Walking in Your Sleep and Other Unusual Sleep Behaviors: A Review of Parasomnias

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Author:

Neil Kavey, MD

Columbia-Presbyterian Medical Center

Medically Reviewed On: March 31, 2006

Few medical disorders arouse as much interest as parasomnias. Parasomnias are sleep disorders in which we see a variety of behaviors that we do not think of as occurring in sleep. Walking, talking, shouting, screaming, eating, flailing about are behaviors we associate with wakefulness. When we see them occurring in someone who is asleep, we are witnessing a parasomnia.

Somnambulism (Sleepwalking)

Somnambulism is the Latin term for sleepwalking. A wide variety of behaviors have been described. Sometimes the behavior can be vigorous and complex, such as moving quickly down the stairs and opening the front door. Other times it is less dramatic and may not even include actually getting out of the bed (lifting up the covers and calmly checking what is underneath or checking out the contents of the night table drawer). Contrary to the popular image, the sleepwalker does not have his/her eyes closed with arms out-lifted. Their eyes are open and they do not necessarily move around like a zombi. They can move quite smoothly as they negotiate stairs and open windows. On the other hand, their level of coordination is unpredictable so that while they could easily walk down the stairs one night, they could fall down the stairs and injure themselves the next.


Their degree of awareness of the environment is also variable. A sleepwalker might move about seemingly with no recognition of the environment or anyone in it. Alternatively, he/she might recognize a partner in the bedroom or see strange people and creatures as well. A patient might awaken in another room with different clothes on and have no sense of how he got there. One of my patients awoke her husband and asked for help as she tried to pick up the fish from the aquarium off the curtains and put them back into the water.

Most often, subjects have little or no memory of what went on in the night during their sleepwalking. They might see evidence of their having moved about or someone might tell them of their activity.

Sleepwalking is very common in children and may be a result of the rapid growth and development of the brain. Usually the behavior stops by the onset of adolescence, but it can continue into the 20's, 30's and even 40's. Some sleepwalkers first start this behavior in their teens or early 20s. Stress can increase the incidence of the sleepwalking episodes but is not the cause. The disorder runs in families and is likely genetically based.

Contrary to the common belief that sleepwalkers are acting out their dreams, sleepwalking does not occur during REM sleep, which is when we typically dream. It actually occurs when we are in the deepest stages of sleep, stages 3 and 4. The behavior occurs in a state between deep sleep and wakefulness and the disorder has been classified as a "disorder of arousal." The subject seems to have been aroused and then stuck in an in-between state.


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