Do you find yourself waking up in strange places, or really tired in the mornings after a seemingly good night sleep? You could be one of the 3% of adults in the UK that sleepwalk. Our resident sleep expert, Christabel Majendie, explores sleep disorders in more detail.

In my household there is a sleepwalker and a sleep talker. Since these behaviours happen only occasionally, I have no cause for concern and we can laugh about it the following morning. However, for people experiencing more frequent sleepwalking or sleep talking, these behaviours can be problematic, disrupting the individual’s sleep and that of other family members and, in some cases, even putting people at risk.

Both sleepwalking and sleep talking are classified as sleep disorders, falling into a category called parasomnia, which also includes other abnormal behaviours occurring during sleep such as teeth grinding, night terrors, or sleep-related eating disorders.

Sleepwalking

Sleepwalking has been described as a dissociation between body sleep and mind sleep. Since it occurs during deep sleep, sleepwalking is much more common in young children as they experience a greater amount of deep sleep compared to adults. We have more deep sleep in the first part of the night so sleepwalking tends to occur at this time. Prevalence of sleepwalking in children aged 4-12 years old is estimated at around 15-20% with this dropping to 2-3% in adulthood. Sleepwalking may involve simply sitting up in bed or more complex behaviours such as eating, dressing, walking up and down stairs, urinating in inappropriate places such as cupboards, or even driving. The person does not often remember sleepwalking or may have a patchy memory of the event.

Sleep talking

Sleep talking may be simple mumbling or nonsensical words or it may be complicated, coherent conversation. The former is more common during deep sleep while more understandable talking tends to occur in the latter part of the night where there is a greater proportion of light sleep. It might be triggered by someone else talking to an individual while they are asleep or may be entirely spontaneous. Sleep talking often occurs in the presence of other sleep disorders, particularly other parasomnias such as sleepwalking and night terrors. What is actually said during sleep talking episodes is often entirely random but it can be related to real events in the individual’s life. However, it is not admissible in a court of law as it occurs outside conscious awareness.

Causes

Although the exact cause is not clear, there does seem to be a genetic tendency with sleepwalking and sleep talking running in families. Certain situations seem to act as triggers. These include a build-up of sleep deprivation or feelings of stress or anxiety, an infection, recreational drug use, alcohol and certain medications. In addition, sleepwalking may be triggered by ‘waking’ abruptly from deep sleep with urges to go to the bathroom or being ‘woken’ by sudden noises or touch. Another trigger can be other sleep disorders such as restless-legs syndrome or sleep-disordered breathing as these can cause sudden ‘waking’ from deep sleep. Sleepwalking is also associated with certain medical conditions such as reflux or epilepsy. Treating the related sleep disorder or medical condition can sometimes resolve the problem. In one study, which found a relationship between sleep disordered breathing and sleepwalking in children, surgery of the enlarged tonsils or adenoids to treat the sleep disordered breathing led to a disappearance of the sleepwalking.

Managing sleepwalking

Most of the time, gently taking an individual back to bed is the best course of action. However, the idea that you shouldn’t wake a sleepwalker is actually a myth. While you definitely shouldn’t startle them, shout at them or try to restrain them, sometimes gently waking an individual can stop another episode of sleepwalking happening in the same sleep cycle. If woken, the person may appear confused.

Although a common misconception, sleepwalkers do not walk with their arms outstretched. They normally are able to move around, avoiding familiar objects and will have their eyes open but with a glassy stare. If sleepwalking occurs regularly, it is advisable to clear obstacles such as toys or other objects, particularly harmful or sharp items. It may also be worth putting up stair gates and locking doors and windows. Definitely avoid the top of bunk beds.

Most children grow out of sleepwalking and treatment is rarely needed. Occasional occurrences in adulthood are also not a concern. If it is something that occurs regularly or if there is any risk of injury, it is worth speaking to your doctor about a referral to a sleep specialist. There are no cures for sleepwalking but you can reduce the likelihood of it happening by following good sleep hygiene and making sure you get sufficient sleep. Setting a regular wind-down routine before bed can help as can avoidance of triggers such as alcohol and recreational drugs. For individuals who sleepwalk regularly at a similar time in the night you can try waking them 15-30 minutes before this usually occurs to alter their sleep cycle. Taking steps to reduce or manage stress and anxiety is also important. For this reason, cognitive behavioural therapy may be helpful as it is an effective treatment for these problems. In some cases, medication is used if the sleepwalking is causing serious disruption to an individual’s sleep or if there’s a risk of serious injury. Hypnosis and relaxation therapy may also be helpful.

Managing sleep talking

Sleep talking is normally harmless but can be embarrassing and can cause disruption to a partner’s sleep if occurring very frequently. In these cases, it may be worth being referred to a sleep specialist to investigate any underlying medical or psychiatric disorders. Avoiding the common triggers for sleep talking is also advisable, as given above. Ear plugs may be helpful for bed partners. Sleeping in separate bedrooms may be a good option until the sleep talking is controlled. Although couples are often very opposed to this idea, it is better than feelings of frustration and resentment building up in a relationship.