Sleepwalking, medically known as somnambulism, is a parasomnia where a person performs complex actions while still mostly asleep. This phenomenon involves an incomplete arousal from the deepest stages of non-rapid eye movement (NREM) sleep. The goal when encountering a sleepwalker is immediate safety. This article provides guidance on how to manage the situation and when to seek professional help.
What Sleepwalking Is
Sleepwalking is classified as a disorder of arousal, occurring during the deepest stage of NREM sleep, typically in the first third of the night. During an episode, a person may sit up, walk around, or perform routine activities with a glazed, unreactive expression. They remain difficult to fully awaken because the brain is in a mixed state, with motor control centers partially awake while consciousness remains mostly asleep.
Factors that increase the likelihood of an episode include a family history of the disorder. Common triggers involve conditions that lead to fragmented sleep, such as sleep deprivation, high fever, or intense stress or anxiety. Certain medications, including some sedatives and antidepressants, can also increase the risk. The episode usually ends with the person returning to bed on their own, often with no memory of the event.
The Immediate Safety Protocol
The central concern when encountering a sleepwalker is their physical safety, as they are unaware of their environment and prone to injury. Waking a sleepwalker will not cause severe medical trauma, but the danger lies in the reaction to being abruptly roused from deep sleep.
Forcibly or suddenly waking someone can trigger severe confusion, known as confusional arousal, which may include panic. The startled sleepwalker may react defensively or aggressively due to this disoriented state, posing a risk of injury to themselves or others. The priority is to prevent the sleepwalker from falling, wandering outside, or running into objects, not to achieve full consciousness.
Practical Steps for Safe Redirection
The approach should be gentle intervention, focusing on redirection rather than abrupt awakening. Speak softly and calmly to the sleepwalker, using simple phrases like “Come back to bed.” A gentle, guiding touch on the arm or shoulder can be used to steer them away from danger and back toward their room.
If the person is engaged in a dangerous activity, such as approaching a window or stairs, a slightly firmer, non-aggressive intervention may be necessary to prevent immediate harm. Once the sleepwalker is safely away from hazards, gently guide them back to their bed, where they will typically resume sleeping. For recurring sleepwalking, proactive safety measures are advised:
- Securing windows and exterior doors.
- Removing tripping hazards from the bedroom and hallways.
- Installing safety gates at the top of stairs.
When Sleepwalking Requires Medical Attention
While occasional sleepwalking is common, especially in children who often outgrow it, certain circumstances warrant consultation with a healthcare professional. Medical evaluation is suggested if episodes occur frequently (multiple times a week) or if they result in significant injury to the sleepwalker or others.
The onset of sleepwalking for the first time in adulthood is a reason to seek medical advice, as it may indicate an underlying medical condition. A sleep specialist should also be consulted if sleepwalking is accompanied by excessive daytime sleepiness, breathing issues during sleep, or violent behavior. Treating any underlying cause, such as sleep apnea or chronic sleep deprivation, can reduce the frequency of episodes.