Sleepwalking, formally known as somnambulism, is a common sleep disorder that involves getting out of bed and performing complex behaviors while still mostly asleep. This phenomenon is classified as a parasomnia, an abnormal event that occurs during sleep, originating from the deepest stage of non-rapid eye movement (NREM) sleep. Because the brain is only partially awakened, the individual is in an unusual state that blends sleep and wakefulness, leading to the cautionary advice: “Do not wake a sleepwalker.” Understanding this state is necessary to appreciate why experts recommend against abruptly forcing a sleepwalker into full consciousness.
The Real Risk of Waking a Sleepwalker
The popular belief that suddenly waking a sleepwalker can cause a heart attack, brain damage, or shock is a medical myth that has no basis in scientific fact. The danger in waking a sleepwalker is not physiological damage, but rather the severe psychological and physical risks that result from the abrupt arousal. When pulled out of deep NREM sleep too quickly, they are immediately plunged into an extreme state of confusion and profound disorientation. They have no comprehension of where they are or what they are doing.
This sudden, jarring awakening triggers an intense fight-or-flight response. The sleepwalker may experience intense fear and panic because they perceive the environment, or the person waking them, as a threat. In this state of acute agitation and confusion, the individual may lash out, thrash, or attempt to flee.
The resulting physical actions are uncontrolled and increase the risk of serious injury to the sleepwalker, such as falling down stairs or colliding with sharp objects. They may also inadvertently harm the person attempting to wake them due to their defensive panic. Therefore, avoiding waking a sleepwalker is a practical safety measure aimed at preventing accidental injury caused by their momentary terror and disorientation.
Guiding a Sleepwalker Safely
Since abrupt awakening is discouraged, the safest course of action when encountering a sleepwalker is to gently guide them back to bed without forcing them into full consciousness. The goal is low-key interaction that avoids startling them and triggering a panic response. Approach the individual calmly and quietly, using a soft, soothing voice to speak their name or offer simple, reassuring directions.
If verbal redirection is not sufficient, a very light touch, such as a gentle hand on the back or arm, can be used to steer them away from hazards. Avoid any sudden movements or physical restraint, as this is most likely to provoke agitation or a violent reaction. The redirection should be slow, patient, and focused on moving them away from danger, like stairs or exterior doors, and back toward their own bed.
If sleepwalking is a frequent occurrence, take preemptive safety measures within the home environment. This involves securing windows and exterior doors and installing safety gates at the top of stairwells to prevent falls during an episode. Clearing pathways of clutter and removing sharp or breakable objects from common areas also helps to mitigate the risk of accidental injury when an episode occurs.
Common Triggers and When to Consult a Doctor
Sleepwalking episodes are often triggered by factors that cause a disruption in the body’s sleep cycle, making a full arousal from deep sleep more difficult.
Common Triggers
Severe sleep deprivation, which increases the amount of deep sleep, is a common trigger, as are high levels of psychological stress or anxiety. Consuming alcohol or certain medications with a sedative effect, such as sleeping pills, can also increase the likelihood of an episode.
In children, a high fever is a common trigger for somnambulism, though episodes in childhood often resolve naturally by adolescence. Other underlying sleep disorders, such as obstructive sleep apnea or restless legs syndrome, can also fragment sleep and increase the frequency of sleepwalking. Addressing these co-existing conditions can help reduce the frequency of episodes.
When to Consult a Doctor
While occasional sleepwalking is not usually a cause for serious concern, professional medical consultation is necessary in several circumstances. A doctor specializing in sleep medicine should be consulted if:
- The episodes occur frequently.
- The episodes result in dangerous or injurious behavior.
- The episodes persist into adulthood.
- The sleepwalking is disruptive to the person’s or their partner’s sleep quality.
- The sleepwalking is accompanied by excessive daytime sleepiness.