Sleepwalking

What is sleepwalking?

Sleepwalking, also known as somnambulism, occurs when a person gets up and walks around while still asleep. It is more commonly seen in children than in adults, and most children typically outgrow the behaviour by their teenage years.

How common is sleepwalking?

15% of children have at least one sleepwalking episode. The episodes peak around 4 to 8 years old.

It is less common in adults, affecting 1% to 4% of the adult population.

What are the symptoms of sleepwalking?

Sleepwalking episodes usually happen in the early part of sleep within 1-2 hours after sleep onset. Other than walking in sleep, it may sometimes involve complex behaviours lasting from a few seconds to an hour.

A sleepwalking event may involve:

• Walking while asleep
• Having open glassy eyes with a blank look on the face during the episode
• Not responding or talking to other
• Not having any recollection of the event in the morning

Sometimes, the sleepwalking episodes can involve complex behaviours such as urinating in inappropriate places, attempting to open doors and windows, or even trying to drive a car. Usually, sleepwalking episodes are self-limiting and are often not a serious problem, but occasionally these episodes can cause injuries due to falls, and the person can become violent if interrupted during these sleepwalking episodes.

What causes sleepwalking?

Genetic causes

Sleepwalking occurs more frequently in identical twins. The risk is ten times higher if a first-degree relative has a history of sleepwalking.

Environmental causes

The following factors can trigger sleepwalking:

• Sleep deprivation
• Chaotic sleep schedules
• Fever
• Stress
• Magnesium deficiency
• Alcohol intoxication
• Sedative/hypnotic drugs
• Stimulants
• Antihistamines

Physiologic causes

Pregnancy and menstruation can increase the frequency of sleepwalking.

Associated medical conditions

• Arrhythmias
• Fever
• Gastroesophageal reflux
• Nighttime asthma
• Night seizures
• Obstructive sleep apnoea
• Psychiatric disorders

How is sleepwalking diagnosed?

Usually, no tests or exams are necessary, but a medical evaluation may be done to rule out medical causes of sleepwalking. A psychological evaluation may also be done to exclude excessive stress or anxiety as a cause. Sleep tests may be done if the diagnosis is still unclear.

How is sleepwalking treated?

The following treatment options can be undertaken for a person with sleepwalking disorder:

General measures

If you see someone sleepwalking, gently guide them back to bed without waking them abruptly.

Some of the things to do to prevent sleepwalking episodes are as follows:

• Go to bed at the same time each night
• Attain adequate sleep
• Avoid daytime napping
• Avoid stress, fatigue and sleep deprivation
• Moderate exercise or relaxation exercises daily
• Avoid any kind of stimuli prior to bedtime
• Do not sleep in bunk beds
• Lock windows and doors
• Keep the floors clear of obstacles which may cause the sleepwalker to trip and fall
• Install lights with motion sensors to light up the room
• Place alarms or bells on bedroom doors and windows, if necessary

Medical treatment

The underlying cause should be treated, for example, gastroesophageal reflux, obstructive sleep apnoea, seizures and other causes mentioned.

Medications may be necessary in the following situations:

• The possibility of injury is real
• Continued behaviours are causing significant family disruption or excessive daytime sleepiness
• Other measures have proven to be inadequate

Benzodiazepines have been shown to be useful for three to six weeks and then discontinued without recurrence of symptoms. However, occasionally, frequency of symptoms can increase briefly after discontinuing the medication.