Sleepwalking (somnambulism)
Sleepwalking means getting out of bed and doing things while still asleep, with no memory of it the next morning.
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Sleepwalking means getting out of bed and doing things while still asleep, with no memory of it the next morning. It looks alarming from the outside, especially the first time, but in children it is common and almost always harmless: the episodes usually fade away on their own by the teenage years. Most people open a page like this for two reasons — how to behave during an episode (you do not have to wake the person, and often it is worse if you do) and how to make the home safe. Both are covered below, and there is a separate section on the rarer situations in which a night-time walk turns out not to be sleepwalking at all.
What it looks like from the outside
An episode almost always falls in the first third of the night, an hour or two after falling asleep, when sleep is deepest. The person sits up, then stands and starts walking. The eyes are open but the gaze is empty, looking straight through you, and the face shows nothing.
What people typically do during an episode:
- walk around the bedroom or the flat, sometimes apparently heading somewhere;
- move objects about, get dressed, undress, sit down on the floor;
- mumble something indistinct, or answer in short words that do not fit the question;
- less often, eat, urinate somewhere other than the toilet, unlock the door and walk out onto the stairs or into the street.
A sleepwalker is hard to rouse, and if they do wake they will need a few minutes to work out where they are and why they are standing in the middle of the hallway. The whole thing usually lasts anywhere from a few seconds to a few minutes: the person goes back to bed alone or can be led there, and remembers nothing in the morning. That blank is not forgetfulness — it is a feature of the state the brain was in at the time.
Why someone gets up without waking
Deep sleep and wakefulness are not two positions of a switch but states that can overlap. During sleepwalking the part of the brain that runs movement has already switched on, while the part responsible for awareness and memory is still asleep. That explains the whole picture: the legs walk, the hands do something, and the person is somehow not there.
The tendency is largely inherited — if a parent sleepwalked, it shows up noticeably more often in the child. But the tendency alone does not produce episodes; something has to deepen sleep or break it up.
- Not enough sleep is the commonest trigger. After several short nights deep sleep becomes heavier and it is harder to surface from it.
- A high temperature with any infection. In children episodes often appear during an illness and disappear along with it.
- Noise, light or being touched — a phone, the cat, a sibling in the next bed, an attempt to move someone who has dozed off.
- A full bladder, a frequent cause and an easy one to remove.
- Alcohol in the evening.
- Certain medicines — sleeping tablets and sedatives, some antihistamines and blood pressure drugs, some antidepressants and medicines prescribed by a psychiatrist. The list differs from person to person, so it is reviewed with a doctor and nothing is stopped without asking.
- Stress and a broken routine — exams, flights across time zones, night shifts, the first night in an unfamiliar place.
- Untreated sleep apnoea and restless legs syndrome, which keep pulling the sleeper out of deep sleep and make episodes more likely.
What to do when someone is sleepwalking
The old line that waking a sleepwalker can frighten them to death is untrue: nothing terrible happens if you wake them. Even so, it is better not to, for a different reason. Someone woken abruptly stays disorientated for several minutes, may take fright, push you away or struggle. Quietly steering them back to bed is almost always faster and calmer.
- Speak quietly and evenly; do not argue and do not try to prove anything.
- Take their arm or put a hand on their shoulder and turn them gently towards the bedroom — people usually go where they are led.
- Clear anything they could trip over out of the way, and do not hold them down: resistance only drags the episode out.
- Do wake them if there is no other way of stopping them — when they are heading for the front door, a window or the cooker, safety comes first.
- In the morning, skip the interrogation and do not show a child the video. They will not remember any of it and will only be left frightened and embarrassed.
Making the home safe
This is the single most useful thing you can do. An episode cannot be predicted, and all the harm it causes comes from one place: what the person walks into, or what they fall from.
- Windows and balcony. Lockable handles or restrictors on the frames, and the key not left on the windowsill.
- Front door. Locked, with the key kept somewhere the sleeper will not reach out of habit. A small bell on the door helps too: it wakes the adults.
- Stairs. Safety gates at the top and the bottom if the home has steps.
- Beds. A child who sleepwalks does not sleep on the top bunk.
- Floors and passageways. Clear away cables, rugs that slide and glass tables, and leave a dim light in the hallway.
- Dangerous items. Knives, tools, medicines, matches and lighters locked away. If the sleepwalker is an adult, the car keys go away too.
What helps reduce the number of episodes
Sleepwalking does not usually need treatment of its own. What works is not a medicine but working out what sets the episodes off and removing it.
- Getting enough sleep is the most effective single measure. The same bedtime and waking time, weekends and holidays included.
- A calm hour before bed: no screens, no boisterous games, no working in bed.
- A trip to the toilet immediately before lying down, and not much to drink late in the evening.
- No alcohol or caffeine in the evening, energy drinks and cola included for teenagers.
- Keeping a short diary: bedtime, how well the night went, what happened that day and whether there was an episode. Within two or three weeks the trigger is usually obvious.
When episodes come almost every night and at roughly the same hour, a doctor sometimes suggests waking the person about fifteen minutes beforehand: that brief waking breaks the cycle. It is a simple measure, but it is used under medical supervision and only for a limited period. Medicines are reserved for the exceptional case — frequent, dangerous episodes that respond to nothing else.
When it is worth seeing a doctor
Sleepwalking in a child is not in itself an illness and needs no tests. There are, though, situations in which something else lies behind the night-time walking.
- Episodes starting for the first time in an adult. In children this is ordinary; starting it as an adult calls for an explanation, because sleep apnoea, a drug side effect and, less often, neurological illness can all present this way.
- Daytime sleepiness, snoring with pauses in breathing, a child who breathes through the mouth at night. Sleep apnoea is a common and treatable cause; treat it and the episodes often stop by themselves.
- Episodes with a scream, a terrified face and a racing heart, in which the person cannot be comforted.
- Movements that are short and identical each time — freezing, lip-smacking, chewing, turning the head, tensing an arm for half a minute or a minute, and especially if this repeats several times a night. That is what nocturnal epileptic seizures look like, and they are treated in a completely different way.
- There have been injuries — bruises, cuts, a fall down the stairs, getting out of the house.
- Episodes are frequent, have gone on for years, or are costing the whole household its sleep.
It helps to bring a sleep diary to the appointment and, if you managed to record one, a short video of an episode: a specialist can tell sleepwalking from a seizure far more reliably from that than from any description. If apnoea or seizures are suspected, a sleep study is arranged.
Night-time agitation in older people is something else
If an older person starts shouting at night, hitting out and flailing their arms as though fighting someone, and on waking comes round at once and describes a dream that matches exactly what they were doing, this is most likely not sleepwalking. The condition is called REM sleep behaviour disorder: during dreaming the muscles of the body are normally switched off, and here that brake fails, so the person literally acts the dream out.
There are three differences from sleepwalking: age (mostly after sixty, and more often men), timing (the second half of the night rather than the first) and the preserved memory of the dream. Injuries happen both to the person and to whoever is sleeping beside them.
It should not be brushed aside: in a proportion of cases it precedes Parkinson's disease and related conditions by years, which is why these patients are followed up by a neurologist. In itself it is not a verdict and does not mean the illness will definitely develop, but a doctor should be found — and the bedroom made safe regardless.
Online consultation
A remote appointment settles the question most families actually have: whether this is the ordinary sleepwalking that children grow out of, or something that needs to be examined in person. The doctor will ask what time of night the episodes happen, how long they last and whether the person remembers them in the morning, because those are precisely the details that separate sleepwalking from night-time seizures and from REM sleep behaviour disorder. Online is also a convenient place to go through the triggers using your sleep diary, show the video you recorded, review the medicines you take and draw up the list of what needs locking away at home. If the conversation raises grounds to suspect sleep apnoea or seizures, the doctor will explain which sleep study is needed and who to see.
This material is for information only and does not replace medical advice.
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