There are different kinds of sleepwalking but the most common one and the one that is often inherited and that many children suffer from occurs in deep sleep (as many as 20% of children may have this - this usually peaks around age 12 - though some 4% of adults will continue to sleepwalk). Associated with sleepwalking are Night Terrors (inconsolable screaming) and Confusional Arousals (violent reactions to awakening after about an hour's sleep). Sleepwalking is associated with deep sleep and children have more deep sleep than adults so, probably, a combination of the brain maturing and with less deep sleep the occurrence of these behaviours goes down. With this type of sleepwalking there are rarely any memories of the 'walk.'
It is know that various factors can promote a sleepwalking episode, though not necessarily every time. The reason why is virtually known:
- Possibly by making the brain more ready to react to something.
- Sleep deprivation - or disturbed sleep
- Sleep deprivation or partial deprivation is likely to subsequently increase deep sleep. Disturbed sleep can also lead to increased deep sleep or the brain may be more reactive.
- Fever is associated with an increase in deep sleep (the factors associated with an immune system response also stimulate the production of deep sleep).
- Some medicines (zolpidem, zopiclone, and a host of other psychoactive medications)
- There are various reasons suggested. For the sleeping pills like zolpidem and zopiclone it may be putting parts of the brain to sleep before the whole brain is ready and keeping those parts asleep even when the unwanted behaviour begins.
- Alcohol (don't use 'Granny's cure to help you sleep)
- This is a complicated, controversial and disputed area. Most recent work shows increases in deep sleep and also disrupted sleep (young healthy adults with a family history of alcoholism).
Some sleep disorders are known to trigger episodes, such as Obstructive Sleep Apnoea (stopping breathing or shallow breathing during sleep) or Periodic Limb Movement (twitching legs, possibly arms). Treatment of these disorders can reduce the incidence of sleepwalking. However, initially when there might be an increase in deep sleep (with CPAP treatment) the incidence may go up for a night or two. Most sufferers don't want to take medication long-term if they only suffer from the occasional episode so the advice below, which generally helps sleep, and is useful to reduce the incidence of sleepwalking is worth following. (It is difficult to give general advice on what medications help as there is little formal research in the area, and the evidence base is poor. Clonazepam is often used, though short sub-therapeutic courses of SSRI antidepressants have also been found to work; the area needs considerably more research).
Episodes can also be triggered by noises, restless partners, hunger, need to go to the loo just about anything that for normal sleepers just causes a momentary disruption of their sleep but sets a sleepwalker off.
Regularity of routine
Sounds boring but is tremendously helpful. Sleep is controlled not only by a 'pressure for sleep' caused by wakefulness but also by the brain's 24h biological clock. That clock and in fact most cells in the body likes regularity - going to bed at roughly the same time every night and getting up at roughly the same time (roughly = 15-30 minutes). If you can't manage both try to fix one - like the time you get up in the morning. Fixing the time you get up often makes the time you fall asleep more regular.
Eating times, activity, everything roughly scheduled helps.
Before the biological clock evolved all organisms had a basic Rest-Activity cycle. It probably arose because we live in a world that cycles between light and dark, day and night and organisms (bacteria, plants, etc) do not operate efficiently 24h a day but have evolved to cope with variations that are imposed by the light/dark cycle. 'Activity' is partly controlled by the clock so sleepwalking can be partly triggered by the 'clock' still being set on 'activity' as opposed to 'rest.'
It's been discovered that there are genes that control 'Morningness' (larks) and 'Eveningness' (owls). So, these traits are inherited and are difficult to change - if you regularly find yourself sleepy at 9pm (21.00) and wake up at 4.30am bright as a lark (?) then it's going to be very difficult to change that trait. Similarly if you're an 'owl' (staying up late and getting up late). Children and adolescents though tend to go through a phase of being 'owls' - that can be helped by reinforcing wind-down routines, reducing over stimulation, and bright light in the morning (possibly another page on this site).
Get enough sleep
How much sleep do you need? Enough to feel rested and to manage the day without feeling excessively sleepy or tired. Sleep duration is partly inherited, if you're a successful short sleeper then don't worry about sleeping 5-6 hours a day there are lots like you. Need 9 hours sleep? Well, you have my sympathy, many society's aren't tuned to the 9-10 hour sleeper. If you can get it don't worry about it. If you can't get it - I'll have to write a generic sleep note some time!
Sleeping environment (external)
Comfortable bed (the Sleep Council offers a lot of advice, including an online questionnaire that enables you to choose the right bed for you and links to the National Bed Federations's product finder).
Minimise noise (use ear plugs if necessary; send snorers to a sleep centre, etc)
A cool room is best for sleep, though it should be warm and comfy at the beginning of the night (or have a bath to open up the blood vessels of hands, face and feet, if you have trouble falling asleep in a room which is always cool). Temperature preferences between partners is tricky - this page won't help you work it out (maybe another page).
Sleeping environment (internal - i.e. you)
- Nicotine (stop), caffeine (restrict intake)
- Alcohol - The effects are complex and depend on many factors including
- how much has been drunk
- when it was drunk in relation to sleep
- how much is usually drunk
- whether the person has never drunk before, is a habitual drinker, is an alcoholic or is an abstinent alcoholic
- Sleeping pills - avoid (particularly zolpidem and zopiclone)
- Other medications - sodium oxybate, antidepressants
- Don't go to bed hungry nor eat a large meal 2 hours before bed
- Avoid naps during the day
- And EXERCISE - but not immediately before sleep (sweat-inducing, 30 minutes, 3-5 days / week)
Protect yourself and others
- Try to ensure that you are safe where you sleep.
- Consider an infra-red alarm by your bed that goes off if you start walking. Or fit an alarm on the bedroom door. It has been suggested actually leaving a note on the door saying 'get back to bed'.
- Get a rush mat or something for your bedside carpet and go to bed with the thought that if you're feet touch the mat and return to bed.
- If you have a partner get them to hide your car keys, and anything dangerous that you might pick up on a nightly wander.
Stepanski and Wyatt, 2003, Sleep Med Rev, 7, 215-25 (Sleep hygiene in insomnia)
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