Sleepwalking – Diagnosis and Treatment
Diagnosis
Doctors use several steps to find out if a person has sleepwalking or a related sleep disorder, such as night terrors, REM sleep behavior disorder, or confusional arousals.
They begin by asking about the person’s sleep habits and experiences, often including a family member or sleep partner in the conversation.
Details about sleep talking, nightmares, and excessive daytime sleepiness are important. A family history of parasomnias or related conditions, such as insomnia disorder or restless legs syndrome, also plays a role.
Main Diagnostic Tools:
| Step | Description |
|---|---|
| Medical history review | Checks for a background of sleep disorders, diabetes mellitus, or cardiovascular disease. |
| Symptom discussion | Gathers details about sleep behavior from the patient and sleep partner. |
| Physical exam | Rules out conditions like panic attacks, seizures, or sleep paralysis. |
| Sleep study (polysomnography) | Monitors brain waves, heart rate, breathing, and movements during sleep. |
| Questionnaires | Assesses sleep behaviors, insomnia, and other symptoms. |
In certain cases, doctors recommend a sleep study called polysomnography. During this overnight test, sensors track the person’s brain waves, breathing, heart rate, oxygen levels, and movements of the legs and eyes.
Video recording can help capture sleepwalking events or related parasomnias like somniloquy or REM behavior disorder.
Doctors may also use actigraphy, which records movement and sleep patterns over several nights. This tool helps detect circadian rhythm disorders, sleep deprivation, delayed sleep phase syndrome, and hypersomnia.
By gathering all this information, doctors develop a clear picture of the sleep disorder and determine further treatment or management steps.
Treatment
Doctors often start treatment for sleepwalking, also known as somnambulism, by ensuring the person is safe.
In mild or rare cases, especially in children, they may not recommend treatment, since most children outgrow sleepwalking as they get older.
For people who need help, doctors may use different approaches:
- Addressing Health Problems: Treating underlying sleep disorders or medical issues, such as sleep apnea (which may involve continuous positive airway pressure, or CPAP), can help.
- Medication: Doctors sometimes prescribe benzodiazepines, certain antidepressants, or sedative-hypnotic agents for severe cases. In some instances, they may also recommend anticonvulsant or anxiolytic medications if other treatments do not work.
- Behavioral Approaches: Cognitive behavioral therapy (CBT) for insomnia and other therapy options like relaxation training may help lower stress and improve sleep.
- Special Techniques: Anticipatory awakenings involve gently waking someone right before they usually sleepwalk. Light therapy and self-hypnosis with a trained expert are other possible methods.
Doctors may recommend a combination of these options, depending on what causes the sleepwalking.
Everyday Habits and Simple Solutions
People living with sleepwalking can make life easier by making homes safer and following good sleep habits.
Remove risks from bedrooms and other areas. Lock doors and windows at night and secure sharp or fragile things so they are out of reach. Use bed rails or gates to prevent sleepwalkers from reaching stairs or unsafe spaces.
Place bells or alarms on doors to alert others if a person gets up in the night. For children, sleeping on the lowest bed or avoiding bunk beds lowers injury risk.
A calm bedtime routine supports better sleep health. Quiet activities like reading, gentle stretching, or enjoying a warm bath help relax the mind and body.
Sticking to a regular sleep schedule makes it easier for the body to rest. Setting a consistent bedtime and wake time, even on weekends, improves sleep quality.
Tips for improved sleep hygiene:
- Go to bed and wake up at the same times each day.
- Limit screen time before bed.
- Keep the bedroom dark, cool, and quiet.
- Avoid caffeine or heavy meals late in the day.
When emotional stress is a factor, talking about worries with a family member or a professional can help.
Managing stress and practicing relaxation techniques, such as deep breathing or meditation, can lower the chances of sleepwalking. For children, create a comforting bedtime environment and check in regularly for any concerns.
For some people, sleepwalking runs in families. If there is a hereditary link, take extra safety precautions. Avoiding alcohol is also recommended, as it can disturb sleep and increase the risk of sleepwalking events.
A simple sleep log or chart helps spot patterns. Noting when sleepwalking episodes happen can guide when to try waking the person a short time before the usual episode.
This step, called anticipatory awakening, can sometimes prevent sleepwalking.
| Safety Precautions | What to Do |
|---|---|
| Lock doors/windows | Prevents leaving the house. |
| Remove tripping hazards | Lowers injury risk. |
| Use door alarms | Alerts others to movement. |
| Lower/ground floor sleeping | Avoids stair accidents. |
Getting Ready for Your Visit
Steps to Take Before Your Appointment
To help your healthcare provider find the cause of your sleepwalking, prepare ahead of time. Keep a sleep diary for at least two weeks before your appointment.
Record:
- Bedtime and wake-up time
- Nighttime routines
- Sleep quality
- Anything unusual about your sleep
- Events that may have influenced your sleep (like stress, travel, or schedule changes)
- Medicines, vitamins, and supplements taken
- Any alcohol or caffeine consumed
Bring this record with you when you visit your healthcare provider. Having this information ready helps your provider spot patterns or possible causes of sleepwalking.
Make a list of symptoms you or your family have noticed, including those that seem unrelated to sleepwalking. Note any big changes or stress in your life. Write down all medications, supplements, or herbal remedies, along with their dosages.
Think of questions you want answered, such as:
| Example Questions |
|---|
| What might be causing these sleep problems? |
| Are tests needed to help with diagnosis? |
| Should I see a specialist? |
| Can you recommend resources for more info? |
| Are there treatment options to consider? |
Bringing a family member or friend may be helpful. They might remember or notice details about your sleepwalking that you are not aware of.
What Your Healthcare Provider May Cover
Your healthcare professional will likely ask detailed questions about your health history, family history, and specific sleepwalking episodes. Be ready to discuss:
- When the sleepwalking started
- Any past issues with sleep, either for you or your child
- Whether other family members have sleep disorders like sleepwalking or night terrors
- What happens during a typical episode (like where you end up or possible injuries)
- Signs of other sleep problems, such as loud snoring, breathing pauses during sleep, or feeling tired during the day
Your healthcare provider might refer you to a sleep specialist or ask you to complete more tests to better understand your situation.
If you provide clear and organized information, like your sleep diary and list of medications, your healthcare provider can make the best recommendations for you.
