, here’s everything you need to know — including whether you should wake up a sleepwalker, how to manage episodes, and when to contact a doctor for help.
1. Sleepwalking is a sleep disorder
Sleepwalking, aka somnambulism, refers to the act of getting up at night, walking around, or doing other activities while partially asleep.
Along with sleep talking and sleep terrors, sleepwalking falls into a category of sleep disorders known as parasomnias. Parasomnias are abnormal events that occur during the transition from one state of sleep or wakefulness to another.
The American Psychiatric Association classifies sleepwalking as a mental illness if, in addition to the ICD-10 CM [8] characteristics, the events cause clinically significant distress or impairment in social, occupational or other important areas of functioning
2. Children are more likely to sleepwalk than adults
About 15% of children sleepwalk at least once between the ages of 4 and 12, while only around 2-4% of adults do, according to some estimates.
Because sleepwalkers typically don’t remember episodes or only have a blurry recollection of the night before, it’s hard to know exactly how common it is. In most cases, you learn about the habit thanks to a parent, housemate, or partner.
3. Sleepwalking usually happens during deep sleep at the beginning of the night
Sleepwalking usually takes place during the non-rapid eye movement (NREM) sleep stage known as deep sleep. Although it’s more difficult to shake you out of heavy slumber at this point, a partial awakening could trigger a sleepwalker to get up and start moving, while still asleep. (Sleepwalking can also occur during REM sleep, but that’s less common.)
You spend more time drifting in and out of deep sleep during the first third to half of the night. That’s why sleepwalkers tend to get up about an hour or two after bedtime, according to the Cleveland Clinic.
4. Different parts of the brain flicker “on” while a person is sleepwalking
Ever wonder why sleepwalkers seem to be in a zombie-like trance? “What researchers believe happens with parasomnias is that some parts of the brain are still heavily asleep while other parts are awake,” says Lennon.
In sleepwalker studies that use an electroencephalogram (EEG) to measure brain activity, areas like the motor cortex (which is responsible for controlling basic movements) and amygdala (the brain’s emotional center) appear to be wide awake. But other areas like the prefrontal cortex (the rational part of the brain) and hippocampus (our memory-keeper) remain totally logged out.
5. Sleepwalking symptoms vary from mild to complex
“Most sleepwalking behaviors are short-lived, lasting a couple of minutes,” says Lennon. “The simpler and easier to achieve the action, the more likely it’s going to happen.”
But sleepwalking symptoms can also be wide-ranging and, in some cases, longer-lasting. A sleepwalker could:
- Sit up in bed and open their eyes
- Mumble or talk (often incoherently)
- Get out of bed and walk or run around
- Have a glazed-over look in their eyes and a flat facial expression
- Not respond to others or be difficult to wake up
- Complete routine activities like getting dressed, eating breakfast, or moving furniture
- Urinate in odd places like the closet
- Feel confused or disorientated after being awakened
- Not remember the sleepwalking episode in the morning or only have a hazy memory
- Have problems getting through the day due to disrupted sleep
- Experience night terrors
While rare, sleepwalkers could also:
- Engage in sexual activity without awareness (aka, sexsomnia)
- Leave the house
- Drive a car
- Become violent
6. Three factors can increase the likelihood of sleepwalking
When it comes to a root cause for sleepwalking, the truth is we don’t have an exact answer just yet, says Lennon.
In general, sleep doctors organize the ideal lead-up to a sleepwalking episode in terms of the three P’s: predisposing factors (aka, risk factors), priming factors (what’s going on in your life leading up to the night), plus a precipitating event (something that partially rips you out of sleep).
7. Age and genetics can factor into your likelihood of sleepwalking
Your risk factors for sleepwalking can increase based on your age and genetics. These factors include:
- Age: While more research is needed, sleepwalking may be more common in children because their brains are still in the process of maturing, part of which involves “pruning” a multitude of connections between brain cells. As we grow up, the boundary between sleeping and waking states may become stronger.
- Genetics: Although there’s no single “sleepwalking gene,” there’s a definite genetic component for sleepwalking and other non-REM parasomnias. If one of your parents has ever been a sleepwalker, you’re three times more likely to also become a sleepwalker. If both have a history, you’re seven times more likely to sleepwalk, one study finds.
8. Sleep disorders and disruptions can trigger sleepwalking
For those who are prone to sleepwalking, certain sleep disruptors, and other issues can trigger episodes. These can include:
- Sleep deprivation: Extreme fatigue when going to bed can lead to more deep sleep the next time you fall asleep, which, in turn, could make you more vulnerable to partial wake-ups and sleepwalking.
- Obstructive sleep apnea: This sleep disorder repeatedly disrupts Zzz’s due to blocked airways and the need to push through them to breathe. These mini-arousals could also lead to sleepwalking.
- Restless leg syndrome: This sleep disorder, which causes an undeniable urge to move your limbs, can trigger nighttime arousals linked to sleepwalking.
- Fever: This and other symptoms of an illness can make children more prone to mini-wakeups and sleepwalking.
- Stress: Unusual stress — like hypervigilance due to the pandemic or a big exam the next morning — could increase your chances of sleepwalking by fragmenting your sleep, which increases the opportunity for semi-wakeups.
- Alcohol and drugs: While substance-fueled wandering and amnesia can be mistaken for sleepwalking, they also fragment sleep — and that could lead to an episode.
- Medications: Sedative medications, especially Z-drugs like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist), can increase your risk of dangerous sleepwalking episodes — so much so the Food and Drug Administration added a black-box warning for them.
- Other sleep disruptions: Anything that partially wakes you up or knocks your sleep schedule out of whack could be enough to trigger sleepwalking in someone already prone to somnambulism. These could be as mild as eating a spicy dinner that triggers acid reflux at night, going to bed with a full bladder, staying up past bedtime, traveling across time zones, rubbing up against a sleep partner, or hearing a dog barking outside.
9. Sleepwalking can be dangerous and — in rare cases — deadly
“There is a risk of injury in sleepwalking,” says Avidan, especially “if the sleepwalking becomes elaborate and includes moving from the bed to other places in the house or outside.” Though there is no definitive study on the frequency of injurious sleepwalking episodes, researchers have explored some of the potential issues that could arise.
Potential dangers of sleepwalking include:
- Bumping into or tripping over furniture
- Falling or jumping down the stairs or from upper-level windows or doors
- Walking off a balcony
- Sleep-related eating activities like eating non-food items or using knives and burners
- Sleepwalking outside in dangerous weather or into areas without awareness such as a swimming pool or street
- Operating a vehicle or weapon
- Unintentionally hurting a sleeping partner or housemate
While these stories are often sensationalized, sleepwalkers have at times died, which has been termed as parasomnia pseudo-suicides. In rare instances, they’ve also killed others. In fact, sleepwalking has been used as a successful defense in murder trials.
10. You should never lock a sleepwalker in their room
“The most important thing with sleepwalking and parasomnias is safety,” says Lennon. But a common piece of advice — locking the bedroom door — can be a fire hazard.
Instead of containing a sleepwalker in a locked bedroom, use these harm reduction tips to keep them safe:
- Safeguard the sleep environment with door and window alarms. These are often enough to wake them up or alert a caregiver to come help them.
- Create an obstacle-free bedroom by clearing the ground of toys and clutter and removing sharp or breakable objects.
- Move the mattress to the floor if a sleepwalker sleeps on the top bunk.
- Lock up all weapons and car keys in the vicinity.
11. Waking up a sleepwalker can help prevent injuries
“In general, if you’re encountering a sleepwalker, it’s a myth you need to let them be,” says Lennon. Contrary to popular opinion, you can (and should) interrupt them.
Here’s what to do:
- Gently guide a sleepwalker back to bed. Sleepwalkers tend to be highly suggestible and will walk right back to bed and fall asleep with your guidance.
- If need be, turn up the volume. If a sleepwalker ignores you, it’s okay to raise your voice or clap to snap them out of it — especially if they’re doing something that could be dangerous to themselves or others.
- Be patient as they awaken. If the sleepwalker awakens as you attempt to guide them back to bed, be prepared for them to be disoriented or confused. They may have no recollection the following day of having been up wandering around.
12. Frequent sleepwalking episodes are a sign that it’s time to contact your doctor
“Sleepwalking usually occurs in children as a normal phenomenon of sleep maturation and may not be abnormal in a child,” says Avidan. Most children outgrow the habit by their teen years. “But in an adult, sleepwalking is often related to another phenomenon or trigger.”
In many cases, medical treatment isn’t necessary — especially if there’s a clear trigger like staying up later than usual for a one-off reason the night before. However, repeated or new episodes could indicate an underlying problem that needs treatment. That you don’t want to ignore.
Contact a healthcare provider if sleepwalking episodes:
- Happen many times per night or more than one to two times a week
- Are so severe that they pose a danger to the sleepwalker or others
- Significantly disrupt sleep for the sleepwalker or others
- Continue into teenage years or begin in adulthood
- Cause daytime sleepiness or difficulty functioning
- Seem to be associated with stress, anxiety, or other psychological issues
- Are accompanied by symptoms of other sleep disorders such as disrupted breathing and snoring or the uncontrollable urge to move one’s legs at night
13. Treatment for sleepwalking depends on the trigger
There are numerous sleepwalking treatments available. To figure out the best treatment for sleepwalking, your doctor will ask you questions about your symptoms and in many cases recommend a sleep study, says Avidan. They may also suggest you keep a sleep diary to get a sense of your sleep quality and duration.
Treatment for sleepwalking may include:
- Addressing underlying causes like sleep apnea or restless leg syndrome.
- Switching up medications if your medication includes sleepwalking as a side effect or could be causing your sleepwalking.
- Scheduled awakenings during which you wake up the sleepwalker about 15-20 minutes before the time they tend to sleepwalk. Then, spend that time doing neutral activities like reading a book or deep breathing before letting them go back to bed. Disrupting the usual time when a partial awakening occurs could help stop them.
- Improving sleep hygiene with a set sleep schedule, stress-reduction activities, and no alcohol or caffeine before bed.
- Cognitive behavioral therapy for insomnia (CBT-I), a form of talk therapy that offers tools to cope with negative thoughts and relax before bed, could help if sleepwalking is linked to insomnia, stress, or anxiety.
- Sleep-supportive medications such as benzodiazepines or certain antidepressants are also sometimes used to treat sleepwalking if other methods are not effective.
Generally, sleepwalking is an occasional annoyance, primarily impacting children. For some adults, it can be an indication that there are issues to be explored, whether with sleep deprivation, sleep disruptions, medications, or other needed lifestyle or diet changes. For frequent, dramatic, or dangerous episodes, it’s best to reach out to a sleep doctor for help. Otherwise, stay calm, gently direct the sleepwalker back to bed, and call it a night.
