Largely genetically determined
“Somnambulism is a parasomnia where a person performs various actions during sleep – sitting up, walking, talking, or performing more complex actions, even though they are in a state of deep sleep. Most often, this occurs in the first half of the night, during deep sleep, and in the morning, the person usually remembers nothing,” says BENU pharmacist Laura Kairiūkštienė in a press release.
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According to Dalia Matačiūnienė, a neurologist at “Meliva” diagnostic and surgical clinics, somnambulism is largely genetically determined. “People who walk in their sleep have a genetically determined deeper than usual, hypersynchronized slow-wave sleep, and sudden awakenings from it, which can be spontaneous or caused by stress, noise, pain, or other illnesses, lead to partial awakening with certain motor activity,” explains the doctor.
Factors provoking episodes
According to L. Kairiūkštienė, somnambulism episodes can be provoked by various factors: lack of sleep, irregular sleep patterns, stress and anxiety, fever, alcohol consumption, sleep environment disturbances, or some other sleep disorders, such as sleep apnea.
“When investigating the causes of somnambulism, we always start with questions about sleep hygiene. Psychological factors are also important, and in adults, somnambulism can recur with weight gain or the onset of obstructive sleep apnea – drops in oxygen due to breathing pauses can provoke these episodes. This disorder is most accurately diagnosed by a polysomnographic study,” states D. Matačiūnienė.
According to the doctor, in atypical cases, diagnostic questions arise as to whether it is truly somnambulism – sleep hypermotor epilepsy seizures or metabolic automatisms can look similar. In such cases, a broader neurological examination is required.
Certain medications can also have an impact
“One of the most important risk factors is insufficient and irregular sleep,” says L. Kairiūkštienė. “Certain medications can also have an impact. For some people, the risk of somnambulism episodes can be increased by sleeping pills, some sedatives, certain antidepressants, and some medications for mental illnesses.”
According to the pharmacist, first-generation antihistamines that cause drowsiness, are used for allergies, or as sleeping aids, can also lead to unusual behavior during sleep in more sensitive individuals.
“If somnambulism episodes or other unusual sleep phenomena occur after starting a new medication, prescription drugs should not be discontinued arbitrarily – one should first consult a doctor or pharmacist,” advises L. Kairiūkštienė.
Can a sleepwalker be woken up?
There is a common myth that a sleepwalker should not be woken up, as they might get injured, fall, or become angry. According to D. Matačiūnienė, this is not entirely true: “The truth is that it’s usually better not to wake a sleepwalker, as it won’t be easy to do – it would be like waking someone in a very deep sleep. And if we were to wake them aggressively, loudly, by shouting, we could scare them badly and disturb their sleep even more. It is recommended to let the person lie down again and continue sleeping, or gently guide them back to bed.”
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The doctor adds that home safety is very important when living with a sleepwalker – doors should be locked, windows closed, and safety barriers installed near steep stairs, as this parasomnia is associated with a higher risk of injury.
When should one be concerned?
Somnambulism episodes most commonly occur in childhood, in children aged 4–8, who naturally sleep more deeply. According to D. Matačiūnienė, this parasomnia recedes for many during adolescence, but in up to 25% of cases, it continues into later age.
“Somnambulism is a sleep disorder, so we should not consider it a normal phenomenon. However, if episodes occur at a typical age, are rare, the child feels well during the day, and the behavior at night is not dangerous, there is no need to worry. Nevertheless, if episodes are not typical, recur frequently, and there are other health problems, I would highly recommend consulting a family doctor, who will most likely refer you for a neurological consultation,” says D. Matačiūnienė.
Sleep hygiene plays an important role
According to L. Kairiūkštienė, going to bed and waking up at the same time improves sleep quality, and adults should sleep 7–9 hours.
“It is also worth limiting caffeine in the afternoon, avoiding alcohol before bed, refraining from screens for at least an hour before bed, ensuring a cool, dark, and quiet bedroom, choosing a lighter dinner, exercising regularly during the day, but not intensely late in the evening,” advises the pharmacist.
If sleep disturbances persist for more than three months and recur at least three times a week, sleep hygiene alone is not enough.
“Also, one should not ignore significant daytime sleepiness, disruption of daily activities, risk of injury during somnambulism episodes, cessation of breathing during sleep, severe snoring, or other unusual behavior. In such cases, it is recommended to consult a family doctor or a sleep medicine specialist to determine the exact cause and, if necessary, prescribe appropriate treatment,” advises L. Kairiūkštienė.
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