Symptoms and Signs of Sleepwalk (Somnambulism)

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 12/3/2021

Doctor's Notes on Sleepwalk (Somnambulism)

Sleepwalking is a disorder characterized by walking while asleep. There are four stages of sleep that makeup one sleep cycle. Stages 1, 2, and 3 are characterized as non-rapid eye movement (NREM) sleep. REM (rapid eye movement) sleep is the sleep cycle associated with dreaming as well as surges of important hormones essential for proper growth and metabolism. Each sleep cycle lasts about 90-100 minutes and repeats throughout the night. Sleepwalking typically occurs in stage 3 of the first or second sleep cycle. When a person is sleepwalking, their eyes are usually open but they may have a glassy-eyed, dazed look. Once awake, the sleepwalker has no memory of the behaviors.

Symptoms of sleepwalking include

  • episodes that range from quiet walking about the room to agitated running or attempts to "escape, " the eyes are usually open with a glassy,
  • staring appearance; if questioned,
  • responses are slow with simple thoughts,
  • contain non-sense phraseology, or are absent;
  • no memory of the sleepwalking event upon awakening.
  • In children, bedwetting may accompany sleepwalking behaviors. 

What Is the Treatment for Sleepwalking?

Treatment for sleepwalking includes medications, cognitive behavioral therapy, and improving sleep quality. In most mild or very occasional cases, no treatment is necessary. In fact, as people get older the frequency of sleepwalking tends to decrease.

Medications used to improve sleep are the mainstays of treatment for sleepwalking. These medications may include:

Patients should avoid things that may make sleep worse or falling asleep more difficult. Things to avoid that make REM sleep behavior disorder worse are:

  • Drinking alcohol 
  • Recreational drugs
  • Certain prescription medications 
    • Stimulants 
  • Exposure to blue light at night from devices such as cell phones, tablets, or e-readers 
  • Loud noises
  • Light exposure 
    • Make the bedroom as dark as possible

Set a strict and regular sleep schedule when possible.

Patients should also make sure the home and bedroom are kept as safe as possible to avoid injuries during sleepwalking. Steps to take to make things safer for sleepwalkers include:

  • No sharp objects in the bedroom
  • Door and window alarms
  • Avoid throwing rugs and clutter

Cognitive-behavioral therapy (CBT) has demonstrated effectiveness in improving sleep, often by reducing stress and reframing how a person thinks about sleep. 

While it is not harmful to wake up a person who is sleepwalking it can be startling and cause confusion or anger. If a sleepwalking person can be guided back to bed safely it is preferred to wake them up.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.