What is sleepwalking?

Causes and Symptoms

Sleepwalking occurs during stages three and four of non-REM sleep and most frequently between one to four hours after falling asleep. Electroencephalograms (EEGs) indicate that children usually make a sudden transition into lighter sleep at the end of the first period of deep sleep. Some children do not make the transition rapidly and engage in parasomnia, or a simultaneous functioning of deep sleep and waking known as sleepwalking. An episode lasts from a few minutes to about an hour; most last for less than ten minutes.

An estimated 15 to 40 percent of children ranging from five to sixteen years of age have reported sleepwalking; an estimated 17 percent do so regularly. The condition is most prevalent in eleven- and twelve-year-olds. While sleepwalking before the age of four is rare, partial wakings can affect toddlers and infants. Although sleepwalking usually ends around the age of seventeen, it can continue into adulthood. An estimated 1.5 to 4 percent of adults sleepwalk. The condition is slightly more common in boys. Although most children sleepwalk infrequently, some sleepwalk frequently and for a period of five years or longer.

Sleepwalkers may have blank, staring faces and remain unresponsive to the attempt of others to communicate with them. They can be awakened only through great effort. Although sometimes sleepwalking children possibly see and walk around objects during their episodes, their behavior may involve leaving the bed violently and running without regard for obstacles. Partial awareness of their environment may be evident in their ability to negotiate hallway turns or objects on the floor. Some children stumble on stairs, crash into glass windows or doors, or walk out of the house into traffic. Serious injuries have occurred. While memory of these episodes is often absent, there may be a dim recall of the need to escape.

During sleepwalking, aggression toward others or toward objects in the vicinity is rare. The activity may be accompanied by sleeptalking that is characterized by poor articulation. Sleepwalkers also have increased incidence of other sleep disorders associated with non-REM sleep, such as night terrors. Sleep apnea and bedwetting are also common in children who sleepwalk.

Hormones or other biological factors may affect the character of these nighttime arousals. Statistics show that as many as 50 percent of sleepwalking children have close relatives with a history of similar phenomena. Although sleepwalking in very young children is developmental, many older children exhibit both a biological and an emotional predisposition for frequent sleepwalking. Some children who struggle to avoid expressing their feelings develop sleep problems.

Treatment and Therapy

Ensuring adequate sleep and providing a normal schedule are the best ways to treat partial wakings in young children. Although these remedies can help, some parents may have to learn to live with their children’s sleepwalking. Understanding what is happening will prevent the parents from intervening by attempting to awaken or question children or returning them to bed immediately. Instead, parents should talk quietly and calmly to sleepwalking children. If the children spontaneously awake after the episode, parents should avoid negative comments and treat the event matter-of-factly. In the case of agitated sleepwalking, restraint merely intensifies and increases the length of time of the episode. One should approach the child only to prevent injury, thus allowing the sleepwalking to run its course.

The child’s environment should be made as safe as possible to prevent accidental injury. Floors and stairs should be cleared, and hallways should be lit. For young children, gates may be installed at their bedroom doors or at the stairs, and should they attempt to leave the house, chain locks above their reach should be affixed to the doors.

In Solve Your Child’s Sleep Problems (1985; revised 2006), author Richard Ferber, director of the Center for Pediatric Sleep Disorders in Boston, states that older children whose sleepwalking may involve both psychological and inherited factors will benefit from psychotherapy. They may find it very difficult to express their feelings, especially if they are involved in situations in which things are happening outside their control. In the event of changes, losses, or an absence of warmth or love within a family, Ferber states that children are often quite angry about the circumstances but do not express it outwardly. Psychotherapy or counseling will encourage children to believe that their feelings are not dangerous and will help them express these feelings. Medication is prescribed reluctantly—only to prevent self-injury—and is decreased as the benefits from psychotherapy increase.

Perspective and Prospects

As late as the 1960s, sleepwalking was believed to be a neurotic or hysterical manifestation or an acting out of a dream. Contemporary studies have confirmed that sleepwalking is a sleep disorder that is not caused by psychiatric illness and is not a walking dream state.

Fortunately, sleepwalking can be outgrown by adulthood. Meanwhile, investigations into the nature of sleep, sleep and waking patterns, and biological rhythms continue to provide the best insight into this distressing family problem.

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