Sleepwalking: A Mind Asleep, Yet Active

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Updated on: Educator Review By: Michelle Connolly

Sleepwalking, also known as somnambulism, is a type of sleep disorder that affects around 4% of adults and is more common in children. It is a condition in which a person engages in activities that are normally done when they are awake while they are still asleep. Sleepwalking can range from simple tasks, such as sitting up in bed, up to more complex actions, such as walking out of the house.

The act of walking or performing complex actions while asleep can be both fascinating and concerning. While harmless, most of the time, images of individuals driving cars or eating pickles in their pyjamas paint a picture of potential danger. Today, we delve into the science behind sleepwalking, exploring its causes, manifestations, and management strategies.

A Mind Unconscious, Yet Active

Somnambulism falls under the umbrella of parasomnias, sleep disorders involving abnormal behaviour during sleep. It typically occurs during deep sleep, known as non-rapid eye movement (NREM) sleep, particularly Stage 3. During this stage, brain activity slows, but not entirely. Certain areas responsible for movement and motor planning remain partially active, leading to the characteristic walkabout.

But what is non-rapid eye movement (NREM) sleep, you ask?

Well, to answer this question, we need to know first what normal sleep is and what happens during it.

During normal sleep, the human body goes through two phases of sleep: rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. NREM sleep has three stages called N1 to N3. These stages occur in the following sequence:

  • The first stage (N1) is light sleep, where we start to relax, and our heart rate and breathing slow down.
  • The second stage (N2) is a deeper sleep where our body temperature drops and our muscles relax even further.
  • The third stage (N3) is the deepest stage of sleep, also known as slow-wave sleep. During this stage, it becomes harder to wake up, and our body does most of its restoration work. This is also the stage when sleepwalking occurs.
  • Finally, we enter the REM (Rapid Eye Movement) stage, where our eyes move quickly, and we often dream.

During sleep, our body goes through all these stages about 4 to 6 times per night. Each cycle lasts around 90 minutes on average. As the cycle repeats throughout the night, each cycle becomes shorter and less deep but with longer periods of REM sleep.

What Causes Sleepwalking

The exact cause of somnambulism is not known, but genetics is one of the primary factors that contribute to the condition. Other factors that can contribute to sleepwalking include sleep deprivation, stress, alcohol consumption, certain medications, other sleep disorders, and medical conditions such as sleep apnea.

A Genetic Predisposition

Studies reveal a strong genetic component to somnambulism. Having a family history significantly increases your risk. Additionally, specific genes have been linked to the condition, suggesting a complex interplay between genetic and environmental factors.

Beyond Genes: Triggers and Risk Factors

While genes set the stage, other factors can trigger somnambulism episodes. These include:

  • Sleep deprivation: When sleep-deprived, the brain struggles to transition smoothly between sleep stages, increasing the risk of partial arousals leading to sleepwalking in predisposed individuals.
  • Stress and anxiety: Mental stress can disrupt sleep architecture, making sleepwalking more likely.
  • Medications: Certain medications, including sedatives and antidepressants, can affect brain activity and sleep patterns, potentially triggering sleepwalking.
  • Medical conditions: Sleep apnea, neurological disorders, and fever can also contribute to sleepwalking episodes.

Your Brain During an Episode

During sleepwalking, some parts of the brain are asleep while others are awake. The parts that are awake are mostly in the middle and back of the brain, and they control things like movement and vision. The part of the brain that helps with memory is still asleep during sleepwalking, which is why sleepwalkers may have trouble remembering what happened. Also, the part of the brain that helps us think and reason is less active during sleepwalking, which can cause sleepwalkers to act in unusual ways.

Symptoms and Behaviours

Somnambulism can have a significant impact on a person’s life. It can lead to injuries, embarrassment, and sleep disruption for both the sleepwalker and the people living with them. In severe cases, sleepwalking can even lead to legal issues, as people who are sleepwalking may engage in criminal acts without being aware of their actions.

The Sleepwalker’s Journey

Sleepwalking usually happens during the first third of the night. These episodes are usually short, lasting just a few minutes. But in some rare and severe cases, people have sleepwalked for several hours. It is common in children, with as many as 17% of them experiencing it. Even some adults, around 2 to 4%, still sleepwalk, especially those who did it as children. It tends to subside during the teenage years in about 80% of cases. This could be due to changes in the arousal pattern or sleep depth during adolescence.

When someone has an episode of sleepwalking, they might suddenly wake up and look around confused. They might sit up in bed, yell, talk, or even walk around. They might do things like texting, searching through drawers, or handling objects as if they are awake, even though they are still asleep. People might also do normal, everyday things like getting ready for school or eating breakfast, but at unusual times, like in the middle of the night.

However, when someone sleepwalks, they are not fully aware or responsive. They might seem confused when you ask them questions and might do things that are dangerous or inappropriate. They might also have strange thoughts or emotions as if they are dreaming, and they might not remember the sleepwalking episode very well afterwards. All of these things suggest that they are partly asleep while sleepwalking.

Forgetting what happened during these episodes is common, especially in children. But sometimes, adults remember some part of what they did during an episode. Adults may also recall having short, scary dreams, and they may even act out these dreams (like pulling someone out of bed to save them from a train). However, if someone remembers a long and detailed dream, it’s more likely a REM sleep nightmare than a sleepwalking episode (since sleepwalking happens during NREM sleep, as mentioned above).

How to Manage

Managing sleepwalking depends on the severity and frequency of the behaviours. While we cannot change genetic susceptibility, we can reduce triggering factors.

Safety First: Protecting the Sleepwalker

Although typically harmless, somnambulism can pose safety risks, especially if the individual exits the house or engages in potentially dangerous activities. Here are some safety tips:

  • Sleepwalkers can improve their condition by following a regular sleep routine, getting enough sleep, and practising relaxation techniques, as sleep deprivation and stress can trigger sleepwalking episodes.
  • Avoid anything that might wake you up during deep sleep. This includes sudden noises, snoring, and drinking alcohol.
  • Parents of sleepwalking children should take steps to keep them safe. For example, they should make sure their child’s bedroom is on the first floor and lock all windows and doors. Also, parents should avoid trying to wake or yell at their child during a sleepwalking episode, remove tripping hazards, and keep sharp objects out of reach.

Seeking Help

While most sleepwalking resolves on its own, particularly in children, seeking professional help is crucial if episodes are frequent, pose safety risks, or cause significant distress. A doctor can assess underlying medical conditions, recommend treatment options, and provide guidance on creating a safe sleep environment. It’s also worth noting that there’s no drug that has been specifically developed to treat somnambulism.

Overall, somnambulism is a complex sleep disorder that can have a notable impact on a person’s life. While the exact cause is not known, there are several factors that are believed to contribute to the condition. Safety measures are essential to manage this condition. However, individuals whose condition is distressing should seek medical attention to help manage their symptoms.

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