Sleepwalking: Causes, Risks, and Management in Australia

In the quiet darkness of night, a figure rises from bed and begins to wander. Eyes open but unseeing, movements ranging from simple to complex, yet with no awareness or memory of these nocturnal journeys. This is sleepwalking – a fascinating yet potentially concerning sleep disorder that affects Australians of all ages, from children in Brisbane to adults in Ararat, Victoria.

What is Sleepwalking and How Common is it in Australia?

Sleepwalking, or somnambulism, is a sleep disorder classified as a parasomnia – abnormal behaviours that occur during sleep. During a sleepwalking episode, a person appears awake as they move about, yet remains in a state of deep sleep. These episodes typically occur during non-REM sleep, specifically during the slow-wave sleep stage that dominates the first third of the night.

Research indicates that sleepwalking affects approximately 2.9% of Australian adolescents, aligning with global statistics that show a lifetime prevalence of about 6.9% in the general population. The condition is more common in children, affecting up to 5% of young Australians, compared to about 1.5% of adults. This age-related pattern suggests that many children outgrow sleepwalking as their nervous systems mature.

A notable University of South Australia study revealed that sleep issues, including parasomnias like sleepwalking, affect a significant portion of Australian youth. These findings highlight that sleepwalking is not an isolated concern but part of a broader spectrum of sleep-related challenges facing Australians.

What Causes Sleepwalking?

The causes of sleepwalking are multifaceted, involving a complex interplay of genetic, environmental, and medical factors. Understanding these underlying mechanisms helps to develop targeted management strategies.

Genetic Factors

Strong evidence supports a genetic component to sleepwalking. If one parent has a history of sleepwalking, their children have a 45% chance of developing the condition. This risk increases dramatically to about 60% if both parents were sleepwalkers. These striking statistics demonstrate that sleepwalking runs in families, suggesting specific genetic markers may predispose individuals to this sleep disorder.

Environmental Triggers

Several environmental factors can trigger sleepwalking episodes in susceptible individuals:

• Sleep deprivation: When the body lacks adequate rest, it attempts to compensate by spending more time in deep sleep, increasing the likelihood of sleepwalking episodes.
• Stress and anxiety: Psychological stress can disrupt normal sleep architecture, potentially triggering parasomnias like sleepwalking. Many Australians report increased sleepwalking during periods of significant life stress.
• Irregular sleep schedules: Shift work, jet lag, or inconsistent bedtimes can disrupt the body’s internal clock, potentially increasing sleepwalking risk.
• Sleep environment: Unfamiliar surroundings, excessive noise, or uncomfortable sleeping conditions may contribute to sleep disruption and subsequent sleepwalking.

Medical and Pharmacological Causes

Several medical conditions and medications can either cause or exacerbate sleepwalking:

• Fever: Particularly in children, elevated body temperature can trigger sleepwalking episodes.
• Sleep disorders: Conditions like obstructive sleep apnoea (OSA) that cause sleep fragmentation may increase sleepwalking risk.
• Neurological conditions: Certain brain disorders can disrupt normal sleep-wake cycles.
• Medications: Some substances can induce sleepwalking as a side effect, including:
• Zolpidem and other sedative-hypnotics
• Some antidepressants
• Certain antihistamines
• Lithium
• Alcohol consumption: Alcohol can fragment sleep and may trigger sleepwalking in predisposed individuals.

What Are the Risks and Complications of Sleepwalking?

While many consider sleepwalking merely an unusual curiosity, it can pose significant risks to the sleepwalker’s physical safety and psychological wellbeing.

Physical Risks

The most immediate concern with sleepwalking is the potential for physical injury. Sleepwalkers may:

• Fall down stairs or from windows
• Walk into furniture or walls
• Wander outdoors into potentially dangerous situations
• Operate appliances unsafely
• Drive vehicles (in rare cases)

These risks are heightened because sleepwalkers lack conscious awareness of their surroundings and have impaired judgment during episodes. Their movements may appear coordinated, but without the protective vigilance of wakefulness, the potential for accidents increases substantially.

Sleep Quality and Daytime Functioning

Sleepwalking disrupts the normal sleep cycle, potentially leading to:

• Insufficient restorative sleep
• Daytime fatigue and drowsiness
• Impaired concentration and cognitive function
• Reduced academic or work performance
• Increased irritability and mood disturbances

Even when sleepwalkers don’t recall their episodes, the disruption to their sleep architecture can affect their daytime functioning and overall quality of life.

Psychological Impact

The psychological effects of sleepwalking shouldn’t be underestimated:

• Embarrassment and social anxiety about potential episodes
• Stress about sleeping away from home
• Concern about performing inappropriate or dangerous actions while sleepwalking
• Relationship strain if a bed partner’s sleep is repeatedly disrupted
• Fear of the condition being misunderstood or stigmatised

For Australians living with sleepwalking, these psychological burdens can be as challenging as the physical risks, particularly for adults who may feel greater social pressure regarding their condition.

How is Sleepwalking Diagnosed?

Accurate diagnosis is essential for developing an effective management plan for sleepwalking. The diagnostic process typically involves several components:

Clinical Assessment

A thorough clinical evaluation forms the foundation of diagnosis. This typically includes:

• Detailed sleep history, including typical sleep patterns and behaviours
• Documentation of sleepwalking episodes (frequency, duration, behaviours)
• Family history of sleep disorders
• Medical history and current medications
• Psychological assessment for stress, anxiety, or other mental health concerns

Healthcare providers may ask family members to keep a sleep diary or even record episodes (when safe and appropriate) to better understand the nature of the behaviours.

Sleep Studies

In some cases, especially when the diagnosis is unclear or other sleep disorders are suspected, formal sleep studies may be recommended:

Polysomnography (PSG): This overnight test conducted in a sleep laboratory measures brain waves, eye movements, muscle activity, heart rhythm, breathing patterns, and other physiological parameters during sleep. While sleepwalking episodes may not occur during a single night of observation, PSG can identify other sleep disorders that might trigger sleepwalking.

Home sleep studies: These simplified versions of PSG allow monitoring in a person’s normal sleep environment, potentially capturing more typical sleep patterns.

Differential Diagnosis

Healthcare providers must distinguish sleepwalking from other conditions with similar presentations:

• Sleep terrors (night terrors)
• REM sleep behaviour disorder
• Nocturnal seizures
• Sleep-related eating disorder
• Psychological dissociative states

The timing of episodes (typically early in the night for sleepwalking), characteristics of the behaviour, and physiological measurements help differentiate these conditions.

What Are the Most Effective Sleepwalking Management Strategies?

Management of sleepwalking focuses primarily on ensuring safety and addressing underlying triggers. The approach should be tailored to the individual’s specific circumstances and the severity of their condition.

Safety Measures

The first priority is creating a safe sleep environment:

• Remove tripping hazards from bedrooms and hallways
• Secure windows and doors with alarms or specialized locks
• Store dangerous items (knives, tools, car keys) securely
• Consider sleeping on the ground floor if possible
• Use motion sensors or bed alarms to alert family members
• Install gates at stairways for children who sleepwalk

These practical measures significantly reduce the risk of injury during sleepwalking episodes.

Lifestyle Modifications

Several lifestyle adjustments can help reduce sleepwalking frequency:

• Maintain a consistent sleep schedule
• Ensure adequate sleep duration (7-9 hours for adults, more for children)
• Practice good sleep hygiene (comfortable bedroom, limited screen time before bed)
• Manage stress through relaxation techniques, mindfulness, or counselling
• Limit alcohol consumption
• Avoid sleep deprivation
• Exercise regularly, but not close to bedtime

Behavioural Interventions

Evidence-based behavioural approaches include:

Scheduled awakenings: This technique involves waking the sleepwalker approximately 15-30 minutes before their typical episode time for several nights. Research shows this can reduce episode frequency, particularly in children.

Relaxation techniques: Progressive muscle relaxation, deep breathing, and meditation before bedtime may help improve sleep quality and reduce sleepwalking episodes.

Cognitive-behavioural therapy (CBT): While not specifically developed for sleepwalking, CBT techniques that address sleep anxiety and improve sleep quality may benefit some individuals.

Medical Interventions

When sleepwalking is severe, dangerous, or resistant to behavioural management, medical interventions may be considered:

Treatment of underlying conditions: Addressing sleep apnoea, restless legs syndrome, or other sleep disorders that fragment sleep can reduce sleepwalking episodes.

Medication: In selected cases, healthcare providers may prescribe medications such as:

• Benzodiazepines (e.g., clonazepam)
• Antidepressants
• Melatonin
• Anticonvulsants

These medications are typically used short-term or intermittently, particularly in adults with severe or potentially dangerous sleepwalking.

Management Approach	Benefits	Considerations	Best For
Safety Measures	Prevents injuries, immediate protection	Doesn’t address underlying causes	All sleepwalkers
Scheduled Awakenings	Research-supported, non-pharmacological	Requires consistent implementation	Children, predictable episodes
Sleep Hygiene & Stress Management	Addresses common triggers, improves overall health	Results may take time	Mild to moderate cases
CBT & Relaxation Techniques	Improves overall sleep quality	May require professional guidance	Adults, stress-related cases
Medication	Rapid effect for severe cases	Potential side effects, typically short-term use	Dangerous sleepwalking, adults

Supporting Someone Who Sleepwalks

Understanding how to respond during a sleepwalking episode is crucial:

• Do not attempt to forcefully wake the person
• Gently guide them back to bed with calm, quiet directions
• Remove obstacles from their path
• Stay with them until they return to bed
• Speak in a soft, reassuring voice if communication is necessary

For parents of children who sleepwalk, maintaining a consistent, calming bedtime routine and addressing any anxiety issues can help reduce episodes.

Finding Support for Sleepwalking in Australia

While most cases of sleepwalking resolve without intensive intervention, particularly in children, persistent or dangerous sleepwalking warrants professional attention. In Australia, several pathways exist for those seeking support:

General practitioners serve as an excellent first point of contact, offering initial assessment and referrals to specialists when needed. Sleep specialists, including sleep physicians and psychologists specialising in sleep disorders, provide comprehensive evaluation and management plans.

Mental health professionals can address any psychological factors contributing to sleepwalking, such as stress or anxiety. The Sleep Health Foundation of Australia offers valuable resources and information for those affected by sleep disorders, including sleepwalking.

For individuals with disabilities, including those experiencing sleepwalking, the National Disability Insurance Scheme (NDIS) may provide funding for specialised sleep products, environmental modifications, or professional support services to ensure safety and wellbeing.

Telehealth consultations have become increasingly available across Australia, making specialist support accessible even to those in remote areas. This approach allows for professional guidance without the need to travel long distances for appointments.