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Sleepwalking, also known as somnambulism, is a fascinating sleep disorder that arises during non-REM (NREM) sleep. This intriguing phenomenon results in individuals performing complex behaviors, such as walking or even sorting clothes, while remaining largely asleep. Despite being asleep, sleepwalkers exhibit limited responsiveness to their surroundings.
Sleepwalking, medically known as somnambulism, is classified as a parasomnia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Parasomnias are a category of sleep disorders that involve unwanted events or experiences that occur while falling asleep, sleeping, or waking up. Sleepwalking typically manifests during the non-rapid eye movement (NREM) sleep, particularly during stage 3, which is the deepest phase of the sleep cycle and is also referred to as slow-wave sleep.
During a sleepwalking episode, the individual experiences a partial arousal from deep sleep which triggers physical activities or behaviors. Despite being engaged in these activities, the sleepwalker is not fully awake; their consciousness is in a state of mixed wakefulness and sleep, which makes them unaware of their actions. This phenomenon most commonly occurs in the first third of the night, when slow-wave sleep is most intense.
Several factors can increase the likelihood of sleepwalking, including genetic predisposition, sleep deprivation, fever, stress, magnesium deficiency, and the consumption of certain medications. Environmental factors and disruptions in the normal sleep schedule can also trigger episodes.
Sleepwalking is most frequently observed in children, particularly those aged between 10 and 13 years. It is during this developmental stage that sleepwalking episodes are most likely to occur due to the rapid brain and body growth children experience. While many cases of sleepwalking begin in childhood, this condition can persist into adulthood. Notably, while less common, sleepwalking can also initiate during adult years. Factors contributing to adult-onset sleepwalking include stress, sleep deprivation, and certain medications.
Several causes can increase the likelihood of sleepwalking episodes. These include:
Genetic factors are also involved, and the risk of experiencing sleepwalking is higher for individuals with at least one first-degree relative with the same condition. Alcohol consumption in the evening can destabilize sleep stages and increase the risk of sleepwalking. The presence of respiratory disorders and some neurological diseases also favor the appearance of sleepwalking episodes. However, sometimes, the causes remain unknown.
During sleepwalking episodes, individuals usually demonstrate limited reactivity towards their environment and do not react to stimuli. They may also talk or make unintelligible sounds. A significant symptom of sleepwalking and other NREM parasomnias is that the person has virtually no memory of the episode upon waking up. Therefore, they often find out about their sleepwalking from a family member or roommate.
Sleepwalking episodes typically occur during the first third to half of the night, when individuals spend a greater percentage of time in deep NREM sleep stages. Sleepwalking behaviors can range from routine actions like getting dressed to more complex actions like driving a car. Sleepwalking episodes can last from a few seconds to half an hour, and most are over in less than 10 minutes.
Accidents that occur during sleepwalking episodes can cause injury if the individual loses balance, trips and falls, or collides with other objects while walking or running. Sleepwalking is also associated with a significant worsening of sleep and excessive daytime sleepiness.
The treatment for sleepwalking depends on the patient's age, the frequency of episodes, and the potential harm caused by the episodes. In many cases, sleepwalking does not require specific treatment, as the episodes are rare and pose few risks. The following strategies can help in controlling and potentially reducing sleepwalking incidents:
Most sleep experts recommend against waking a sleepwalker during an episode. Abruptly awakening someone who is sleepwalking can lead to intense reactions such as fear, confusion, anger, or disorientation. These reactions occur because the sleepwalker is suddenly pulled out of a deep sleep state, and their brain may not immediately recognize their surroundings or understand what is happening.
However, there are situations where it might be necessary to intervene, especially if the sleepwalker is at risk of harming themselves or others. In such cases, it is advisable to gently guide them away from potential hazards, such as stairs or sharp objects, without fully waking them. If possible, calmly direct them back to their bed. If you must wake a sleepwalker, do so with minimal agitation by speaking softly and reassuringly, and gradually increasing the amount of light in the room, which can help orient them back to a wakeful state safely.
Always ensure the sleepwalker's environment is as safe as possible to prevent accidents during such episodes. This can include installing gates on stairs, locking windows and doors, and removing sharp or breakable objects from common areas where sleepwalking might occur.