What Is Sleepwalking (Somnambulism)?
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Medically reviewed by Valerie Cacho, MD
Sleepwalking is a common sleep disorder that causes a person to walk and do other activities while asleep and not fully conscious. Sleepwalking, or somnambulism, is a parasomnia—a sleep disorder characterized by unusual behaviors or perceptions during sleep. Possible sleepwalking activities include walking, playing instruments, moving furniture, going to the bathroom, and leaving the house.
Sleepwalking occurs in approximately 5% of children and teenagers ages 2-18, peaking between ages 8-12. It usually resolves on its own over time.
Sleepwalking is much less common in adults. Episodes are triggered by factors like sleep deprivation, fever, anxiety, medications, and other sleep disorders. Treatment focuses on the underlying causes of sleepwalking and might include medication.
Sleepwalking Symptoms
During a sleepwalking episode, the person sits up and walks around while asleep. Sleepwalking episodes can last from a few minutes to about half an hour. Some of the main symptoms include:
Walking
Talking or mumbling incoherently
A blank expression
Opening eyes
Returning to a different place to continue sleeping
Another major symptom of sleepwalking is performing detailed and specific activities while asleep. People typically perform activities they usually do during the day, such as:
Putting on or taking off clothing
Moving furniture
Playing a musical instrument
Going to the bathroom, sometimes in odd places (e.g., urinating in the closet)
Leaving their home
Driving a car
Going into the kitchen and eating
If a person is woken up while sleepwalking, they are often confused and do not remember sleepwalking.
What Causes Sleepwalking?
Researchers are still trying to identify what exactly causes sleepwalking. Sleepwalking and other parasomnia sleeping disorders might occur due to an incomplete transition between stages of sleep.
The normal sleep-wake cycle involves the transition from waking to non-rapid eye movement sleep (NREM), followed by rapid-eye-movement (REM) sleep. Sleepwalking happens during a stage of NREM called N3 sleep. N3 sleep is one of the deepest sleep stages. It has a high arousal threshold, meaning it's difficult to be woken up when in this stage.
A disruption in the transition to N3 sleep might cause sleepwalking.
Childhood Sleepwalking
Children are more susceptible because their sleep cycles are still developing and not yet regulated. As a result, they spend a larger proportion of their sleeping time in N3 sleep. This increases the likelihood of sleepwalking.
Childhood sleepwalking is usually benign and most children experience fewer and fewer episodes over time. Sleepwalking is much rarer in adults and is usually triggered by sleep deprivation, a physiological condition, or medications.
Sleep Deprivation
Sleep deprivation is one of the main triggers of sleepwalking in adults. Long periods of sleep deprivation (over 24 hours) can increase the likelihood of sleepwalking. Studies have shown that longer periods of sleep deprivation result in more complex activities during sleepwalking episodes.
Sleeping after a long period of sleep deprivation causes you to spend more time in deep N3 sleep, making a sleepwalking episode more likely. Some people experience sleepwalking episodes while having a fever, which can also cause you to spend more time in deep N3 sleep.
Sleep deprivation often causes fatigue and anxiety, which are both triggers for sleepwalking.
Medications
Some medications can trigger sleepwalking episodes in adults, probably because they can disrupt sleep patterns. Medications that can trigger sleepwalking include:
Benzodiazepines: A class of medications used to treat conditions like anxiety, muscle spasms, and seizures
Lithium: Used to treat mental health conditions like bipolar disorder
Selective serotonin reuptake inhibitors (SSRIs): A class of antidepressant medications
Quinine: Used to treat malaria
Beta-blockers: A class of medications used to treat hypertension (high blood pressure)
Other Conditions
Sleepwalking can be caused by arousal disorders—conditions that cause you to wake up abruptly throughout the night. These include:
Obstructive sleep apnea: A chronic sleep disorder that causes repeated breathing disruptions while you sleep
Restless legs syndrome (RLS): A sleep and neurological sensory condition (related to your brain and spinal cord) that causes urges to move your body due to unusual sensations in your legs
Gastroesophageal reflux disease (GERD): A digestive disorder that occurs when your stomach acid repeatedly flows back into your esophagus (the tube that carries food from your mouth to your stomach)
Brain conditions like acute head injuries, encephalitis (brain inflammation), and migraine might also contribute to sleepwalking. More research is needed in this area.
Risk Factors
A family history of sleepwalking is the most common risk factor for sleepwalking. One longitudinal study of over 2,000 children found that sleepwalking was almost twice as likely in children who had at least one parent with a history of sleepwalking.
Other risk factors for sleepwalking include:
Being between the ages of 8-12
Sleep deprivation (especially more than 24 hours)
Having a fever
Experiencing anxiety
Taking medications like antidepressants, benzodiazepines, lithium, antipsychotics, and SSRIs
How Is Sleepwalking Diagnosed?
Testing isn't usually needed to diagnose sleepwalking. It's typically identified by a bed partner, family member, or parent (in the case of children).
Keep a Sleep Diary
Keep a sleep diary that tracks recent episodes. This can be helpful information for the provider. You can ask another person in your household to help with this.
Your healthcare provider will ask about other symptoms and review any medications you're taking. If you experience frequent sleepwalking episodes, the provider may perform tests to rule out conditions like sleep apnea, seizures, encephalitis, and mental health conditions like anxiety.
Polysomnography is often the most accurate way to diagnose sleepwalking. It's an overnight test that records your brain waves, oxygen levels, heart rate, and breathing during sleep. However, it's not usually the first approach to diagnosis because it's expensive and time-consuming.
Sleepwalking Treatment
Most cases of sleepwalking do not require treatment. For children, sleepwalking is usually a benign sleep disorder that resolves itself as they age. However, kids can still develop sleep disorders like sleep apnea.
For adults, the first course of action is to address any underlying disorders that might be triggering sleepwalking. This includes sleep disorders like:
Sleep apnea: A chronic breathing disorder that causes your breathing to stop and restart repeatedly while you sleep
Restless legs syndrome (RLS): A condition that causes urges to move your body due to unusual sensations you feel in your legs
Nocturnal seizure disorder: Having seizures as you fall asleep or wake up
It also includes ruling out mental health conditions like post-traumatic stress disorder (PTSD), a disorder that occurs in people who have experienced or witnessed a traumatic event.
Medication is another treatment approach. Your healthcare provider may stop or change your prescription dosage if they determine that medications might be causing sleepwalking.
They might also prescribe medications to help minimize the frequency of sleepwalking episodes. Low doses of benzodiazepines (medications that help you relax), melatonin, and tricyclic antidepressants have been shown to help control symptoms and reduce sleepwalking in some people.
Medication is often used alongside treatments that help manage underlying stress, anxiety, and behavioral triggers. These treatments include cognitive behavioral therapy (CBT) and mindfulness-based stress reduction. CBT focuses on identifying negative or disruptive thinking patterns and replacing them with healthier thoughts and emotions.
How To Prevent Sleepwalking
Many techniques can help manage and prevent sleepwalking episodes. For example:
Reduce stress and anxiety: Identifying and managing triggers can promote more restful sleep.
Avoid alcohol: Alcohol—especially before bed—can disrupt sleep.
Maintain a consistent sleep routine: Keeping a similar sleep/wake schedule and creating a peaceful sleep environment can reduce the risk of disrupted sleep pattern transitions that cause sleepwalking.
Anticipatory awakening is another prevention strategy. It involves having a family member or bed partner keep a "sleep diary" to monitor when during the night sleepwalking occurs. You can use this information to schedule an alarm to wake you about 15-20 minutes before sleepwalking usually occurs. Scheduled awakening might help reduce sleepwalking frequency.
Related Conditions
Having a neurological condition or sleep disorder can increase the likelihood of sleepwalking.
For example, increased arousal sleep disorders are conditions that cause you to wake up abruptly throughout the night. They include obstructive sleep apnea (OAS), restless legs syndrome, and gastroesophageal reflux disease (GERD). GERD is a condition that occurs when your stomach acid repeatedly flows back into your esophagus (the tube that carries food from your mouth to your stomach).
Some brain disorders or conditions might increase the likelihood of having sleepwalking episodes. Documented neurological conditions associated with sleepwalking include:
Head injuries
Encephalitis (brain inflammation)
Stroke
Seizures
There are also some documented cases of hyperthyroidism (overactive thyroid) causing sleepwalking. More research is needed to determine how hyperthyroidism triggers sleepwalking.
Living With Sleepwalking
Sleepwalking can be burdensome for the person and their loved ones or housemates. It can disrupt sleep, disturb the sleep of other people in the home, and even cause injuries.
Creating a safe environment helps ensure that the sleepwalking person is safe and doesn't hurt themselves or others during an episode. Common environmental safety techniques include:
Removing sharp objects and furniture near the bed area
Removing electrical cords near the bed and any other thing that might cause a sleepwalking person to trip and fall
Removing firearms from the bedroom and any easily accessible locations
Locking windows and doors
Installing door alarms to activate at night
Using extra pillows and padding on the side of the bed
Blocking stairs with a gate
Sleepwalking in children typically occurs because their sleep cycles aren't yet regulated. It usually resolves on its own over time.
In adults, sleepwalking is often a sign of an underlying issue—such as sleep deprivation, stress or anxiety, or an underlying condition. Medication is another possible cause. Treatment can help, and you can also take steps to prevent sleepwalking episodes.
Frequently Asked Questions
Why are you not supposed to wake up a sleepwalker?
It's not dangerous to wake a sleepwalker. They might wake up confused and disoriented, which could result in aggressive behavior. However, this is not the case for all sleepwalkers.
If a family member or loved one is sleepwalking, you can gently guide them back to bed. Wake them as soon as possible if they are engaging in a dangerous or life-threatening activity.
Is sleepwalking related to mental illness?
The relationship between sleepwalking and mental illness is unclear. Some studies suggest that sleepwalking—and parasomnias in general—seems to be more common in people who have psychiatric disorders.
It's still not clear whether this is due to their condition or if sleepwalking episodes are a result of a side effect from medications taken to treat these psychiatric disorders.
Sleepwalking can also be stressful. The challenges of managing it might increase the risk of depression or anxiety, making it hard to determine if sleepwalking episodes are a result of psychiatric disorders or vice versa. More long-term studies are needed.
Can anxiety trigger sleepwalking?
Anxiety is a common sleepwalking trigger. Managing your anxiety can help prevent or reduce sleepwalking episodes.
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