Sleepwalking

What Causes Sleepwalking?

The exact cause of sleepwalking is unknown, but it is sometimes associated with medical conditions, stress, and other external situations.

Some potential risk factors for sleepwalking include:

• Lack of adequate sleep
• Bad sleep environment (e.g., an unfamiliar place or one that is too noisy or bright)
• Ongoing emotional stress or anxiety
• Digestive issues
• Sleep apnea
• Other sleep disorders
• Fever
• Alcohol use
• Sedative medications
• Migraines
• Restless legs syndrome

Is Sleepwalking Hereditary?

Research suggests that there is a strong genetic component to sleepwalking. The disorder often runs in families. When a parent has experienced sleepwalking, almost half the time, their children will also sleepwalk. If both parents are sleepwalkers, their children will also be sleepwalkers nearly two-thirds of the time.

Scientists have not yet identified a gene or genetic mutation definitely associated with sleepwalking. Likely, some people are genetically predisposed to experiencing the disorder, but some external environmental factor usually triggers the terrors.

How Is Sleepwalking Detected?

Sleepwalking, especially in children, may not require any intervention by a doctor, therapist, or sleep specialist. However, you should seek professional help if the episodes are severe. Warning signs that you should consult a doctor include:

• Episodes are frequent (e.g., two or more times a week or more than once a night).
• The sleepwalking behavior is dangerous or causes injury.
• Episodes lead to daytime sleepiness or cause any type of impairment.
• Episodes seem to be connected to a medical or psychological issue.
• Episodes continue after adolescence.
• Episodes begin in adulthood.

How Is Sleepwalking Diagnosed?

Doctors may take several different diagnostic steps when a patient is experiencing sleepwalking.

• Physical exam. A basic physical exam will screen for indications of medical conditions that could be causing the episodes.
• Blood tests. The doctor may order laboratory blood tests to rule out conditions, such as thyroid dysfunction, that may be causing the problems.
• Sleep diary. Your doctor may ask you to keep a log of your sleep over two weeks or so to look for patterns in your sleep behavior. You may also be asked to track other habits that could impact your sleep, such as your caffeine use.
• Sleep study. A study of your sleep patterns, which may be conducted at a sleep center, may be recommended if your doctor suspects a condition such as sleep apnea could be the cause of your sleepwalking.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Sleepwalking Treated?

Most cases of sleepwalking in children do not require treatment. Symptoms usually resolve on their own by adolescence. However, in adults and children with underlying sleep, medical, or mental health disorders, treatment of the underlying disorder may help relieve the symptoms of sleepwalking. Treatment may also be necessary if the episodes are frequent.

Parents and caregivers of people experiencing sleepwalking episodes can take steps to minimize the likelihood of episodes and prevent potentially harmful situations during them.

• Ensure the person is practicing good sleep hygiene, including keeping to a regular sleep schedule and maintaining a sleep space conducive to a good night’s sleep.
• Don’t attempt to wake a person during a sleepwalking episode. This may cause confusion, fear, or potentially harmful behavior.
• Make sure the bedroom is free of potential hazards, such as sharp-edged furniture.
• Stay with the person until the episode is over.
• In the case of frequent episodes, waking a person gently about 30 minutes before the time they most often sleepwalk may help prevent episodes.

In some cases that do not respond to other interventions, doctors may recommend medications such as sedatives or antidepressants.

How Does Sleepwalking Progress?

Sleepwalking usually does not have long-term complications. Children who sleepwalk typically grow out of it by late childhood, and studies have not found any consistent association between sleepwalking in children and subsequent mental health problems.

However, chronic sleepwalking and other sleep disturbances can lead to a wide variety of medical problems, quality-of-life complications, and mental health-related issues, including:

• Problems at work or school
• Relationship difficulties
• Accidents caused by sleepwalking, daytime fatigue, or mental fogginess
• Anxiety or depression

How Is Sleepwalking Prevented?

Good sleep habits and a healthy lifestyle can help prevent sleepwalking and other sleep disorders. Steps you can take to ensure better sleep include:

• Stick to a regular sleep schedule (even on weekends)
• Don’t eat or drink close to bedtime
• Avoid stimulating activities (e.g., watching TV, using electronics) 30 minutes before bedtime
• Use your bedroom only for sleep
• Keep your bedroom dark and cool
• Get plenty of exercise
• Limit consumption of caffeine and alcohol
• Quit smoking
• Don’t take naps
• Try meditation or relaxation techniques

Sleepwalking Caregiver Tips

Some people who sleepwalk also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with sleepwalking:

• Depression is more common in adults who sleepwalk.
• Anxiety disorders are also sometimes co-morbid with sleepwalking in adults.
• People with obsessive-compulsive disorder (OCD) or substance use disorders are at increased risk of sleepwalking.

Sleepwalking Brain Science

Sleepwalking usually occurs when a person is transitioning to deep sleep. Scientists believe that the episodes result from a mixed state in which parts of the brain are asleep and other parts are awake. In the case of sleepwalking, it’s possible that parts of the brain that control rational thought and memory, such as the neocortex and the hippocampus, are asleep, and the parts responsible for muscle movements and physical activity are awake.

The mixed-state theory would help explain why people generally don’t remember their sleepwalking episodes. During rapid eye movement (REM) sleep, the brain’s higher-level functions are more active, allowing for the creation of memories and vivid dream narratives. However, those parts of the brain are less active during the deep-sleep periods when sleepwalking episodes usually occur, resulting in the episodes leaving no lasting memory.

Sleepwalking Research

Title: Parents Advancing Toddler Health (PATH)

Stage: Recruiting

Principal investigator: Amanda R. Tarullo, PhD

Boston University

Boston, MA

Children living in poverty have a high incidence of early-developing sleep and behavior problems, which are often co-morbid. Early sleep and behavior problems are prevalent and persistent risk factors for lifelong poor mental and physical health outcomes. They may be key mechanisms underlying early and enduring socioeconomic health disparities. While effective interventions exist, low-income families have low enrollment and retention in these interventions. The stigma of treating behavior problems creates an additional barrier to treatment. This RCT aims to address these barriers to treatment for low-income children with co-morbid sleep and behavior problems. Sleep and behavior problems and family dysfunction transact across time, increasing in severity, while healthy sleep, positive child behaviors, and effective parenting can support each other across development. Thus we posit that intervention in one domain, either sleep or behavior, may improve outcomes both within and across domains.

Although early interventions can improve health equity in young children living in poverty, this promise often is not realized because of barriers to family engagement. The proposed study will target co-morbid behavior and sleep problems in early childhood, comparing child outcomes and family response to sleep and behavior interventions and investigating the novel strategy of letting families select their intervention. Five hundred low-income toddlers with co-morbid sleep and behavior problem are enrolled and randomized to 4 parent coaching interventions: sleep, behavior, family choice (sleep or behavior), and active control. At baseline and 1, 5, and 9 months post-intervention, researchers will assess the child’s sleep and behavior, and family functioning. Researchers will measure family preference, engagement, and perceived value of each intervention. The goals of the study are: (1) to examine the effects of evidence-based sleep and behavior interventions in young low-income children with co-morbid sleep and behavior problems on child sleep and behavior and family functioning; (2) to determine whether parents prefer, engage with, and value a sleep or behavior intervention more; and (3) to examine if giving families a choice of intervention results in higher engagement, higher perceived value and better family and child outcomes than assignment to intervention. By informing best practices for engaging low-income families to treat co-morbid sleep and behavior problems, results will be critical to reducing health disparities for children living in poverty.

Title: Feasibility Study of Personalized Trials to Improve Sleep Quality

Stage: Not Yet Recruiting

Principal investigator: Karina Davidson, PhD, MASc

Northwell Health

New Hyde Park, NY

This pilot study aims to assess the feasibility of using N-of-1 methods in a virtual research study of melatonin intervention for poor sleep quality. Participants (N=60) will be sent a Fitbit device and three smart pill bottles, with one containing 3 mg of melatonin, one containing 0.5 mg of melatonin, and the final bottle containing a placebo pill. The first two weeks will be a baseline period, where no supplement is assigned, but data are collected, including self-report of sleep quality and duration and accelerometer-derived sleep and activity data. After successfully completing the baseline period, participants will be randomized to six 2-week intervention blocks of a 3 mg dose of melatonin, a 0.5 mg dose of melatonin, and a placebo. At the end of the trial, participants will be asked to complete the System Usability Scale, a satisfaction survey (electronic or phone/video call if they are non-responders), and participate in a virtual interview (such as over Microsoft Teams or a phone call) to inform feasibility and acceptability of protocol requirements, study materials, and personalized reports.

Title: Telehealth Delivery of Treatment for Sleep Disturbances in Young Children With Autism Spectrum Disorder

Stage: Recruiting

Principal investigator: Cynthia Johnson, PhD

The Cleveland Clinic

Cleveland, OH

Ninety children with Autism Spectrum Disorder (ASD), between the ages of 2 to less than seven years, and their parents will be recruited for this ten-week randomized clinical trial. Participants will be randomized to five individually delivered sessions of Sleep Parent Training (SPT) or five individually delivered sessions of Sleep Parent Education (SPE). Delivery of the programs will be via a telehealth platform that includes parent-child coaching in real-time. In addition to baseline, outcome measures will be collected at week 5 (midpoint of trial) and week 10 (endpoint of trial), as well as follow-up at week 16, to determine the durability of the treatment.

This study will deliver an already initially tested manualized parent training program especially targeting bedtime and sleep disturbances, but delivered via a telehealth platform and enhancing the program using live parent coaching at bedtime. Utilizing REDCap automated survey invitations feature, investigators will provide reminders of the intervention recommendations and data collection requirements. In a randomized clinical trial of 90 children with ASD, ages 2 to less than seven years, a parent training program targeting sleep disturbance (Sleep Parent Training; SPT) will be compared to Sleep Parent Education (SPE). The investigators hypothesize that SPT will be superior in improving child sleep, child daytime functioning as well as parent well-being compared to SPE.