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Somnambulism

What Is It, Causes, Signs, Symptoms, Diagnosis, and More

Author:Lily Guo

Editors:Alyssa Haag,Józia McGowan, DO,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW


What is somnambulism?

Somnambulism, commonly known as sleepwalking, refers to a sleep disorder where the individual walks and does activities while in a deep sleep. Sleepwalking is most common in children between the ages of 8 and 12. During the event, the individual is disoriented to time and place and they can exhibit slow speech with blunt responses to questions or requests. There is often both anterograde and retrograde memory impairment upon waking. Anterograde memory impairment is the inability to form new memories. In contrast, retrograde impairment refers to the failure to recall old memories—some people who sleepwalk recall vague visual imagery and auditory impressions after awakening. Somnambulism occurs during non-rapid eye movement (NREM) sleep stage three when the individual is in a deep sleep and can be challenging to awaken. 

Somnambulism is classified as parasomnia, a term that encompasses disruptive sleep-related disorders that occur just before falling asleep, while sleeping, or when waking up. Other parasomnias include sleep terrors, sleep-related eating disorders, and sleep paralysis. While somnambulism is relatively benign, there can be potential for injury, such as leaving the house or falling downstairs. 

Walking while asleep.

What causes somnambulism?

The cause of somnambulism is thought to be genetic. There is a familial predisposition to parasomnias, with studies suggesting the rate of sleepwalking is six times higher in monozygotic twins than dizygotic twins. Furthermore, it is up to three times as common in children whose parent(s) had exhibited sleepwalking when they were younger compared to children whose parent(s) did not. 

Somnambulism is also influenced by age, as the disorder is most common in childhood and gradually resolves by adolescence. Factors that trigger sleepwalking include sleep deprivation, fever, noise, medication, and sleep-related respiratory events, such as sleep apnea

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What are the signs and symptoms of somnambulism?

The signs of somnambulism include sitting up and walking around while appearing to be awake. It is typically seen in toddlers and school-aged children. Ambulation is typically slow, and the individual may walk around quietly. Others may seem agitated and run around the house or have confused, inappropriate behaviors. Children may injure themselves by performing dangerous behaviors such as leaving the house on a cold night and becoming hypothermic

Adults sleepwalking have been reported to prepare foods, eat, clean, move furniture, urinate in inappropriate places, or drive a car. Those in a state of somnambulism may have concurrent autonomic dysfunction, such as sweating and flushing of the face. It is common for those who also sleepwalk to experience sleep terrors, episodes of intense fear accompanied by screaming and flailing while asleep. 

How is somnambulism diagnosed?

Somnambulism is diagnosed from a comprehensive clinical history outlining the timing and frequency of events. This can be obtained from observing the individual who is sleepwalking since they may have little to no memory of the events. Recording and reviewing home videos can also be helpful in diagnosis. The clinician may also ask questions about personal and family history of similar events in childhood, if the individual is usually sleep deprived, and if there are symptoms of other sleep disorders, such as obstructive sleep apnea

If the clinical history is atypical or there is suspicion of a comorbid sleep disorder, a polysomnography, also called a sleep study, can be performed. A polysomnography is a comprehensive test when brain waves, activity, oxygen levels, heart rate, breathing, and eye and leg movements are monitored while the individual is sleeping. 

How is somnambulism treated?

Many children with somnambulism grow out of it by adulthood and do not require treatment or intervention. For those who have recurrent somnambulism and those who are at risk of injuring themselves, behavioral and preventative strategies may be used. 

The goal is to eliminate precipitating factors and increase environmental safety for the sleepwalking individual. The individual may be advised to avoid sleep deprivation, drinking alcohol, and taking sleep medicines like zolpidem. Maintaining regular and consistent sleep cycles, including having a routine bedtime, may also be necessary. Changes in the sleep environment should be minimized, and the bedroom should be safeguarded to avoid injury. This may include using padding on the furniture and the floor next to the bed, lowering the mattress to the floor, using the bedroom on the ground floor of the house, securing windows and doors, using a bedroom door alarm, and removing sharp and dangerous objects in the bedroom. For children, having scheduled awakenings where the parents arouse the child before the usual sleepwalking time is typically recommended. If an underlying condition, such as sleep apnea, is causing somnambulism, treatment using a continuous positive airway pressure (CPAP) machine may be used.

What are the most important facts to know about somnambulism?

Somnambulism, commonly called sleepwalking, is walking around and performing tasks while in NREM sleep. It is most common in children and has a genetic component. Those with somnambulism are often confused and agitated upon waking and typically do not remember what has occurred. Diagnosis is generally made on clinical presentation, and the clinician can interview those who have witnessed the sleepwalking episode. Sometimes, a polysomnography can be ordered to monitor the individual while sleeping and assess abnormal brain activity or physical dysfunction. Treatment for sleepwalking is often not needed. However, if treatment is warranted, it is mainly preventative, which can include safeguarding windows and bedroom doors, lowering the mattress, and having an individual sleep on the ground floor of the house. Those who sleepwalk can decrease the frequency of episodes by maintaining a regular sleep schedule and avoiding lack of sleep, drinking alcohol, or taking sleep aids before bed. 

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Related links

Narcolepsy (NORD)
Night terrors
Psychological sleep disorders: Pathology review

Resources for research and reference

American Academy Of Sleep Medicine. International Classification of Sleep Disorders. American Acad. Of Sleep Medicine; 2014.

Bargiotas P, Arnet I, Frei M, Baumann CR, Schindler K, Bassetti CL. Demographic, clinical and polysomnographic characteristics of childhood- and adult-onset sleepwalking in adults. Eur Neurol. 2017;78(5-6):307-311. doi:10.1159/000481685

Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Medicine Reviews. 2003;7(5):413-421. doi:https://doi.org/10.1053/smrv.2001.0247‌

Licis AK, Desruisseau DM, Yamada KA, Duntley SP, Gurnett CA. Novel genetic findings in an extended family pedigree with sleepwalking. Neurology. 2011;76(1):49-52. doi:10.1212/WNL.0b013e318203e964

Petit D, Pennestri MH, Paquet J, et al. Childhood sleepwalking and sleep terrors: a longitudinal study of prevalence and familial aggregation. JAMA Pediatrics. 2015;169(7):653-658. doi:https://doi.org/10.1001/jamapediatrics.2015.127

Sauter TC, Veerakatty S, Haider DG, Geiser T, Ricklin ME, Exadaktylos AK. Somnambulism: Emergency department admissions due to sleepwalking-related trauma. West J Emerg Med. 2016;17(6):709-712. doi:10.5811/westjem.2016.8.31123

Stallman HM. Assessment and treatment of sleepwalking in clinical practice. Aust Fam Physician. 2017;46(8):590-593.