Why Not Wake Up a Sleepwalker?

Why Not Wake Up a Sleepwalker?


What is Sleepwalking?

Sleepwalking is a sleep disorder, which is one of the parasomnias non-REM; therefore, it originates during Deep sleep and results in walking or performing other complex behaviors while still mostly asleep.

Although he continues to sleep, the sleepwalker (or night owl) shows a limited reactivity towards the surrounding environment. Someone who experiences an episode of sleepwalking may get out of bed, sit up, walk, or exhibit other complex movements or behaviors such as sorting clothes, without being aware of it.

During the episode of sleepwalking, it is not appropriate to try to wake the subject, but it is important to prevent him from getting hurt by moving him away from dangerous situations and objects. Sleepwalking can, in fact, cause injury if the individual loses balance or collides with other objects.


Sleepwalking is a sleep disorder codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), drawn up by the American Psychiatric Association as parasomnia.

Parasomnias can be classified according to the part of the sleep cycle during which they occur: Sleepwalking occurs during non-REM sleep (NREM), usually in stage 3 of the sleep cycle, also known as Deep sleep.

In practice, sleepwalking episodes normally occur when a person is in a deep sleep phase and partially wakes up, in a way that triggers an activity or behavior while remaining mostly asleep. Various factors influence the likelihood of this type of occurrence of partial awakening.

Night owl or sleepwalker?

Nightwalking is a term, now obsolete, used to indicate sleepwalking.

How common is sleepwalking?

Sleepwalking is more common in children (aged 2 to 13, with peak incidence between 10 and 13 years) than adults.

In children who sleepwalk, the episodes may be limited as they grow or may continue into adulthood. Although most cases begin in childhood, the condition can also begin in adulthood.

Factors Predisposing and/or Aggravating Sleepwalking

Sleepwalking is more likely to occur if a person:

  • Presents a family history of the condition: Studies have shown that some people have a genetic predisposition to sleepwalking and other NREM parasomnias. About 22% of children with parents with no history of sleepwalking will experience this condition. On the other hand, it has been highlighted that approximately 47% of children experience this parasomnia if a parent is sleepwalking;
  • She is sleep deprived: lack of nightly rest has been linked to a high risk of sleepwalking, potentially due to the increased time spent in deep sleep after a period of deprivation;
  • He is prone to repeated nocturnal awakenings.

What are Parasomnias?

Parasomnias are non-pathological sleep disturbances. This heterogeneous group of disorders is characterized by anomalous behaviors or unusual physiological events that occur while you sleep. In particular, parasomnias can occur: during falling asleep, near awakening or while sleeping. Parasomnias occur without particular alterations to the mechanisms or daily time cycles of sleep itself.

What are the causes of sleepwalking?

As anticipated, the sleep deprivation it’s a poor night sleep hygiene increase the likelihood of these episodes occurring.

Other causes that increase your chances of having a sleepwalking episode include:

  • Sound or light stimulations during sleep;
  • Irregular sleep-wake rhythms;
  • Fever;
  • Anxiety and emotional or physical stress (like pain);
  • Some drugs with sedative effect.

A key role is also played by genetic factors: the risk of experiencing the disorder is higher for people who have at least one first-degree relative with the same problem. Drink alcohol in the evening it can create instability in a person’s sleep phases and can increase the risk of sleepwalking. The presence of also favors the appearance of these episodes respiratory disorders (e.g. obstructive sleep apnea, restless legs syndrome) and some neurological diseases (e.g. encephalitis, brain lesions). Sometimes, however, the causes remain unknown.

Symptoms and Health Risks

What are the Symptoms of Sleepwalking?

During episodes of sleepwalking, the person usually demonstrates limited reactivity towards the surrounding environment and does not react to stimuli: despite the motor activity, the sleepwalker is, in reality, continuing to sleep. Night owls may also talk or make unintelligible sounds.

A key symptom of sleepwalking and other NREM parasomnias is that the person practically never has a memory of the episode when he wakes up. For this reason, they most often find out about their sleepwalking from a family member or roommate.

A another common element of NREM parasomnias is that they typically occur during the first third or half of the nightwhen a person tends to spend a greater percentage of time in stages of deep NREM sleep.

Behaviors and Movements of the Sleepwalker

Despite the term, sleepwalking is not limited to walking. The phenomenon involves, in fact, the realization of various types of simple or complex actions, while the person is still mostly asleep; are, for example, still under the specter of sleepwalking:

  • Routine actions, such as getting dressed;
  • Moving furniture;
  • Engaging in sexual behavior (sexsomnia, also called sexual somnambulism);
  • Urinating in inappropriate places.

Less often, the behaviors may be violent or more complex, including attempting to drive a car.

During these activities, the sleepwalker may have open, glassy eyes with a blank look on his or her face. Usually, sleepwalkers are minimally responsive or inconsistent in their speech.

Sleepwalking: How Long Does an Episode Last?

Sleepwalking episodes can last from a few seconds to half an hour, and most are over in less than 10 minutes.

At the conclusion, the sleepwalker:

  • can go back to bed and go back to sleep on his own;


  • may wake up confused, while still out of bed.

In view of the fact that sleepwalkers do not remember the episodes, it makes it difficult to accurately determine how often they occur.

Consequences of Sleepwalking

Accidents that occur during sleepwalking episodes can cause injuries or traumas if the individual loses balance, trips and falls or collides with other objects while walking or running. Sleepwalking is also associated with a significant worsening of sleep and to excessive daytime drowsiness. It is not yet known whether these problems arise due to actual disturbances due to parasomnia or whether there is an underlying factor that influences sleepwalkers’ rest and makes them at risk for both sleepwalking and daytime sleepiness.

Associated dangers

  • Mishandling sharp objects or attempting to drive a car during a sleepwalking episode can be life-threatening;
  • Violent behavior can cause harm to the sleepwalker or others;
  • Some actions during sleepwalking episodes can cause embarrassment: for example, a person may feel ashamed for sexually explicit behavior (in the case of sexsomnia), for aggressive outbursts, or for urinating in the wrong place.
Treatment and Remedies

How is sleepwalking treated?

Treatment of sleepwalking depends on the patient’s age, how often it occurs, and how dangerous or harmful the episodes are.

First, seeing a doctor to identify and address the most likely underlying cause is the best approach to creating a tailored treatment plan.

In many cases, sleepwalking does not require a specific therapeutic procedure, as the episodes are rare and pose few risks to those sleeping or those around them. Episodes often become less frequent with age, so for some people sleepwalking resolves spontaneously, without intervention.

However, when episodes are more frequent or intense, several approaches may be useful in managing the disorder:

  • Eliminate security risks: taking steps to reduce or avoid potential dangers to the sleepwalker is an important consideration. In this regard, it is indicated:
    • Remove objects that may be harmful or an obstacle if the sleepwalker gets up and walks around the rooms;
    • Make sure doors and windows are closed;
    • Make stairs inaccessible (for example, with a tightly closed gate at the top);
    • Keep sharp objects, such as cooking utensils, out of the sleepwalker’s reach;
    • Install lights with motion sensors;
    • If necessary, use alarm systems, capable of being activated if a person gets out of bed and starts walking around the room;
  • Treat the underlying causes: If a person’s sleepwalking is linked to an underlying disorder such as obstructive sleep apnea, treating that condition may resolve the sleepwalking. Likewise, if the use of sedatives or other medications contributes to sleepwalking, your doctor may recommend changing the dosage or switching to a different medication.
  • Early awakening: involves waking someone up just before a potential sleepwalking episode occurs; being, in fact, linked to a specific sleep phase, it often occurs at the same time of night. Waking the sleepwalker shortly before that time can prevent him from having partial awakening, capable of triggering the activities and behaviors typical of the disorder. This approach has been found to be useful and effective in many children, but has not been studied in depth in adult patients.
  • Improve sleep hygiene: This strategy refers to a person’s environment and sleep habits. Poor sleep hygiene, such as having an inconsistent nighttime sleep schedule or drinking caffeine or alcohol before bed, or having an uncomfortable mattress, can contribute to sleep disorders. Improving sleep hygiene encourages you to have more stable and reliable sleep, reducing the risk of sleep deprivation that can trigger sleepwalking.
  • Cognitive behavioral therapy: some psychotherapy protocols for managing stress and anxiety, in combination with the adoption of relaxation techniques, can help prevent episodes of sleepwalking related to stressful events; Cognitive behavioral psychotherapy has also proven effective in reformulating the rest model with improvement in the quality of sleep.
  • Medicines: When other treatments are not effective, you may consider using medicines to try to stop sleepwalking. Depending on each person’s specific situation, their doctor may recommend taking benzodiazepines and antidepressants, after evaluating the potential benefits and risks.

Is It Safe to Wake a Sleepwalker?

Most experts advise against awakening the sleepwalker in the middle of an episode: not being aware of the situation, the abrupt awakening can cause fear, confusion, anger or disorientation. Trying to forcibly wake the person suffering from sleepwalking could increase agitation and prolong the duration of the episode. If it is necessary to wake up a person who is walking in his sleep, it is possible to try to guide him away from potential dangers and facilitate his return to bed. To direct the sleepwalker, a calm and reassuring voice and, at most, a light touch can be useful, remembering to avoid jerks and sudden movements.

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