Sleepwalking: what it is, symptoms and treatment

Sleepwalking is intriguing and frightening: it occurs during sleep, the person gets up and walks, talks, or performs automatic actions without full awareness, and the next day remembers little or nothing. Although more common in childhood, it can also occur in adults, especially in contexts of sleep deprivation, stress and alcohol consumption.

The good news is that in most cases it is benign and improves with simple safety measures and sleep habits. When it persists or poses risks, effective clinical strategies exist.

Sleepwalking: what is it?

Sleepwalking is a parasomnia of non-REM sleep. It typically occurs in the first third of the night, starting from deep sleep, when there is an incomplete awakening: part of the brain wakes up enough to move the body, but not enough to gain full consciousness.

Result: automatic behaviors, vacant stare, confused speech, and partial or total amnesia of the episode.

Nuclear characteristics:

• It begins during deep sleep, usually within the first 2 hours after sleep. fall asleep.

• Duration ranging from seconds to 10–30 minutes, sometimes longer.

• Fixed gaze, little reactivity, and unintelligible speech.

• Difficulty in fully waking the person during the episode.

• Partial or complete amnesia of what happened.

Who is most likely to experience sleepwalking?

• Children between the ages of 4 and 12, especially those with a family history of parasomnias.

• Adults with chronic sleep deprivation or irregular schedules.

• People under intense physical or emotional stress.

• After consuming alcohol or sedatives.

• In the context of fever, jet lag or shift work.

• In the presence of other sleep disorders, such as sleep apnea or restless legs syndrome.

If episodes are frequent, dangerous, or occur in adulthood without explanation, it is wise to schedule an evaluation. sleep therapy for targeted investigation.

Symptoms and signs of sleepwalking

Before the list, a practical note: many episodes are only detected by family members. It's worth observing patterns.

• Get out of bed and walk around the house.

• Perform simple actions: open doors, get dressed, look for objects.

• To speak, murmur, shout, or have a neutral facial expression.

• Eyes open with a vacant stare; low responsiveness.

• Confusion upon waking and momentary irritability.

• Amnesia from the episode the following morning.

Warning signs that require special attention:

• Potentially dangerous behaviors: leaving the house, using utensils, climbing to high places.

• Frequent falls, injuries, episodes of unintentional violence.

• Sudden onset in adulthood with no apparent triggering factor.

What can trigger episodes?

Sleepwalking results from incomplete awakenings from deep sleep. Several factors greatly increase the likelihood of it occurring.

• Sleep deprivation and irregular schedules.

• Stress, anxiety, and emotional changes.

• Fever and acute illnesses.

• Alcohol and sedatives at night.

• External stimuli: noise, urge to urinate, discomfort.

• Other sleep disorders that fragment rest, such as sleep apnea.

What to do during an episode

Safety is the priority. The approach should be calm and simple.

• Accompany the person in a calm voice and guide them back to bed.

• Avoid shaking or trying to wake the person abruptly.

• Discreetly remove dangerous objects from the path.

• If the person wakes up confused, explain calmly and reassure them that they are comfortable.

Diagnosis of sleepwalking

Most cases in children do not require testing. The diagnosis is clinical, based on the description of the episodes, sleep schedules, and associated factors. In adults, late, violent, or atypical episodes warrant further evaluation.

Useful tools:

• Sleep diary and record of episodes (frequency, time, duration, context).

• Home video of an episode to show to the professional.

• Sleep study when there is diagnostic uncertainty, high risk, suspicion of sleep apnea, or confusion with other conditions.

Not everything is sleepwalking.

Some conditions may resemble sleepwalking, but they have a different origin and treatment.

• Night terrors: waking up with intense screaming, panic, and tachycardia, more common in children; the person does not recognize who is nearby and has no clear memory.

• REM sleep behavior disorders: vivid dreams with motor activity, more common in adults and the elderly; requires neurological investigation.

• Nocturnal epileptic seizures: stereotyped movements, brief duration, and sudden onset; requires neurological evaluation.

• Dissociative or psychological episodes related to stress.

Treatment of sleepwalking

Intervention begins with what you control every day: safety, sufficient sleep, and reducing triggers. In persistent or high-risk cases, there are additional options.

1) Home safety measures

• • Close doors and windows, remove keys from the lock.

  • Install discreet locks or alarms on doors in upper floors.

  • Protect staircases with gates, and keep furniture and sharp objects away from them.

  • Keep the room on the ground floor if episodes are frequent.

2) Regularity and quality of sleep

• • Fixed wake-up time, including weekends.

  • Adequate sleep window for age; avoid sleep deprivation.

  • Reduce light and screens 60–90 minutes before bedtime.

  • Avoid alcohol and sedatives at night.

3) Stress management and wind-down routine

• • A relaxing 30-minute ritual: hygiene, low lighting, light reading, slow breathing.

  • A list of things to do at the end of the afternoon to clear your head.

4) Medical and sleep triggers

• • To assess and treat sleep apnea when there is loud snoring, breathing pauses, or excessive daytime sleepiness.

  • Review nighttime medication that may worsen episodes.

5) Scheduled wake-up calls

• • Useful for children with episodes at predictable times.

  • Wake the child 15 minutes before the usual time of the episode, keep them awake for 5 minutes, and then put them back to bed.

  • Repeat every night for 1 to 2 weeks and reassess.

6) Clinical interventions

• • When episodes are dangerous, very frequent, or persistent, consider specialized follow-up.

  • Individual behavioral techniques and, in selected cases, time-limited medication may be used after evaluation.

Sleepwalking in children

• It's common and tends to improve with age.

• Focus on safety, getting enough sleep, and establishing consistent routines.

• Avoid waking them up abruptly; guide them back to bed calmly.

• Scheduled wake-up calls are especially useful when there is a predictable pattern.

• Inform the school if these episodes are frequent and pose a risk.

Sleepwalking in adults

In adults, sleepwalking is less frequent and warrants investigation when:

• It starts late with no prior history in childhood.

• There are injuries, dangerous behaviors, or incidents following alcohol consumption.

• There are other associated sleep disorders, such as sleep apnea.

Common myths about sleepwalking

• “"The person must be forcibly awakened." Abrupt waking creates confusion and resistance. It's safer to guide them back to bed.

• “"It only happens to children." Although more common in childhood, it can occur in adults, especially with sleep deprivation or alcohol.

• “"It's a sign of mental illness." Sleepwalking is a parasomnia; in most cases it is not related to psychiatric illness.

When to seek expert help

• Frequent episodes involving risk of falls, leaving the house, or using dangerous objects.

• Onset in adulthood without explanation, with a negative family history.

• Suspected signs of sleep apnea: loud snoring, pauses in breathing, excessive sleepiness.

• Significant impact on the daily life of the person or family.

A consultation of sleep therapy It provides assessment, differentiation of diagnoses, and a tailored plan.

Conclusion

Sleepwalking is usually temporary and benign. Prioritize safety, consolidate sleep, and reduce triggers. If episodes are dangerous, frequent, or reappear in adulthood, seek guidance. With strategy and consistency, it's possible to reduce episodes and regain peaceful nights for the whole family.