Sleepwalking

Sleepwalking is another example of a sleep behavior that has been made humorous in television shows and situation comedies, but is often no laughing matter.  Sleepwalking can happen to both children and adults – in fact, it is far more common in children  - but when it happens in adulthood the risk of injury and danger is far greater. The official medical word for sleepwalking is somnambulism. Most people have done it at least once, but usually during childhood; approximately fifteen percent of children have chronic episodes of sleepwalking. In most cases, children sleepwalk between the ages of four and twelve, though they can start as soon as they are able to crawl, and ten is the most likely age for it to occur. By the time children reach adulthood they grow out of sleepwalking – in fact only one adult out of every two hundred will ever sleepwalk. If you’ve ever seen a child walk in their sleep, you can understand why it is seen as amusing. Sleepwalking appears to happen just as we are transitioning out of our deepest sleep cycle, so although our bodies are able to move, our brains are not fully engaged. Eyes may be open but they are generally vacant, speech might be attempted but it is largely unintelligible.  If the child actually gets out of bed their walking is slow and purposeful, as though they are on a mission. Children who walk in their sleep are rarely upset or distressed, though they can be easily confused if you try to engage them in conversation, and are likely to get frustrated with you for not understanding them. Guiding hem back to bed is generally easy to do, and the best remedy for the situation. When adults sleepwalk, however, things can be a lot more troubling. The behavior may be similar, at least at the inception of the incident, but because adults are generally more powerful, it is much more difficult to stop them and guide them back to bed, and they can actually become violent to anybody who attempts to move them from their path.  Where children who sleepwalk do so without any indication of behavioral disorders, when the behavior continues into adulthood it is often a symptom of some kind of psychological problem. Adults who sleepwalk often do so following periods of extreme exhaustion or sedation from alcohol, and their behavior is often a physical playing out of what is happening in their dreams: adults who sleepwalk are often prone to violence, and though it is rare they can actually be dangerous to both themselves and to others depending upon how deeply they are asleep.  One of the dangers of sleepwalking as an adult is that most instances occur when the adult is not sleeping in their own bed; sleepwalking in an unfamiliar environment can lead to dangerous accidents, including climbing out of windows or balconies and walking into the middle of crowded streets or a hotel swimming pool. Understanding sleepwalking is an important step to preventing it and dealing with it. It seems to take place as the sleeper is transitioning from one sleep cycle to another, usually from deep sleep into the twilight sleep in which we normally shift positions and ready ourselves to enter REM sleep. This is referred to as a partial arousal, and it is related to other partial arousals including talking in your sleep and night terrors. In all cases the brain has not fully roused itself, but the body is no longer in a state of paralysis. As the body is able to function, moving around and walking before the brain is fully engaged, the decisions that are made are not rational, which is why they can so often lead to behaviors that seem comical to observers. It has been noted that sleepwalking and other sleep arousal behaviors seem to occur more frequently during times when the person is particularly stressed or tired. There are a number of things that should be kept in mind when dealing with somebody who walks in their sleep. If your child is sleepwalking, it is nothing to worry about. Children generally outgrow sleepwalking and no intervention is required. Just make sure that your child is safe by locking doors, putting up gates in front of stairs and securing all windows. It is a good idea to remove breakable or fragile items and sharp objects.  Adults however are a different story. Keeping them safe is much more difficult to control and to keep safe, especially if the sleepwalking event takes place in surroundings that are unfamiliar. Being aware of the things that trigger sleepwalking in adults is particularly helpful, both in terms of anticipating an event and prevention. Most adult sleepwalking is preceded by periods of heavy drinking, sleep deprivation, extreme fatigue or highly stressful situations. Preventing these triggers is optimal, but in some cases medication that prevents the patient from entering the deepest sleep phases can be helpful.  Also be mindful that some medicines can exacerbate sleepwalking tendencies. When working with a child it is often relatively easy to get them back into bed during a sleepwalking episode. Speaking quietly to them and guiding them back to bed with a light touch is generally all that is needed.  Though it is tempting, it is best not to tell a child about their sleepwalking episode once they are awake. Sleepwalking is characterized by amnesia and they aren’t likely to remember, and will become self-conscious if they are teased about it the next day. Controlling and guiding an adult who is sleepwalking requires more knowhow and an assessment of the danger that the situation may pose. In most cases an adult sleepwalker can be guided back to bed, and there is no need to wake them.  If they resist being redirected, simply do what you can to make sure that they are safe, keeping them away from balconies and windows. If the sleepwalking becomes a regular occurrence, seek medical help.