Sleep walking

Alternative names 
Walking during sleep; Somnambulism

Definition
Sleep walking is a disorder characterized by walking or other activity while seemingly still asleep.

Causes, incidence, and risk factors

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. Rapid eye movement (REM) sleep is a different type of sleep, in which the eyes move rapidly and vivid dreaming is most common.

During a night, there will be several cycles of non-REM and REM sleep. Sleep walking (somnambulism) most often occurs during deep non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning.

In children, the cause is usually unknown but may be related to fatigue, prior sleep loss, or anxiety. In adults, sleep walking is usually associated with a disorder of the mind but may also be seen with reactions to drugs and alcohol, and medical conditions such as partial complex seizures. In the elderly, sleep walking may be a symptom of an organic brain syndrome or REM behavior disorders.

The sleep walking activity may include simply sitting up and appearing awake while actually asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer.

One common misconception is that a sleep walker should not be awakened. It is not dangerous to awaken a sleep walker, although it is common for the person to be confused or disoriented for a short time on awakening. Another misconception is that a person cannot be injured when sleep walking. Actually, injuries caused by such things as tripping and loss of balance are common for sleep walkers.

Sleep walking occurs at any age, but it occurs most often in children aged 6 to 12. It may occur in younger children, in adults, or in the elderly, and it appears to run in families.

Symptoms

     
  • eyes open during sleep  
  • may have blank facial expression  
  • may sit up and appear awake during sleep  
  • walking during sleep  
  • other detailed activity during sleep, any sort  
  • no recall of the event upon awaking  
  • confusion, disorientation on awakening  
  • sleep talking is incomprehensible and non-purposeful

Signs and tests
Usually, no further examination and testing is necessary. If sleep walking is frequent or persistent, examination to rule out other disorders (such as partial complex seizures) may be appropriate. It may also be appropriate to undergo a psychologic evaluation to determine causes such as excessive anxiety or stress, or medical evaluation to rule out other causes.

Treatment
Usually no specific treatment for sleep walking is needed.

Safety measures may be necessary to prevent injury. This may include modifying the environment by moving objects such as electrical cords or furniture to reduce tripping and falling. Stairways may need to be blocked off with a gate.

In some cases, short-acting tranquilizers have been helpful in reducing the incidence of sleep walking.

Expectations (prognosis)
Sleep walking may or may not reduce with age. It usually does not indicate a serious disorder, although it can be a symptom of other disorders.

Complications
A complication is injury sustained during sleep activities.

Calling your health care provider
Sleep walking usually does not require a visit to your health care provider. However, the condition should be discussed with your health care provider if:

     
  • sleep walking is accompanied by other symptoms.  
  • sleep walking is frequent or persistent.  
  • sleep walking includes potentially dangerous activities (such as driving).

Prevention

     
  • Avoid the use of alcohol or central nervous system depressants if prone to sleep walking.  
  • Avoid fatigue or insomnia, because this can instigate an episode of sleep walking.  
  • Avoid or minimize stress, anxiety, and conflict, which can worsen the condition.

 

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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