Sleepwalking and Sleep Terrors

What Is It?

A person who is sleepwalking walks or makes other movements that seem purposeful. This occurs while in a state of partial wakefulness from deep sleep. Contrary to popular belief, sleepwalkers don't act out their dreams. Sleepwalking doesn't take place during the dreaming stage of sleep.

Sleepwalking is also called somnambulism. It is common in school-age children. Repeated sleepwalking is more common in boys. It is frequently associated with nighttime bedwetting.

Sleepwalking probably occurs because the brain's ability to regulate sleep/wake cycles is still immature. Most children outgrow the symptoms as their nervous systems develop. Sleepwalking that begins later in life or lasts into adulthood may have psychological causes. These include extreme stress or, rarely, medical causes such as epilepsy.

Sleep terrors are a disorder in which a person wakes up quickly in an extremely frightened state. Sleep terrors (also called night terrors) are related to sleepwalking. The disorder usually occurs in young children.

Sleepwalking and sleep terrors tend to run in families.

Symptoms

Sleepwalkers make purposeful movements while in a state of partial awakening from deep sleep. Some sleepwalkers simply sit up in bed and move their legs. Others carry out more complex tasks. These may include dressing and undressing, eating, or urinating.

Sleepwalking episodes usually occur 1 to 2 hours after going to sleep. They last from 1 to 30 minutes. A sleepwalker has open eyes and a blank expression. He or she is usually difficult, if not impossible, to awaken. The next morning, he or she won't remember the episode.

In sleep terrors, a child suddenly sits up in bed 1 or 2 hours after falling asleep. During the sleep terror, the child:

• Exhibits intense fear or agitation

• May thrash out violently

• Is not aware of his or her surroundings

• May be breathing fast and/or have a rapid heart rate

• May be sweating

• May scream or cry out that others are in the room

• Cannot be comforted or awakened

A sleep terror episode may last for 10 to 20 minutes. As the disturbance subsides, the child returns to deep sleep. When the child wakes up in the morning, he or she cannot recall the sleep terrors.

Sleep terrors are different from nightmares. Nightmares are frightening dreams that often can be recalled the next morning in vivid detail.

Diagnosis

A person's history usually provides enough information for a doctor to diagnose sleepwalking. This is particularly true in children.

More difficult cases may require a consultation with a sleep specialist. The specialist may recommend an overnight sleep test called polysomnography. During this test, various body functions are recorded while the person is sleeping. In rare cases, a brainwave recording may be ordered to rule out seizures.

Expected Duration

Children usually stop sleepwalking during adolescence. Sleepwalking continues beyond puberty in a small percentage of people.

Sleep terrors are most common between the ages of 1 and 8. However, they may begin as early as 6 months and occasionally last into adulthood.

Prevention

Children are more likely to sleepwalk or experience sleep terrors when they are overtired or anxious. Provide a relaxing bedtime routine for your child. Follow it up with an early bedtime to help prevent sleep disturbances.

Avoid sleepwalking injuries by making the bedroom and house as safe as possible. Consider the following precautions:

• Don't let the child sleep in a bunk bed.

• Make sure there are no sharp or breakable objects near the bed.

• Install gates on stairways.

• Lock doors and windows.

Treatment

Usually, treatment is not necessary. Most episodes of sleepwalking or sleep terrors go away on their own. Focus on keeping the sleepwalking child safe.

To help a sleepwalking child return to normal sleep, gently lead the child back to bed. During an episode of sleep terrors, offer reassurance with repeated, soothing statements such as, "You are safe. You are home in your own bed." You don't need to wake the child. You may not even be able to.

A technique called prompted awakenings may help to prevent future episodes in children with frequent sleepwalking or night terrors. For several nights, record the length of time between when the child falls asleep and the sleepwalking or night terrors begin. Then for seven nights in a row, awaken the child 15 minutes before the expected time of the episode. Tell the child at bedtime that you will try to wake him or her quickly. Keep the child fully awake for 5 minutes.

If psychological stress contributes to disordered sleep, counseling may help. Both children and adults may benefit from hypnosis or biofeedback.

In some cases, a doctor may prescribe short-acting sleep or antianxiety medications to reduce or eliminate episodes.

When To Call a Professional

Seek professional help if:

• Episodes are frequent or severe.

• The sleepwalker gets injured during episodes.

• The sleepwalker leaves the house.

• Episodes last beyond puberty.

• Nighttime episodes are accompanied by daytime sleepiness.

• Stress, anxiety or other psychological factors may be contributing to sleep disturbances.

Prognosis

Sleepwalkers occasionally injure themselves or others. But most episodes of sleepwalking and sleep terrors are brief and harmless. Episodes tend to stop before adulthood.

External resources

American Academy of Sleep Medicine
One Westbrook Corporate Center
Suite 920
Westchester, IL 60154
Phone: 708-492-0930
Fax: 708-492-0943
http://www.aasmnet.org/

Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a health professional. Use of this content is subject to specific Terms of Use & Medical Disclaimers.