May 9, 2023 – Is there a link between sleepwalking and the sleep disorder insomnia?
Sleepwalking, also called somnambulism, affects approximately 4% of the U.S. population on a regular basis – although many more people may not be aware they do it. (Sleepwalking is classified as a parasomnia, or abnormal behavior while you’re asleep.)
Sleepwalking can happen when you are briefly aroused from non-rapid eye movement sleep, which is a deeply restful stage that helps restore body tissue and repair important body functions.
“The non-rapid eye movement stage is approximately 80% of sleep in adults,” said Kenneth Lee, MD, an assistant professor of neurology and sleep medicine and clinical medical director at the UChicago Medicine Sleep Center. “Generally speaking, sleepwalking occurs when you are no longer fully asleep, but also not fully awake – you’re in a limbo between the two states. In addition, things that increase the number of times your brain wakes up puts you at risk for episodes of sleepwalking, if you happen to be prone to them, including sleep apnea and leg movements.”
If you sleepwalk, it usually happens during the first third of the night, and you won’t be able to think, plan, or function properly. You won’t know where you are. Even though you’re moving around in a dreamlike state, you won’t be able to remember any dreams you actually have while sleepwalking.
Many doctors believe that a lack of sleep is a major cause of sleepwalking. If you have insomnia, it's hard for your brain and body to pass between sleep stages; when you do get to sleep, you may not settle into deep enough sleep, and your brain can get "tricked" into thinking your body should be active.
But what is the exact link between insomnia and sleepwalking? Can you retrain your brain into a restful sleep pattern? Here’s what to know.
What Are the Risk Factors for Sleepwalking?
Children are more likely to sleepwalk, because as you get older, you have less non-rapid eye movement sleep. But sleepwalking can sometimes continue into adulthood, said Reza Radmand, DMD, a diplomate of the American Board of Dental Sleep Medicine and fellow of the American Academy of Oral Medicine.
“Adult onset sleepwalking is rare, and is usually associated with certain medications such benzodiazepines and antidepressants. Psychological trauma could also be a contributing factor to episodes of sleepwalking," said Radmand, who is also a lecturer and research collaborator in sleep medicine at Brigham and Women’s Hospital in Boston and Harvard Medical School.
Sleepwalking can run in families, especially if one of both of your parents have done it. Other potential risk factors include:
- Drinking alcohol
- Having gastroesophageal reflux disease (GERD)
- Having a fever
- Being stressed
- Having a seizure disorder
“Our mental state also has an impact on sleep quality,” said Jordan Standlee, MD, a neurologist at University of Michigan Health and a clinical assistant professor of neurology at University of Michigan Medical School in Ann Arbor.
“During periods of high situational stress, our brains have a more active fight-or-flight signal, and this often carries over into the sleep period, where our brains have a harder time achieving deep, relaxed, stable sleep. Many people who sleepwalk will report that it happens more often during periods when they are especially stressed or worried," he said.
What Are the Symptoms of Sleepwalking?
According to Penn Medicine, signs of sleepwalking include:
- Walking during sleep
- Having your eyes open with a blank look on your face
- Talking, but what you say doesn’t make sense
- Acting confused or aggressive if someone wakes you up
- Appearing awake to others
- Sitting up or engaging in activities as though you were awake
- Not remembering anything that happened when you wake up
Does Insomnia Cause Sleepwalking?
While insomnia on its own doesn't directly cause sleepwalking, there at least four major ways in which the two conditions interact, said Standlee.
Those ways are:
- A disruptive sleep environment
- Periods of "situational stress"
- Sleep apnea
- Medication effects
"Sleepwalking has strong genetic factors, meaning some people are inherently more at risk for this symptom. It tends to arise not from deep, stable sleep, but rather from disrupted and twilight sleep. Sleepwalking also occurs more when someone is sleeping in a foreign environment, like in a hotel room, or in the setting of sleep deprivation," he said. "Again, this is likely because during those scenarios, at night their sleep is less stable and more time is spent in a transitional sleep state.”
And distractions in your sleeping environment can make things worse.
“Noise or light in the room can cause both insomnia and sleepwalking, particularly having a television on in the bedroom throughout the night,” Standlee said. “It is hard for the brain to stay in deep, stable sleep while this kind of light or noise is present, and the result can be either recurrent full awakenings – insomnia – or partial awakenings, which predispose you to sleepwalking.”
Another concern: Trying to treat insomnia could actually bring on a sleepwalking episode.
“Some of the common medications used to treat insomnia can themselves cause sleepwalking,” Standlee said. “Sedating medications such as zolpidem, eszopiclone, zaleplon, suvorexant, lemborexant, and daridorexant have all been described to cause complex sleep behaviors, meaning sleepwalking, as well as other sleep activities such as cooking and eating food, making phone calls, and driving while asleep.”
What Is the Right Way to Treat Insomnia, and Solve Your Sleepwalking?
First of all, talk to your doctor.
“If you know you’ve had a sleepwalking episode, then a sleep study needs to happen,” said Andrea Matsumura, MD, a sleep medicine specialist in Portland, OR. “You also need to take safety measures – for example, if you live in a two-story home, you want to put up a barrier to your stairs, and lock your windows.”
You can also discuss problems falling and staying asleep with a psychologist.
“The best course of treatment is cognitive behavioral therapy for severe insomnia,” said Lee. “This is a way to retrain your brain and body how to sleep again. Making sure that insomnia is addressed and sleep is consolidated will reduce risk of sleepwalking.”
Good sleep hygiene should also be a nightly ritual.
“Don’t eat or exercise close to going to sleep, and stop drinking caffeine for 6 hours beforehand,” said Matsumura.
Yoga, meditation, and deep breathing can also help. Focusing on being kind to your mind and body can help you rest a lot easier.