Sleepwalking: what causes walking in your sleep and how does it affect your health

An hour or two after my school-age son has gone to bed, he sometimes wakes up from a nightmare, walks to my room and mumbles incoherently about what’s scaring him. But he seems off, and I can't get through to him when I try to soothe him. It's eerie and unnerving. In fact, though my son appears to be awake in these instances, he is actually sleepwalking.

Although sleepwalking can be deeply unnerving, it is not uncommon. Read on to learn more about sleepwalking, or somnambulism, and what to do about it.

What is sleepwalking?

Sleepwalking is a sleep disorder, or parasomnia, that happens during the deep part of nonrapid eye movement (NREM) sleep — usually within a couple of hours after falling asleep. Nearly 7% of people experience it at least once in their lives. While it's more common in kids, with reported rates of 5% experiencing an episode within the previous year, as many as 1.5% of adults also report walking in their sleep each year.

Sleepwalkers may sit up in bed, talk, walk and even carry out more complex tasks — like dressing or eating — with their eyes open, although they are not responsive.

"Think of sleep as a well-choreographed dance," explains Dr. Dylan Petkus, a sleep apnea expert, who says that unexpected interruptions "cause the dance to lose its rhythm." In a sleepwalker, this means that the "parts of the brain responsible for movement wake up, but the conscious part of the brain remains asleep," he says.

Common causes of sleepwalking

Researchers don't know exactly why sleepwalking occurs. "The exact cause of sleepwalking is not fully understood, but it appears to be related to a mix of environmental and physiological factors," says Jonathan Berent, CEO of NextSense, a company dedicated to brain health.

Sleepwalking is known to occur more frequently among boys as well as in children of individuals who sleepwalk. And some research indicates it's more common in white people. The following factors appear to play some role in affecting somnambulism:

• Genetics

• Sleep disorders

• Sleep deprivation

• Migraines

• Medications (like Zolpidem, brand name Ambien)

• Fever

• Stress

• Sleep apnea

• Brain injury

• Sleep schedule disruptions like travel

"Maintaining a regular sleep schedule, creating a safe sleep environment, managing stress and ensuring adequate sleep can help reduce the frequency of sleepwalking episodes," Berent says. "Avoiding alcohol and certain medications that can disrupt sleep might also be beneficial."

Signs or symptoms of sleepwalking

Since people often don't remember their own episodes of walking in sleep, it's hard to know if you've even had the disorder.

"If you find yourself in another room or location in the home, or even outside the home and don't have recollection as to how you got there," you might have been sleepwalking, says Brian Licuanan, a clinical psychologist and author. Other signs might include discovering food remnants, noticing cabinets or windows open or finding objects out of place in the home after waking up.

To more accurately determine whether you might be sleepwalking, "some people choose to film themselves throughout the night or use sleep-tracking technology, such as in-ear EEG devices or wearable rings or watches that can help monitor and identify sleepwalking episodes by tracking brain activity and heart rate during sleep," Berent says.

Many people remain unaware of their sleepwalking episodes unless a bed partner or someone else in the home tells them about it.

"A sleepwalker may exhibit behaviors such as sitting up in bed, walking around the room or house and performing routine activities while appearing confused or dazed," Berent says. "They might have open eyes with a glassy stare and may not respond to communication."

Licuanan says that sleepwalkers might be identified when they "engage in patterns of behaviors that may be out of the ordinary" for them, like pacing.

Dangers or side effects of sleepwalking

Most sleepwalking isn't immediately harmful, but it can cause daytime sleepiness, fatigue and similar quality-of-life concerns. "Sleepwalking can deprive a person of consolidated, restorative sleep as it disrupts the sleep cycle," Licuanan says. "When sleepwalking becomes a frequent occurrence, it can negatively impact mental and physical health because a person is not getting adequate rest."

That said, some episodes of sleepwalking can be dangerous. For instance, if the sleepwalker attempts to drive a car or navigate a staircase, these activities can pose serious injury. One study found nearly 3 in 5 adult sleepwalkers had harmed themselves or others during a sleepwalking episode.

"Sleepwalking can be a health concern especially if the person puts themselves at risk for falls or leaves the home and sleepwalks to environmental conditions that may inflict harm such as traffic, harsh weather conditions or other situations that put a person in high-risk scenarios," Licuanan says.

While there's a myth that you shouldn't wake up a sleepwalker, the truth is that if they're putting themselves or others at risk, you should wake them up. If, however, they're simply seeming disoriented, you can simply lead them back to bed, according to doctors at Northwestern Medicine.

When to see a doctor about sleepwalking

According to Licuanan, you should talk to a doctor if your episodes of sleepwalking:

• Become more frequent (one or two times a week)

• Last longer than usual (into adult years)

• Impair other areas of life (like relationships and career)

• Put you or others at risk of injury

• Affect other health conditions by lowering your immunity or worsening mental health conditions like anxiety and depression

In these cases, Berent says it's important to consult a health care professional who may recommend a sleep study to evaluate any potential underlying causes and develop a treatment plan.

Treatment options and ways to manage sleepwalking

To manage sleepwalking, start with making sleep hygiene tweaks — optimize your bedroom temperature, eliminate ambient light with a sleep mask or blackout curtains and avoiding technology close to bed — and eliminate any potential triggers you can identify. Also, work to reduce your stress levels; Licuan suggests practicing mindfulness techniques like yoga or journaling.

Further, it's key to address any existing conditions, such as sleep apnea, Berent says.

If you take Ambien, consider lowering your dose or cutting out this medicine altogether as it can make sleepwalking episodes "more complex and potentially dangerous because the individual might engage in activities like driving, cooking or using machinery while not fully awake," Berent says.

Beyond that, you might move to treatments like cognitive behavioral therapy (there are online therapy services for adults and kids if it's hard to make time for in-person appointments), hypnosis or even medication. But proceed with caution and only under the care of a doctor: "There are certain sleep medications that can treat sleepwalking, but it is important to note that these same medications may even induce or worsen sleepwalking in some people," he says.

He recommends asking a bed partner or roommate to report your sleepwalking episodes and jot down details in case you need to report the symptoms to a health professional.

FAQs

How can sleepwalking affect your health?

Sleepwalking can lead to quality of life issues such as daytime sleepiness and excess fatigue. Although less common, sleepwalking can result in injury to the sleepwalker or another person, if the somnambulist engages in harmful actions while asleep.

What happens in the brain to cause sleepwalking?

"The brain is caught between wakefulness and sleep," says Petkus. This mismatch can result in sleepwalking episodes. In these moments, the "brain becomes partially aroused from deep sleep without fully waking up," he explains, where the body can move but the mind is still asleep.

What are the behaviors of sleepwalking?

While sleepwalking, people may sit up in bed, walk around and talk, all with their eyes open. They may also attempt more complex (and potentially harmful) activities, like getting dressed, eating or even driving.

How can sleepwalking be treated?

Sleepwalking can be counteracted with behavioral and sleep hygiene management as well as stress reduction. In rare cases, it can be treated with hypnosis, cognitive behavioral therapy or medication.

Meet our experts

• Dylan Petkus, MD, MPH, MS and sleep apnea specialist

• Brian Licuanan, PhD, board-certified clinical psychologist, cognitive behavioral therapist and author

• Jonathan Berent, Stanford University guest lecturer and NextSense founder/CEO