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Sleepwalking
Somnambulism
Ivan Kramskoi, Somnambula, 1871
SpecialtySleep medicine, Neurology, Psychiatry

Sleepwalking, also known as somnambulism or noctambulism, is a phenomenon of combined sleep and wakefulness.[1] It is classified as a sleep disorder belonging to the parasomnia family.[2] It occurs during the slow wave stage of sleep, in a state of low consciousness, with performance of activities that are usually performed during a state of full consciousness. These activities can be as benign as talking, sitting up in bed, walking to a bathroom, consuming food, and cleaning, or as hazardous as cooking, driving a motor vehicle,[3][4][5] violent gestures and grabbing at hallucinated objects.[6]

Although sleepwalking cases generally consist of simple, repeated behaviors, there are occasionally reports of people performing complex behaviors while asleep, although their legitimacy is often disputed.[7] Sleepwalkers often have little or no memory of the incident, as their consciousness has altered into a state in which memories are difficult to recall. Although their eyes are open, their expression is dim and glazed over.[8] This may last from 30 seconds to 30 minutes.[6]

Sleepwalking occurs during slow-wave sleep (N3) of non-rapid eye movement sleep (NREM sleep) cycles. It typically occurs within the first third of the night when slow-wave sleep is most prominent.[8] Usually, it will occur once in a night, if at all.[6]

Signs and symptoms

[edit]

Sleepwalking is characterized by:[9]

  • partial arousal during non-rapid eye movement (NREM) sleep, typically during the first third of the night
  • dreamy content that may or may not be recalled when awake
  • dream-congruent motor behavior that may be simple or complex
  • impaired perception of the environment
  • impaired judgement, planning and problem-solving.[10]

Despite how it is portrayed in many cultures (eyes closed and walking with arms outstretched), the sleepwalker's eyes are open but may appear as a glassy-eyed stare or blank expression and pupils are dilated. Despite their reduced sensory perception due to being asleep, sleepwalkers demonstrate some ability to navigate their surrounding environment due to a combination of simple stumbling and habit.[11] They are often disoriented, consequent to awakening: the sleepwalker may be confused and perplexed, and might not know why or how they got out of bed; however, the disorientation will fade within minutes. They may talk while sleepwalking, but the talk typically does not make sense to the observer. There are varying degrees of amnesia associated with sleepwalking, ranging from no memory at all, vague memories or a narrative.[12]

Associated disorders

[edit]

Most studies look at sleep disorders in adults, but children can also be affected. In the ten percent of the population that experience sleep-related disorders, children are most affected due to their developing brains.[13] A study conducted in Australia,[14] looked at sleepwalking and its association with sleep behaviors in children. It was found that sleepwalking could be associated with children's bedtime routines. Those who have behavioral problems are more likely to develop a sleep disorder and should be assessed. The relationship between sleepwalking and the behavioral and emotional problems are more associated than their bedtime routines. This may very well be because sleep related disorders and sleepwalking happen simultaneously; one cannot exist without the other.[14]

In the study "Sleepwalking and Sleep Terrors in Prepubertal Children"[15] it was found that, if a child had another sleep disorder – such as restless leg syndrome (RLS) or sleep-disorder breathing (SDB) – there was a greater chance of sleepwalking. The study found that children with chronic parasomnias may often also present SDB or, to a lesser extent, RLS. Furthermore, the disappearance of the parasomnias after the treatment of the SDB or RLS periodic limb movement syndrome suggests that the latter may trigger the former. The high frequency of SDB in family members of children with parasomnia provided additional evidence that SDB may manifest as parasomnias in children. Children with parasomnias are not systematically monitored during sleep, although past studies have suggested that patients with sleep terrors or sleepwalking have an elevated level of brief EEG arousals. When children receive polysomnographies, discrete patterns (e.g., nasal flow limitation, abnormal respiratory effort, bursts of high or slow EEG frequencies) should be sought; apneas are rarely found in children. Children's respiration during sleep should be monitored with nasal cannula or pressure transducer system or esophageal manometry, which are more sensitive than the thermistors or thermocouples currently used in many laboratories. The clear, prompt improvement of severe parasomnia in children who are treated for SDB, as defined here, provides important evidence that subtle SDB can have substantial health-related significance. Also noteworthy is the report of familial presence of parasomnia. Studies of twin cohorts and families with sleep terror and sleepwalking suggest genetic involvement of parasomnias. RLS and SDB have been shown to have familial recurrence. RLS has been shown to have genetic involvement.

Sleepwalking may also accompany the related phenomenon of night terrors, especially in children. In the midst of a night terror, the affected person may wander in a distressed state while still asleep, and examples of sufferers attempting to run or aggressively defend themselves during these incidents have been reported in medical literature.[16]

In some cases, sleepwalking in adults may be a symptom of a psychological disorder. One study suggests higher levels of dissociation in adult sleepwalkers, since test subjects scored unusually high on the hysteria portion of the "Crown-Crisp Experiential Index".[17] Another suggested that "A higher incidence [of sleepwalking events] has been reported in patients with schizophrenia, hysteria and anxiety neuroses".[18] Also, patients with migraine headaches or Tourette syndrome are 4–6 times more likely to sleepwalk.

Consequences

[edit]

During the amnesic state sleepwalkers are in, many things can happen without their recollection. One thing that can happen is a sleep disorder called sexsomnia, where an individual can engage in sexual behaviors with oneself or others.[19] Its occurrence is rare, but can happen during sleepwalking.[20] Sleep-related eating disorder, in which sleepwalkers eat involuntarily, can also happen. The events can include eating/drinking regular foods or odd combinations of food.[21] Insomnia and daytime sleepiness can also occur.[22] Most sleepwalkers get injuries at some point during sleepwalking, often minor injuries such as cuts or bruises.[23][24] In rare occasions, however, sleepwalkers have fractured bones and died as the result of a fall.[25][26] Sleepwalkers may also face embarrassment of being found naked in public.[27][28]

Causes

[edit]

The cause of sleepwalking is unknown. A number of, as yet unproven, hypotheses are suggested for why it might occur, including: delay in the maturity of the central nervous system,[6] increased slow wave sleep,[29] sleep deprivation, fever, and excessive tiredness. There may be a genetic component to sleepwalking. One study found that sleepwalking occurred in 45% of children who have one parent who sleepwalked, and in 60% of children if both parents sleepwalked.[8] Thus, heritable factors may predispose an individual to sleepwalking, but expression of the behavior may also be influenced by environmental factors.[30][10] Genetic studies using common fruit flies as experimental models reveal a link between night sleep and brain development mediated by evolutionary conserved transcription factors such as AP-2.[31] Sleepwalking may be inherited as an autosomal dominant disorder with reduced penetrance. Genome-wide multipoint parametric linkage analysis for sleepwalking revealed a maximum logarithm of the odds score of 3.14 at chromosome 20q12-q13.12 between 55.6 and 61.4 cM.[32]

Sleepwalking has been hypothesized to be linked to the neurotransmitter serotonin, which also appears to be metabolized differently in migraine patients and people with Tourette syndrome, both populations being four to nine times more likely to experience an episode of sleepwalking.[33] Hormonal fluctuations have been found to contribute to sleepwalking episodes in women, with the likeliness to sleepwalk being higher before the onset of menstruation.[34] It also appears that hormonal changes during pregnancy decrease the likelihood of engaging in sleepwalking.[35]

Medications, primarily in four classes—benzodiazepine receptor agonists and other GABA modulators, antidepressants and other serotonergic agents, antipsychotics, and β-blockers—have been associated with sleepwalking.[36] The best evidence of medications causing sleepwalking is for zolpidem and sodium oxybate; all other reports are based on associations noted in case reports.[36]

A number of conditions, such as Parkinson's disease, are thought to trigger sleepwalking in people without a previous history of sleepwalking.[37][needs update]

Diagnosis

[edit]

Polysomnography is the only accurate assessment of a sleepwalking episode. Because this is costly and sleepwalking episodes are usually infrequent, other measures commonly used include self-, parent-, or partner-report. Three common diagnostic systems that are generally used for sleepwalking disorders are International Classification of Diseases (ICD-11),[1] the International Classification of Sleep Disorders (ICSD-3-TR),[38] and the Diagnostic and Statistical Manual (DSM-5-TR).[2]

The Diagnostic and Statistical Manual defines two subcategories of sleepwalking, although sleepwalking does not need to involve either behaviours:

  • sleepwalking with sleep-related eating.
  • sleepwalking with sleep-related sexual behavior (sexsomnia).[2]

Sleep eating involves consuming food while asleep. These sleep eating disorders are more often than not induced for stress related reasons. Another major cause of this sleep eating subtype of sleepwalking is sleep medication, such as Ambien for example (Mayo Clinic). There are a few others, but Ambien is a more widely used sleep aid.[39] Because many sleep eaters prepare the food they consume, there are risks involving burns and such with ovens and other appliances. As expected, weight gain is also a common outcome of this disorder because food that is frequently consumed contains high carbohydrates. As with sleepwalking, there are ways that sleep eating disorders can be maintained. There are some medications that calm the sleeper so they can get longer and better-quality rest, but activities such as yoga can also be introduced to reduce the stress and anxiety causing the action.[40]

Differential diagnoses

[edit]

Sleepwalking should not be confused with alcohol- or drug-induced blackouts, which can result in amnesia for events similar to sleepwalking. During an alcohol-induced blackout (drug-related amnesia), a person is able to actively engage and respond to their environment (e.g., having conversations or driving a vehicle), however the brain does not create memories for the events.[41] Alcohol-induced blackouts can occur with blood alcohol levels higher than 0.06 g/dl.[42] A systematic review of the literature found that approximately 50% of drinkers have experienced memory loss during a drinking episode and have had associated negative consequences similar to sleepwalkers, including injury and death.[41]

Other differential diagnoses include rapid eye movement sleep behavior disorder, confusional arousals, and night terrors.

Assessment

[edit]

An assessment of sleepwalking via polysomnography poses the problem that sleepwalking is less likely to occur in the sleep laboratory, and if an episode occurs, it is usually less complex than what the patient experiences at home.[43][44][45] Therefore, the diagnosis can often be made by assessment of sleep history, time-course and content of the sleep related behaviors.[46] Sometimes, home videos can provide additional information and should be considered in the diagnostic process.[47]

Some features that should always be assessed include:[48]

  • Age of onset
  • When the episode occurs during the sleep period
  • How often these episodes occur (frequency) and how long they last (duration)
  • Description of the episode, including behavior, emotions, and thoughts during and after the event
  • How responsive the patient is to external stimuli during the episode
  • How conscious or aware the patient is, when awakened from an episode
  • If the episode is remembered afterwards
  • The triggers or precipitating factors
  • Sleep–wake pattern and sleep environment
  • Daytime sleepiness
  • Other sleep disorders that might be present
  • Family history for NREM parasomnias and other sleep disorders
  • Medical, psychiatric, and neurological history
  • Medication and substance use history

The assessment should rule out differential diagnoses.

Treatment

[edit]

There have been no clinical trials to show that any psychological or pharmacological intervention is effective in preventing sleepwalking episodes.[9] Despite this, a wide range of treatments have been used with sleepwalkers. Psychological interventions have included psychoanalysis, hypnosis, scheduled or anticipatory waking, assertion training, relaxation training, managing aggressive feelings, sleep hygiene, classical conditioning (including electric shock), and play therapy. Pharmacological treatments have included tricyclic antidepressants (imipramine), an anticholinergic (biperiden), antiepileptics (carbamazepine, valproate), an antipsychotic (quetiapine), benzodiazepines (clonazepam, diazepam, flurazepam and triazolam), melatonin, a selective serotonin reuptake inhibitor (paroxetine), a barbiturate (sodium amytal) and herbs.[9]

There is no evidence to show that waking sleepwalkers is harmful or not, though the sleepwalker is likely to be disoriented if awakened.[49][medical citation needed]

Unlike other sleep disorders, sleepwalking is not associated with daytime behavioral or emotional problems. This may be because the sleepwalker's sleep is not disturbed—unless they are woken, they are still in a sleep state while sleepwalking.[citation needed]

Maintaining the safety of the sleepwalker and others and seeking treatment for other sleep problems is recommended.[9] Reassurance is recommended if sleepwalking is not causing any problems.[9] However, if it causes distress or there is risk of harm, hypnosis and scheduled waking are recommended as treatments.[9]

Safety planning

[edit]

For those whose sleepwalking episodes are hazardous, a door alarm may offer a measure of protection. There are various kinds of door alarms that can attach to a bedroom door and when the door is opened, the alarm sounds.[50] The intention is that the sound will fully awaken the person and interrupt the sleepwalking episode, or if the sleepwalker lives with others, the sound will prompt them to check on the person.

Sleepwalkers should aim to have their bedrooms on the ground floor of a home, apartment, dorm, hotel, etc.

Sleepwalkers should not have easily accessible weapons (loaded guns, knives) in the bedroom or any room of the house for that matter. If there are weapons, they should be locked away with keys secluded from the sleepwalker.[12]

For partners of sleepwalkers who are violent or disturb their sleep, sleeping in another room may lead to better sleep quality and quantity.

Epidemiology

[edit]

The lifetime prevalence of sleepwalking is estimated to be 4.6–10.3%. A meta-analysis of 51 studies, that included more than 100,000 children and adults, found that sleepwalking is more common in children with an estimated 5%, compared with 1.5% of adults, sleepwalking at least once in the previous 12 months. The rate of sleepwalking has not been found to vary across ages during childhood.[51]

History

[edit]

Sleepwalking has attracted a sense of mystery, but was not seriously investigated and diagnosed until the 19th century. The German chemist and parapsychologist Baron Karl Ludwig von Reichenbach (1788–1869) made extensive studies of sleepwalkers and used his discoveries to formulate his theory of the Odic force.[52]

Sleepwalking was initially thought to be a dreamer acting out a dream.[6] For example, in one study published by the Society for Science & the Public in 1954, this was the conclusion: "Repression of hostile feelings against the father caused the patients to react by acting out in a dream world with sleepwalking, the distorted fantasies they had about all authoritarian figures, such as fathers, officers and stern superiors."[53] This same group published an article twelve years later with a new conclusion: "Sleepwalking, contrary to most belief, apparently has little to do with dreaming. In fact, it occurs when the sleeper is enjoying his most oblivious, deepest sleep—a stage in which dreams are not usually reported."[54] More recent research has discovered that sleepwalking is actually a disorder of NREM (non-rapid eye movement) arousal.[6] Acting out a dream is the basis for a REM (rapid eye movement) sleep disorder called REM Behavior Disorder (or REM Sleep Behavior Disorder).[6] More accurate data about sleep is due to the invention of technologies, such as the electroencephalogram (EEG) by Hans Berger in 1924[55] and BEAM by Frank Duffy in the early 1980s.[56]

In 1907, Sigmund Freud spoke about sleepwalking to the Vienna Psychoanalytic Society (Nunberg and Federn). He believed that sleepwalking was connected to fulfilling sexual wishes and was surprised that a person could move without interrupting their dream. At that time, Freud suggested that the essence of this phenomenon was the desire to go to sleep in the same area as the individual had slept in childhood. Ten years later, he speculated about somnambulism in the article "A Metapsychological Supplement to the Theory of Dreams" (1916–17 [1915]). In this essay, he clarified and expanded his hypothetical ideas on dreams. He described the dream as a fragile equilibrium that is destabilized by the repressed unconscious impulses of the unconscious system, which does not obey the wishes of the ego. Certain preconscious daytime thoughts can be resistant and these can retain a part of their cathexis as well. Unconscious impulses and day residues can come together and result in a conflict. Freud then wondered about the outcome of this wishful impulse: an unconscious instinctual demand that becomes a dream wish in the preconscious. Freud stated that this unconscious impulse could be expressed as mobility during sleep. This would be what is observed in somnambulism, though what actually makes it possible remains unknown.[57]

As of 2002, sleepwalking has not been detected in non-human primates. It is unclear whether it simply has not been observed yet, or whether sleepwalking is a uniquely human phenomenon.[58]

Culture

[edit]

Opera

[edit]
Amina, the somnabuliste, at the mill

Vincenzo Bellini's 1831 Italian opera semiseria, La sonnambula, the plot of which is centered on the question of the innocence of the betrothed and soon-to-be married Amina, who, upon having been discovered in the bedchamber of a stranger, and despite the assurances of that stranger that Amina was entirely innocent, has been rejected by her enraged fiancé, Elvino — who then decides to marry another. In fact, when stressed, Amina was susceptible to somnambulism; and had come to be in the stranger's bedchamber by sleep-walking along a high parapet (in full view of the opera's audience). Elvino, who later observes the (exhausted by all the fuss) Amina, sleep-walking across a very high, very unstable, and very rickety bridge at the local mill, realizes his mistake, abandons his plans of marriage to the other woman, and re-unites with Amina.

Drama

[edit]
Mary Hoare's painting Lady Macbeth, Sleepwalking
  • The sleepwalking scene (Act V Scene 1) from William Shakespeare's tragic play Macbeth (1606) is one of the most famous scenes in all of literature.
  • In Walley Chamberlain Oulton's two act farce The Sleep-Walker; or, Which is the Lady (1812), "Somno", a histrionic failed-actor-turned-manservant relives his wished-for roles when sleepwalking.[59]

Literature

[edit]
[edit]

As sleepwalking behaviours occur without volition, sleepwalking can be used as a legal defense, as a form of legal automatism.[60] An individual can be accused of non-insane or insane automatism.[where?] The first is used as a defense for temporary insanity or involuntary conduct, resulting in acquittal. The latter results in a "special verdict of not guilty by reason of insanity."[61] This verdict of insanity can result in a court order to attend a mental institution.[62]

In the 1963 case Bratty v A-G for Northern Ireland, Lord Morris stated, "Each set of facts must require a careful examination of its own circumstances, but if by way of taking an illustration it were considered possible for a person to walk in his sleep and to commit a violent crime while genuinely unconscious, then such a person would not be criminally liable for that act."[63] While the veracity of the cases are disputed,[by whom?] there have been acts of homicide where the prime suspect may have committed the act while sleepwalking.

Alternative explanations to homicidal or violent sleepwalking include malingering, drug-induced amnesia, and other disorders in which sleep-related violence may occur, such as REM behavior disorder, fugue states, and episodic wandering.[64]

Sleep driving,[65] also known as sleepwalk driving,[66] is a rare phenomenon where the person drives a motor vehicle while they are sleepwalking. If stopped by police, sleepwalk-drivers are totally incapable of having any interaction with the police, if they are still sleepwalking during the event.[67] Sleepwalk-driving can occur to people who normally don't experience sleepwalking, since some medications, especially zolpidem and eszopiclone, can cause sleepwalking as unwanted side effect.[68] A case of a fatal hit-and-run accident involving the driver claiming to be sleep-driving has been recorded. However, no evidence of the claims could be found by a sleep expert during the following trial.[69][70]

Historical cases

[edit]
Albert Tirrell was acquitted of the murder of Maria Bickford in 1846, under a defense that he was sleepwalking. (National Police Gazette, 1846)
  • 1846, Albert Tirrell used sleepwalking as a defense against charges of murdering Maria Bickford, a prostitute living in a Boston brothel.
  • 1961, Sergeant Willis Boshears confessed to strangling a local woman named Jean Constable in the early hours on New Years Day 1961, but claimed that he was asleep and only woke to realize what he had done. He pled not guilty on the basis of being asleep at the time he committed the offence and was acquitted.[71][72]
  • In 1981, Steven Steinberg of Scottsdale, Arizona was accused of killing his wife and acquitted on the grounds of temporary insanity.
  • 1991, R v Burgess: Burgess was accused of hitting his girlfriend on the head with a wine bottle and then a video tape recorder. He was found not guilty at Bristol Crown Court, by reason of insane automatism.[73]
  • 1992, R. v. Parks: Parks was accused of killing his mother-in-law and attempting to kill his father-in-law. He was acquitted by the Supreme Court of Canada.[74]
  • 1994, Pennsylvania v. Ricksgers: Ricksgers was accused of killing his wife. He was sentenced to life in prison without parole.[75]
  • 1999, Arizona v. Falater: Scott Falater, of Phoenix, Arizona, was accused of killing his wife. The court concluded that the murder was too complex to be committed while sleepwalking. Falater was convicted of first-degree murder and sentenced to life with no possibility of parole.[76]
  • 2001, California v. Reitz: Stephen Reitz killed his lover, Eva Weinfurtner. He told police he had no recollection of the attack but he had "flashbacks" of believing he was in a scuffle with a male intruder. His parents testified in court that he had been a sleepwalker from childhood. The court convicted Reitz of first-degree murder in 2004.[75]
  • 2001, Antonio Nieto murdered his wife and mother-in-law and attempted to murder his daughter and son, before being disarmed. Nieto claimed to have been asleep during the attack and dreaming that he was defending himself against aggressive ostriches. However, his children stated that he had recognized them and had told his son to not turn on the lights because their mother (gravely injured already) was sleeping. In 2007, Nieto was sentenced to 10 years internment in a psychiatric hospital and ordered to pay 171,100 euros as compensation to the victims.[77]
  • 2004, Jules Lowe confessed to causing the death of his father Edward but did not remember committing the act. Jules used automatism as his defense, and was found not guilty by reason of insanity and detained indefinitely in a secure hospital.[78] He was released after ten months.
  • 2008, Brian Thomas was accused of killing his wife while dreaming that he was fighting off intruders.[79] He was freed in 2009 by a judge, who found him not guilty of murder.[80][81]

See also

[edit]

Citations

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  1. ^ a b Zivetz, Laurie (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Organization. hdl:10665/37958. ISBN 978-92-4-154422-1. OCLC 26553093. Archived from the original on 18 February 2022.
  2. ^ a b c "Diagnostic and Statistical Manual of Mental Disorders (DSM–5)". www.psychiatry.org. Archived from the original on 18 February 2022. Retrieved 2022-02-18.
  3. ^ "I went driving and motorbiking in my sleep". BBC News. 2017-12-11. Archived from the original on 18 February 2022. Retrieved 2020-02-27.
  4. ^ "SLEEP: Sex While Sleeping Is Real, and May Be No Joke", Michael Smith (June 19, 2006), MedPage Today, access date 18 February 2022
  5. ^ "SLEEP: Sex While Sleeping Is Real, and May Be No Joke". www.medpagetoday.com. 19 June 2006. Archived from the original on 18 February 2022. Retrieved 2022-02-18.
  6. ^ a b c d e f g Swanson, Jenifer, ed. "Sleepwalking". Sleep Disorders Sourcebook. MI: Omnigraphics, 1999. 249–254, 351–352.
  7. ^ Rachel Nowak (15 October 2004). "Sleepwalking woman had sex with strangers". New Scientist. Archived from the original on 2007-05-09. Retrieved 2007-04-30.
  8. ^ a b c Lavie, Peretz, Atul Malhotra, and Giora Pillar. Sleep disorders: diagnosis, management and treatment: a handbook for clinicians. London: Martin Dunitz, 2002. 146–147.
  9. ^ a b c d e f Stallman, Helen M. (2017). "Assessment and treatment of sleepwalking in clinical practice". Australian Family Physician. 46 (8): 590–593. PMID 28787563.
  10. ^ a b "Sleepwalking - Symptoms and causes". Mayo Clinic. Archived from the original on 18 February 2022. Retrieved 2022-02-18.
  11. ^ Popat, Shreeya; Winslade, William (24 April 2015). "While You Were Sleepwalking: Science and Neurobiology of Sleep Disorders & the Enigma of Legal Responsibility of Violence During Parasomnia". Neuroethics. 8 (2): 203–214. doi:10.1007/s12152-015-9229-4. PMC 4506454. PMID 26203309.
  12. ^ a b Schenck, Carlos H. (March 2007). Sleep: The Mysteries, the Problems, and the Solutions. Avery Publishing. pp. 105–109. ISBN 978-1-58333-270-2. OCLC 1265420054.
  13. ^ Willock, Brent (April 2022). "On dreaming, parasomnia, dream enactment, and murder". Psychoanalytic Psychology. 39 (2): 97–110. doi:10.1037/pap0000382. ISSN 1939-1331. S2CID 244209446.
  14. ^ a b Stallman, Helen M; Kohler, Mark J; Biggs, Sarah N; Lushington, Kurt; Kennedy, Declan (2017-09-25). "Childhood Sleepwalking and Its Relationship to Daytime and Sleep Related Behaviors". Sleep and Hypnosis: 61–69. doi:10.5350/Sleep.Hypn.2016.18.0122.
  15. ^ Guilleminault, Christian; Palombini, Luciana; Pelayo, Rafael; Chervin, Ronald D. (1 January 2003). "Sleepwalking and Sleep Terrors in Prepubertal Children: What Triggers Them?". Pediatrics. 111 (1): e17 – e25. doi:10.1542/peds.111.1.e17. PMID 12509590.
  16. ^ "Sleep terrors (night terrors) - Symptoms and causes". Mayo Clinic. Retrieved 2019-03-25.
  17. ^ Crisp, A.H.; Matthews, BM; Oakey, M; Crutchfield, M; et al. (1990). "Sleepwalking, night terrors, and consciousness". British Medical Journal. 300 (6721): 360–362. doi:10.1136/bmj.300.6721.360. PMC 1662124. PMID 2106985.
  18. ^ Orme, J.E. (1967), "The Incidence of Sleepwalking in Various Groups", Acta Psychiatrica Scandinavica, Vol 43, Iss 3, pp 279–28.
  19. ^ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4) e13596. doi:10.1111/jsr.13596. ISSN 0962-1105. PMID 35388549. S2CID 248000922.
  20. ^ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4) e13596. doi:10.1111/jsr.13596. ISSN 0962-1105. PMID 35388549. S2CID 248000922.
  21. ^ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4) e13596. doi:10.1111/jsr.13596. ISSN 0962-1105. PMID 35388549. S2CID 248000922.
  22. ^ Idir, Yannis; Oudiette, Delphine; Arnulf, Isabelle (August 2022). "Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new". Journal of Sleep Research. 31 (4) e13596. doi:10.1111/jsr.13596. ISSN 0962-1105. PMID 35388549. S2CID 248000922.
  23. ^ Milliet N, Ummenhofer W. Somnambulism and trauma: case report and short review of the literature. J Trauma. 1999;47(2):420–2
  24. ^ Sillesen NH, Nielsen LT, Bonde C. Complex injuries associated with somnambulism. Ugeskr Laeger. 2010;172(50):3489–90
  25. ^ "Sleepwalker dies after falling from hotel window following night out with work colleagues". Daily Mirror. 2014-01-03.
  26. ^ "Tragedy as sleepwalker plunges to death from hotel window". 2014-01-02. Archived from the original on 2022-01-12.
  27. ^ "Naked sleepwalker stumbles out of city hotel then makes an odd request to police". Daily Mirror. 2016-05-22.
  28. ^ "Sleep walker mows lawn naked". 2005-03-21.
  29. ^ Pressman. "Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications." Sleep Med Rev 11.1 (2007):5–30.
  30. ^ Kales, A.; Soldatos, C. R.; Bixler, E. O.; Ladda, R. L.; Charney, D. S.; Weber, G.; Schweitzer, P. K. (1 August 1980). "Hereditary factors in sleepwalking and night terrors". The British Journal of Psychiatry. 137 (2): 111–118. doi:10.1192/bjp.137.2.111. PMID 7426840. S2CID 13186645.
  31. ^ Kucherenko, Mariya M.; Ilangovan, Vinodh; Herzig, Bettina; Shcherbata, Halyna R.; Bringmann, Henrik (2016-01-01). "TfAP-2 is required for night sleep in Drosophila". BMC Neuroscience. 17 (1): 72. doi:10.1186/s12868-016-0306-3. ISSN 1471-2202. PMC 5103423. PMID 27829368.
  32. ^ Dogu, Okan; Pressman, Mark R. (4 January 2011). "Identification of sleepwalking gene(s): Not yet, but soon?". Neurology. 76 (1). American Academy of Neurology: 12–13. doi:10.1212/WNL.0b013e318203e9c0. ISSN 0028-3878. PMID 21205687. S2CID 207118557. Archived from the original on 18 February 2022.
  33. ^ Barabas, Gabor; Matthews, Wendy S.; Ferrari, Michael (2008). "Somnambulism in Children with Tourette Syndrome". Developmental Medicine & Child Neurology. 26 (4): 457–460. doi:10.1111/j.1469-8749.1984.tb04471.x. PMID 6148287. S2CID 1759571.
  34. ^ Schenck, C. H., & Mahowald, M. W. (1995b). Two cases of premenstrual sleep terrors and injurious sleep-walking. Journal of Psychosomatic Obstetrics & Gynecology, 16, 79–84.
  35. ^ Hedman, C., Pohjasvaara, T., Tolonen, U., Salmivaara, A., & Myllyla, V. (2002). Parasomnias decline during pregnancy. Acta Neurologica Scandinavica, 105, 209–214.
  36. ^ a b Stallman, HM; Kohler, M; White, J (February 2018). "Medication induced sleepwalking: A systematic review". Sleep Medicine Reviews. 37: 105–113. doi:10.1016/j.smrv.2017.01.005. PMID 28363449. S2CID 10381396.
  37. ^ Poryazova, R; Waldvogel, D; Bassetti, CL (October 2007). "Sleepwalking in patients with Parkinson disease". Archives of Neurology. 64 (10): 1524–7. doi:10.1001/archneur.64.10.1524. PMID 17923637.
  38. ^ Sateia, Michael J. (1 November 2014). "International classification of sleep disorders-third edition: highlights and modifications". Chest. 146 (5): 1387–1394. doi:10.1378/chest.14-0970. ISSN 1931-3543. OCLC 986580999. PMID 25367475.
  39. ^ Staff, Mayo Clinic. "Sleep-related Eating Disorders". Mayo Clinic. Retrieved 5 May 2014.
  40. ^ Clinic, Cleveland. "Sleep-Related Eating Disorders". Cleveland Clinic. Retrieved 5 May 2014.
  41. ^ a b Wetherill, Reagan R.; Fromme, Kim (2016). "Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies". Alcoholism: Clinical and Experimental Research. 40 (5): 922–935. doi:10.1111/acer.13051. PMC 4844761. PMID 27060868.
  42. ^ Hartzler, Bryan; Fromme, Kim (2003). "Fragmentary and en bloc blackouts: Similarity and distinction among episodes of alcohol-induced memory loss". Journal of Studies on Alcohol. 64 (4): 547–550. doi:10.15288/jsa.2003.64.547. PMID 12921196.
  43. ^ Blatt, I., Peled, R., Gadoth, N., & Lavie, P. (1991). The value of sleep recording in evaluating somnambulism in young adults. Electroencephalography & Clinical Neurophysiology, 78, 407–412.
  44. ^ Joncas, S., Zadra, A., Paquet, J., & Montplaisir, J. (2002). The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology, 58, 936–940.
  45. ^ Kales, A., Soldatos, C. R., Caldwell, A. B., Kales, J. D., Humphrey, F. J., 2nd, Charney, D. S., & Schweitzer, P. K. (1980). Somnambulism. Clinical characteristics and personality patterns. Archives of General Psychiatry, 37, 1406–1410.
  46. ^ Hublin, C., Kaprio, J., Partinen, M., Heikkila, K., & Koskenvuo, M. (1997). Prevalence and genetics of sleepwalking: A population-based twin study. Neurology, 48, 177–181.
  47. ^ Kavey, N. B., Whyte, J., Resor, S. R., Jr., & Gidro-Frank, S. (1990). Somnambulism in adults. Neurology, 40, 749–752.
  48. ^ Zadra, Antonio; Pilon, Mathieu (2012-03-01). Parasomnias II. Oxford University Press. doi:10.1093/oxfordhb/9780195376203.013.0028.
  49. ^ Suni, Eric; Vyas, Nilong (18 November 2020). "Sleepwalking: What Is Somnambulism?". Sleep Foundation. Retrieved 15 June 2024.
  50. ^ "Wandering & Movement Alarms & Monitors / Page 1 - Independent Living Centres Australia". ilcaustralia.org.au. Archived from the original on 18 February 2022. Retrieved 2018-09-09.
  51. ^ Stallman, HM; Kohler, M (2016). "Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis". PLOS ONE. 11 (11) e0164769. Bibcode:2016PLoSO..1164769S. doi:10.1371/journal.pone.0164769. PMC 5104520. PMID 27832078.
  52. ^ Kushida, Clete A. (30 December 2012). Encyclopedia of Sleep. Academic Press. pp. 154–155. ISBN 978-0-12-378611-1. OCLC 1033861556.
  53. ^ Society for Science & the Public. "Sleepwalking Cause." The Science News-Letter. 27 February 1954: 132.
  54. ^ Society for Science & the Public. "Sleepwalker Not Dreaming." The Science News-Letter, 25 June 1966: 508
  55. ^ Magiorkinis, Emmanouil; Diamantis, Aristidis; Sidiropoulou, Kalliopi; Panteliadis, Christos (24 August 2014). "Highights in the History of Epilepsy: The Last 200 Years". Epilepsy Research and Treatment. 2014 e582039. doi:10.1155/2014/582039. ISSN 2090-1348. PMC 4158257. PMID 25210626.
  56. ^ "History of the Scientific Standards of QEEG Normative Databases" (PDF). Archived (PDF) from the original on 18 February 2022.
  57. ^ "Somnambulism". International Dictionary of Psychoanalysis. 2005. Archived from the original on 22 September 2020.
  58. ^ Kantha, S. S. (28 November 2003). "Is somnambulism a distinct disorder of humans and not seen in non-human primates?". Medical Hypotheses. 61 (5–6): 517–518. doi:10.1016/s0306-9877(03)00206-8. ISSN 0306-9877. PMID 14592779.
  59. ^ Oulton, Walley Chamberlain (16 March 1812). "The Sleep-Walker; or, Which Is the Lady? A Farce, in Two Acts". OCLC 1061924365 – via Google Books.
  60. ^ Popat, S; Winslade, W (2015). "While You Were Sleepwalking: Science and Neurobiology of Sleep Disorders & the Enigma of Legal Responsibility of Violence During Parasomnia". Neuroethics. 8 (2): 203–214. doi:10.1007/s12152-015-9229-4. PMC 4506454. PMID 26203309.
  61. ^ Lederman, Eliezer. "Non-Insane and Insane Automatism: Reducing the Significance of a Problematic Distinction." The International and Comparative Law Quarterly 34.4 (1985): 819.
  62. ^ Mackay, Irene (1992). "The Sleepwalker is Not Insane". The Modern Law Review. 55 (5): 715–716. doi:10.1111/j.1468-2230.1992.tb02845.x.
  63. ^ Culebras, A. (1996). Clinical Handbook of Sleep Disorders. Massachusetts, MA, USA: Butterworth-Heinemann. pp. 317–319. ISBN 978-0-7506-9644-9. OCLC 34932724.
  64. ^ Sobo, Frank (2004). Crumpet Strumpet. Nightengale Press. ISBN 978-0-9743348-3-7. Retrieved 10 July 2022.
  65. ^ Roman, Frank (22 September 2012). "Why Sleepwalk When You Can Sleepdrive". Thefreelibrary.com. Retrieved 10 July 2022.
  66. ^ Pressman, Mark R. (2 March 2011). "Sleep driving: sleepwalking variant or misuse of z-drugs?". Sleep Medicine Reviews. 15 (5): 285–292. doi:10.1016/j.smrv.2010.12.004. PMID 21367628.
  67. ^ Woodbury, Emily (18 August 2021). "You've heard of sleepwalking, but what about sleep-driving?". Rv Travel. Retrieved 10 July 2022.
  68. ^ Russell, Mark (2 November 2021). "Expert doubts sleepwalk in fatal hit-run". Canberratimes.com.au. Retrieved 10 July 2022.
  69. ^ Mitchell, Georgina (2021-11-02). "Troy Grant's father 'drinking red wine, dozing in chair' before hit-and-run, court told". The Sydney Morning Herald. Retrieved 2024-08-11.
  70. ^ Shearer, Lloyd (October 14, 1961). "He killed in his sleep". Ottawa Citizen.
  71. ^ Donnelley, Paul (2000). Essex Murders. Wharncliffe Books.
  72. ^ Heaton-Armstrong A, Shepherd E, Wolchover D, eds. (2002). Analysing Witness Testimony: Psychological, Investigative and Evidential Perspectives: A Guide for Legal Practitioners and Other Professionals. Blackstone Press. ISBN 978-1-85431-731-5.
  73. ^ Broughton et al. Homicidal Somnambulism: A Case Report. Sleep (1994); 17(3):253-64. doi:10.1093/sleep/17.3.253
  74. ^ a b Lyon, Lindsey (8 May 2009). "7 Criminal Cases That Invoked the 'Sleepwalking Defense'". US News & World Report.
  75. ^ Paparella, Andrew; Engel, Scott; Resendez, MaryEllen; Effron, Lauren (January 28, 2021). "'Sleepwalking' killer Scott Falater still wracked with guilt over murdering wife". ABC News. Retrieved 2025-08-27.
  76. ^ "Acuerdan internar 10 años al hombre que mató a su mujer y su suegra creyéndolas avestruces" [They agreed to intern the man who killed his wife and mother-in-law for 10 years, believing them to be ostriches]. Diario Sur (in European Spanish). 2007-02-21. Retrieved 2023-05-29.
  77. ^ "'Sleepwalker' accused of murder". BBC News Online. 10 March 2005.
  78. ^ de Bruxelles, Simon (18 November 2009). "Sleepwalker Brian Thomas admits killing wife while fighting intruders in nightmare". The Times. London. Retrieved 2009-12-26.[dead link]
  79. ^ "Camper van 'dream killer' Brian Thomas freed by judge". BBC News Online. 2009-11-20. Retrieved 2016-05-30.
  80. ^ "Man who killed his wife while sleeping goes free". The Independent. 2009-11-21. Retrieved 2016-05-30.

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Sleepwalking

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Sleepwalking, also known as somnambulism, is a disorder characterized by a person arising from bed and performing complex behaviors, such as walking or engaging in routine activities, while in a state of partial arousal from deep non-rapid eye movement (NREM) sleep, typically without full or of the event. Episodes usually occur within the first few hours after falling asleep, lasting from seconds to minutes, and the individual often appears unresponsive to external stimuli, with a blank or glassy-eyed stare. This condition is most prevalent in children, affecting up to 5% according to a 2016 , compared to 1.5% of adults, with a lifetime prevalence of about 6.9% across all ages; it frequently resolves by but can persist or emerge in adulthood due to genetic factors or triggers like , stress, fever, certain medications, or coexisting disorders such as or . Risk is higher in those with a family history, and while episodes in children are generally benign, adult cases may involve more elaborate or potentially dangerous actions, increasing the risk of injury from falls, wandering, or inadvertent harm to others. Diagnosis relies on clinical history and observation, often ruling out seizures or other neurological issues through sleep studies if needed, while management focuses on safety measures like securing the environment and addressing triggers; severe or frequent cases may benefit from behavioral interventions such as scheduled awakenings or, rarely, medications like low-dose benzodiazepines to suppress stages.

Signs and Symptoms

Behavioral Manifestations

Sleepwalking episodes typically occur during deep non-REM (NREM) sleep, particularly stage N3, and are most common in the first third of the night, often 1 to 2 hours after falling asleep. These episodes arise from partial arousals, where the individual transitions incompletely from sleep to , resulting in a state of low responsiveness. The duration of an episode usually ranges from a few seconds to about 30 minutes, though most last less than 10 minutes. Common behaviors during sleepwalking include sitting up in bed, walking around the room or house, and performing simple routine tasks such as opening doors, turning on lights, or even dressing and undressing, all while exhibiting poor coordination and balance. The eyes are often open but appear glazed or unfocused, with a blank stare that reflects the confused . Individuals show limited responsiveness to external stimuli; attempts to communicate or wake them may provoke agitation or resistance rather than full awakening, and they may respond incoherently if spoken to. Upon eventual full awakening, often at the episode's end, the person typically experiences confusion and disorientation for a short period, followed by complete for the event. In rare cases, sleepwalkers may engage in more complex actions, such as rearranging furniture, , or even leaving the home to drive a vehicle, though these are infrequent and carry heightened risk due to impaired judgment. Episodes are far more prevalent in children, with a current 12-month rate of approximately 5% (95% CI 3.8%–6.5%), compared to about 1.5% (95% CI 1.0%–2.3%) in adults. Frequency tends to decrease with age, often resolving by , but episodes can persist into adulthood or, less commonly, begin de novo in later life.

Associated Health Issues

Sleepwalking is frequently comorbid with other parasomnias, particularly within the spectrum of disorders of arousal (DoA) from non-rapid eye movement (NREM) sleep, which encompass confusional arousals and sleep terrors (also known as night terrors). In children, these comorbidities are especially common, with sleepwalking often co-occurring alongside night terrors and confusional arousals, reflecting shared incomplete arousals from deep NREM sleep stages. Additionally, (bedwetting) shows a notable association, as children with enuresis are over 1.5 times more likely to experience parasomnias like sleepwalking due to overlapping sleep fragmentation and arousal thresholds. Restless legs syndrome (RLS) has also been linked, potentially exacerbating motor restlessness that primes sleepwalking episodes in pediatric populations. In adults, sleepwalking comorbidities extend to a broader range of sleep and medical conditions. Migraines are significantly associated, with sleepwalkers exhibiting nearly four times the likelihood of chronic headaches compared to controls, possibly due to shared neurophysiological vulnerabilities in regulation. (OSA) frequently co-occurs, affecting up to 10% of OSA patients with parasomnias including sleepwalking, as respiratory disruptions during sleep can trigger incomplete . (GERD) is another common associate, with nighttime reflux events disrupting sleep architecture and increasing the propensity for disorders like sleepwalking. As a core component of DoA, sleepwalking exhibits substantial overlap with other NREM parasomnias, with studies indicating that 20-30% of individuals with one such disorder experience concurrent manifestations of others, such as combined sleepwalking and confusional arousals. This clustering underscores the unified involving partial awakenings from , often without full cognitive awareness. Recurrent sleepwalking episodes disrupt overall architecture, leading to fragmented rest and consequent impairments in daily functioning. Affected individuals commonly report heightened daytime sleepiness, chronic fatigue, and symptoms, which compound over time to hinder work, school, or social performance. Anxiety may also arise, stemming from awareness of episodes or fear of recurrence, further perpetuating a cycle of sleep disturbance and emotional strain. A 2013 study highlight sleepwalking's association with diminished health-related quality of life (HRQoL), including elevated risks for mood disorders like depression and anxiety, though these are secondary to sleep disruption rather than primarily psychiatric in . For instance, adult sleepwalkers demonstrate significantly lower HRQoL scores, driven by persistent and psychological distress, emphasizing the need for targeted sleep management to mitigate long-term effects. In older adults, sleepwalking has been linked to a higher of dementia-related mortality (HR 6.13, 95% CI 3.8-9.9).

Potential Complications

Sleepwalking episodes pose significant physical , primarily due to impaired awareness and coordination during non-rapid eye movement (NREM) sleep. Individuals may fall down stairs, collide with objects, or wander into hazardous environments such as traffic or bodies of water, leading to injuries like fractures, lacerations, or concussions. In adults with frequent sleepwalking, injury rates during episodes have been reported as high as 17%, often resulting from such accidents. Violent behaviors during sleepwalking are uncommon but can occur, particularly in adults, where they may manifest as aggressive actions toward oneself or others in response to perceived threats in a confused state. These episodes, classified under disorders of arousal, are more prevalent in males and can lead to harm such as self-inflicted wounds or assaults on bed partners. A 2013 study of adult sleepwalkers highlighted that such violent manifestations contribute to the condition's severity, affecting up to 58% of participants with some form of aggressive sleep . Psychological impacts of sleepwalking often stem from the embarrassment and unpredictability of episodes, leading individuals to avoid sleep or experience heightened anxiety about recurrence. This fear can exacerbate stress within families, disrupting relationships and causing ongoing emotional distress if episodes persist untreated. Long-term, untreated sleepwalking may contribute to reduced , including social withdrawal and chronic worry. Rare but severe outcomes include fatalities from sleepwalking-related accidents, such as in bathtubs or pools, falls from heights, or accidental through ingestion of harmful substances while ambulatory. Documented cases demonstrate these risks, with forensic reviews noting instances of lethal self-injury or environmental hazards during episodes.

Pathophysiology

Involvement in Sleep Stages

Sleepwalking episodes primarily originate during stages 3 and 4 of non-rapid eye movement (NREM) sleep, collectively known as (SWS), and often emerge during transitions from these phases to lighter stages. This timing aligns with the brain's dominance in SWS, where cortical activity is at its slowest. The underlying mechanism involves incomplete awakenings from SWS, resulting in a dissociated state where electroencephalographic (EEG) patterns of sleep persist alongside wakeful motor activity, such as ambulation or complex behaviors. During these events, the individual remains unresponsive to external stimuli, reflecting the incomplete transition to full . Episodes predominantly cluster in the early sleep cycles, especially within the first third of the nocturnal sleep period when SWS is most prominent, with incidence decreasing in later cycles as SWS duration shortens. This pattern underscores the dependence on peak SWS consolidation early in the night. The elevated prevalence of sleepwalking in children relative to adults stems from children's greater proportion of SWS in their sleep architecture, which naturally declines across development into adulthood. This age-related reduction in SWS correlates with the abatement of episodes in most individuals by .

Neurological and Autonomic Mechanisms

Sleepwalking arises from a dissociated state in which and non-rapid (NREM) sleep coexist asynchronously across brain regions, enabling motor behaviors while remains impaired. evidence, including EEG source imaging and functional MRI, demonstrates hyperactivation in the —particularly the cingulate motor area—and limbic structures during episodes, facilitating ambulatory actions without volitional control. In contrast, the frontal lobes, including the orbitofrontal and dorsolateral prefrontal cortices, exhibit hypoactivation, as evidenced by reduced regional cerebral blood flow in perfusion studies, which accounts for the lack of awareness and judgment typically associated with . The during sleepwalking episodes shows a distinct profile dominated by elevated parasympathetic activity, promoting a rest-and-digest state, alongside diminished sympathetic activation that would otherwise trigger a . analyses in studies from 2021 reveal this parasympathetic predominance during recovery following arousals, contrasting with the expected sympathetic surge in full awakenings and contributing to the persistence of sleep-like physiological regulation amid behavioral arousal. Recent investigations in 2025 employing resting-state functional MRI have identified altered functional connectivity within the in individuals with disorders of , including sleepwalking, indicating disrupted integration between emotional and motor processing networks. Complementary (PET) scans reveal metabolic changes, with relative hypometabolism in anterior cingulate regions and in posterior areas, suggesting spatially heterogeneous energy demands that perpetuate instability during NREM sleep transitions. These findings build on earlier work by highlighting how such connectivity and metabolic shifts in limbic hubs impair over subcortical motor pathways. Imbalances in key systems further underpin these mechanisms, with reduced inhibition and altered serotonergic modulation leading to unstable thresholds. Seminal reviews from 2023 propose that diminished GABA activity in frontal and thalamic circuits fails to suppress subcortical drives, while serotonin dysregulation—potentially linked to impaired —exacerbates incomplete awakenings from deep NREM . This neurochemical profile aligns with pharmacological evidence where GABA-enhancing agents like benzodiazepines mitigate episode frequency, reinforcing the role of inhibitory-excitatory disequilibrium in generating dissociated states.

Causes and Risk Factors

Genetic Predispositions

Sleepwalking exhibits a significant genetic component, with estimates of approximately 56% in childhood and 36% in adulthood based on twin studies, indicating that genetic factors substantially influence susceptibility to the disorder. Familial aggregation is common, as the condition often runs in families; for instance, children with at least one who has a of sleepwalking are at markedly higher risk, with prevalence rates increasing from 22.5% in those without parental history to 47.4% when one parent is affected. This hereditary pattern underscores the role of inherited traits in predisposing individuals to non-rapid eye movement (NREM) parasomnias like sleepwalking. A key associated with sleepwalking is the *05:01 , which has been linked to increased risk in multiple studies. In one investigation, this allele was present in 35% of sleepwalkers compared to 13.3% of controls, yielding an of 3.5 (95% CI: 1.4-8.7). Further research confirmed its prevalence at 41% in sleepwalkers versus 24.2% in matched controls (p < 0.05), suggesting involvement in immune-related pathways that may modulate sleep regulation. Although not identified through large-scale genome-wide association studies specifically for sleepwalking, this allele's association highlights targeted genetic vulnerabilities. Evidence points to a polygenic influence on sleepwalking, involving multiple genes that affect sleep architecture, particularly the stability of (SWS), during which episodes typically occur. Genes related to SWS regulation contribute to this multifactorial basis, as disruptions in these pathways can lower the threshold and promote parasomnic behaviors. Whole exome sequencing in affected families has begun to uncover rare variants in such genes, supporting a complex genetic architecture beyond single loci. The age of onset for sleepwalking is typically in childhood, often between 4 and 10 years, and a positive family history strongly predicts persistence into adulthood in up to 25% of cases. Individuals with familial predisposition may experience episodes that continue or recur later in life, with reduced frequency but notable impact. This persistence is particularly evident in those with early-onset and recurrent episodes during childhood. Twin studies reinforce the genetic underpinnings, demonstrating higher concordance rates for sleepwalking in monozygotic twins compared to dizygotic twins. For example, probandwise concordance was 0.55 in monozygotic pairs versus 0.35 in dizygotic pairs during childhood, and 0.32 versus 0.10 in adulthood. More recent analyses, including a review of twin data, indicate that adult sleepwalking is 5.3 times more prevalent in monozygotic twins compared to dizygotic twins, further quantifying the . These findings highlight the interplay of shared genetic factors in the disorder's expression.

Environmental and Lifestyle Triggers

Sleep deprivation is one of the most common environmental triggers for sleepwalking episodes, as it increases the duration of and lowers thresholds, making partial awakenings more likely in susceptible individuals. Irregular sleep schedules, such as those caused by or , similarly disrupt normal sleep architecture and can precipitate somnambulism by promoting sleep pressure accumulation. Fever and illness also act as precipitants, potentially by altering and sleep stage transitions during recovery. A full , often due to evening intake, may further trigger episodes by creating internal stimuli during deep non-REM sleep. Certain medications, particularly sedatives like , have been strongly associated with inducing sleepwalking, with systematic reviews identifying it as the drug with the most robust evidence for this side effect based on multiple case reports and clinical observations. Lifestyle factors such as alcohol consumption exacerbate the risk by initially promoting deeper sleep but later causing fragmented arousals that facilitate parasomnias. Excessive intake, especially in the evening, interferes with sleep onset and quality, indirectly increasing episode frequency through heightened sleep instability. Psychological stress, including emotional distress or anxiety, heightens vulnerability by disrupting continuity, as evidenced in studies of adult sleepwalkers where stressful events triggered episodes in over half of cases. Coexisting medical conditions such as (OSA) and (GERD) can also trigger or exacerbate sleepwalking episodes by inducing arousals during deep NREM sleep. Environmental disturbances like sudden noises can provoke incomplete arousals leading to sleepwalking, particularly in noisy sleeping environments that interrupt phases. extremes, such as overheating from heavy or exposure, may similarly trigger episodes by affecting and sleep depth. arrangements, while not a direct cause, can amplify risks in shared spaces by introducing movement or proximity-related disturbances that lower arousal barriers. Recent research from 2023 highlights sleep deprivation's specific role in impairing arousal regulation, with studies showing it worsens episode severity in vulnerable adults by enhancing instability and reducing the brain's ability to fully transition between sleep states. This underscores the modifiable nature of these triggers, particularly in combination with genetic predispositions.

Diagnosis

Clinical Assessment

The clinical assessment of sleepwalking begins with a comprehensive history taking, which relies on reports from both the patient and eyewitnesses to characterize the episodes. This includes descriptions of the behaviors observed, such as rising from bed and walking while appearing asleep, along with details on the frequency (e.g., occurring multiple times per week), duration (typically lasting several minutes), and potential triggers like , stress, or medication use. Patients often exhibit partial or complete for the events, with episodes arising from non-REM sleep, usually in the first third of the night. Diagnosis aligns with the , Third Edition (ICSD-3) criteria for sleepwalking as a disorder of from non-REM . The general criteria (A-E) require recurrent episodes of incomplete awakening from ; inappropriate or absent responsiveness to intervention during the episode; limited or no associated or dream imagery; partial or complete amnesia for the episode; and the disturbance not being better explained by another , , medical condition, , or substance. Specific criteria for sleepwalking include meeting the general disorder of criteria and the arousals being associated with ambulation or other complex behaviors out of bed. Family history is also elicited, as genetic factors increase risk. A is performed to rule out underlying neurological deficits or conditions that could mimic sleepwalking, such as seizures or , though findings are typically normal in uncomplicated cases. This includes a neurological assessment to evaluate for focal deficits and an evaluation of practices, such as irregular sleep schedules or environmental factors that may exacerbate episodes. Questionnaires aid in quantifying the severity and impact of sleepwalking. The Paris Arousal Disorders Severity Scale (PADSS) is a self-rated tool validated in patients with sleepwalking and sleep terrors, consisting of three parts: PADSS-A lists 17 parasomniac behaviors; PADSS-B assesses their frequency (from never to twice or more per night); and PADSS-C evaluates consequences like injuries, need for assistance, , and daytime sleepiness. The total score ranges from 0 to 61, with higher scores indicating greater severity and functional impairment. Medical evaluation is recommended when episodes are persistent, cause significant distress, pose injury risks, disrupt family sleep, or lead to embarrassment or daytime consequences for the individual.

Polysomnography and Differential Diagnosis

Polysomnography (PSG) serves as the gold standard for confirming sleepwalking, particularly in cases where clinical history is inconclusive or differential diagnoses are suspected. This comprehensive sleep study involves overnight monitoring in a laboratory setting, incorporating electroencephalography (EEG), video recording, and physiological sensors to capture brain waves, eye movements, muscle activity, and heart rate. During PSG, sleepwalking episodes are identified as partial arousals from non-rapid eye movement (NREM) sleep, typically stages 3 or 4, characterized by incomplete awakenings with automatic behaviors and persistent slow-wave EEG patterns without epileptic discharges. The procedure has a high diagnostic yield, revealing an alternative diagnosis or precipitating factors in over 40% of patients with suspected NREM parasomnias. To increase the likelihood of capturing an episode, techniques such as 24- to 25-hour sleep deprivation prior to the study are sometimes employed, enhancing arousal instability in predisposed individuals. In routine practice, PSG is not always necessary and is reserved for complex or , forensic evaluations, or when distinguishing from other disorders is challenging. Instead, home-based assessments are increasingly recommended as a first-line approach. Home video recordings, using cameras, allow patients or families to document episodes in natural settings, often capturing behaviors like ambulation or confused actions during without the artificial constraints of a lab. These recordings provide objective evidence of NREM-related arousals, such as eyes open with a blank stare and lack of responsiveness, and are emphasized in recent guidelines for initial evaluation before escalating to PSG. , involving wrist-worn devices that track movement and infer sleep-wake patterns over multiple nights, complements this by identifying circadian disruptions or sleep fragmentation that may trigger episodes, though it does not directly visualize behaviors. Differential diagnosis is crucial to rule out mimicking conditions, as sleepwalking shares features like nocturnal motor activity with several disorders. REM sleep behavior disorder (RBD) involves dream enactment during REM sleep, with patients often recalling vivid, violent dreams upon awakening, in contrast to the amnesia and non-purposeful, automatic movements typical of sleepwalking. RBD episodes feature atonia loss with thrashing but rarely include walking or leaving the bed, and PSG confirms REM-stage occurrence with rapid eye movements. Nocturnal seizures, particularly nocturnal frontal lobe epilepsy, present with stereotyped, hypermotor behaviors arising from sleep, but are distinguished by ictal EEG abnormalities, shorter episode duration (under 2 minutes), and potential postictal confusion with partial recall. Video-EEG during PSG is essential here, as parasomnias show no epileptiform activity. Other differentials include , where full awareness and purposeful actions occur post-trauma without sleep linkage, and nocturnal attacks, characterized by abrupt awakenings with intense fear, hyperventilation, and complete recall. In cases, episodes may simulate sleepwalking but lack the partial from deep NREM sleep and instead reflect daytime extensions into night. Nocturnal , often tied to anxiety disorders, involves sympathetic activation without motor complexity. Key differentiators across these include sleepwalking's hallmark of , eyes-open unresponsiveness, and occurrence early in the night during NREM, versus recall, oriented responses, or EEG spikes in alternatives. According to 2023 updates, integrating home videos with targeted PSG enhances accuracy in excluding these, prioritizing non-invasive methods initially.

Treatment and Management

Behavioral and Safety Strategies

Behavioral and safety strategies form the cornerstone of non-pharmacological for sleepwalking, focusing on environmental modifications to minimize risks and promote safer sleep patterns. Primary measures include securing the sleeping environment by locking and windows to prevent unintended exits, removing potential hazards such as sharp objects, furniture, or electrical cords from the , and installing gates at the top and bottom of staircases to avoid falls. Additionally, bed alarms—devices placed under the or on the that alert caregivers when the individual leaves the bed—can effectively interrupt episodes and reduce the likelihood of during nocturnal wandering. These precautions are recommended as first-line interventions to decrease risks associated with sleepwalking. Sleep hygiene practices play a vital role in reducing the frequency of sleepwalking episodes by addressing factors that exacerbate the condition. Maintaining a consistent sleep schedule, aiming for 7-9 hours of nightly, and avoiding triggers such as alcohol, , or heavy meals close to bedtime can stabilize sleep architecture and lower arousal thresholds. Relaxation techniques, including deep exercises, , or before bed, help mitigate stress—a common precipitant—and foster a calming pre-sleep routine. These strategies emphasize creating an optimal environment, such as a cool, dark, and quiet bedroom, to support uninterrupted rest. Scheduled awakenings represent a targeted behavioral intervention, particularly effective for recurrent episodes in children and adults. This technique involves gently waking the individual 15-30 minutes before the typical onset time of sleepwalking, based on a log of previous episodes, and then allowing them to return to sleep after a brief period of full . Studies have demonstrated high , with scheduled awakenings eliminating episodes in up to 100% of treated pediatric cases in small-scale trials, and achieving partial or full remission in a significant proportion of patients overall. Educating family members and caregivers is essential for safe intervention during episodes, promoting non-confrontational responses to avoid escalating or agitation. Witnesses should gently guide the sleepwalker back to bed without attempting to wake them abruptly, using calm verbal reassurance if needed, and never shake or shout, as this can lead to defensive reactions. Informing household members about these guidelines ensures consistent, supportive handling that prioritizes and reduces potential harm. Recent systematic reviews, including a 2023 analysis of behavioral treatments for NREM parasomnias, indicate that these combined strategies—encompassing safety modifications, , and scheduled awakenings—yield substantial benefits, with sleep hygiene alone contributing to symptom remission in approximately 13% of cases and scheduled awakenings showing particularly strong success rates in pediatric populations, thereby significantly lowering injury risks in chronic sleepwalking.

Pharmacological Options

Pharmacological interventions for sleepwalking are typically reserved for cases where behavioral strategies prove insufficient and episodes pose significant safety risks or cause substantial distress. These treatments primarily aim to reduce the frequency and intensity of episodes by modulating (SWS), during which sleepwalking most commonly occurs. First-line pharmacological options include benzodiazepines such as , which suppress SWS and thereby decrease arousal from deep non-REM sleep. , administered at low doses (0.5–2 mg at bedtime), has demonstrated response rates of 74–84% in clinical series of patients, including those with sleepwalking. For pediatric cases, tricyclic antidepressants like are sometimes used, particularly when episodes co-occur with night terrors; in a small series of seven children, (25–50 mg at bedtime) led to complete symptom cessation after eight weeks of treatment. Emerging treatments include supplementation, which may help regulate sleep architecture and reduce episode frequency. Early research suggests that may help address sleepwalking, though evidence is limited and larger studies are needed to confirm efficacy. These medications are used off-label for sleepwalking, as no agents are specifically approved by regulatory bodies like the FDA. Common side effects include daytime drowsiness, dizziness, and cognitive impairment with benzodiazepines, while tricyclic antidepressants may cause dry mouth or gastrointestinal upset; sedatives that increase confusion, such as certain hypnotics, should be avoided as they can exacerbate parasomnias. The evidence base for pharmacological options remains limited, with few randomized controlled trials available; however, case studies and small observational series support efficacy in 40–60% of cases, particularly when combined with confirmation of diagnosis via .

Prevalence and Demographics

Sleepwalking exhibits a global lifetime ranging from 1% to 15%, with a estimating an overall lifetime rate of 6.9% (95% CI 4.6%–10.3%) based on 20 studies. Prevalence peaks during childhood, particularly at ages 10–13, where rates can reach up to 13.4% based on longitudinal cohort data. In adults, the condition persists at lower rates, with current estimated between 1% and 7%. Demographically, sleepwalking is more common in males, with male-to-female ratios reported as high as 3:1 in some populations. It also occurs at higher rates in individuals with a family history, where parental sleepwalking increases childhood to 47.4% if one parent is affected and up to 61.5% if both are (compared to 22.5% with no parental history). In the United States, a national survey indicated that approximately 8.4 million experience sleepwalking episodes annually, representing about 3.6% of the population. The condition typically onsets in early childhood, with most cases—around 75–80%—remitting spontaneously by adolescence. However, recent analyses suggest increasing recognition of adult-onset sleepwalking, potentially linked to rising stress and sleep disruptions. Prevalence appears consistent across geographic regions and cultures, as evidenced by multinational meta-analyses, though underreporting is likely in stigmatized contexts due to cultural attitudes toward sleep behaviors. Reports of adult sleepwalking have shown an upward trend since 2020, potentially linked to elevated stress levels from the and improved public awareness of sleep disorders. A study of healthcare workers exposed to COVID-19 patients found a higher incidence of sleepwalking compared to non-exposed groups, attributed to pandemic-related stressors and disrupted sleep patterns. These shifts align with broader escalations in parasomnias during the pandemic, where stress and exacerbated arousal disorders. Subgroup variations highlight elevated risks in certain populations. Sleepwalking occurs more frequently among individuals with neurodevelopmental disorders, such as ADHD, where exhibit rates of around 50% in affected children and adolescents, exceeding general population figures, such as 47.6% for sleepwalking. This association persists into adulthood, with ADHD linked to heightened susceptibility independent of other factors like . Regarding sex differences, sleepwalking is more common in males during childhood, but these disparities lessen in the elderly, where overall drops sharply to under 1%, resulting in more balanced rates across sexes due to age-related declines in stability. Recent research from 2022-2024 underscores evolving patterns in chronic cases. In persistent sleepwalkers, episodes tend to worsen developmentally with age, featuring increased mental content (mentation) during arousals and greater behavioral complexity, such as coordinated actions or violent tendencies. The amplified sleep disruptions, with studies reporting increases in episodes tied to stress and changes during the acute phases. These findings emphasize how external pressures can intensify underlying vulnerabilities in long-term sleepwalkers. Methodological considerations affect reported trends and variations. Self-reports, often used in large-scale surveys, can inflate prevalence estimates by including partial recollections or second-hand accounts, while underestimating silent episodes due to . Objective measures, such as video-polysomnography, provide more accurate detection but are resource-intensive and less feasible for population studies, leading to potential biases in subgroup data like those in neurodevelopmental cohorts. As noted in overviews, these discrepancies highlight the need for standardized hybrid approaches to refine estimates across demographics.

History

Early Observations

Sleepwalking, known historically as somnambulism, has been observed and documented since ancient times, though early accounts lacked the scientific rigor of later studies. In the 4th century BCE, described instances of individuals moving and performing waking-like activities during sleep, noting in his treatise De somno et vigilia that "some people move in their sleep and do many waking acts but not all." These nocturnal wanderings were seen as peculiarities of the body's state between sleep and wakefulness, without deeper pathological interpretation. Such references highlight an early recognition of the phenomenon as a disruption in the normal progression of rest, though attributed it broadly to the incapacitation of sensory organs during sleep. During the medieval period, interpretations of sleepwalking shifted toward supernatural explanations, often framing it as demonic possession or influenced by lunar phases. Accounts from this era portrayed sleepwalkers as potentially under the sway of evil spirits, with behaviors like wandering or viewed as instigated by the to provoke destruction or reveal hidden sins. Lunar influence was a common , where full or waning moons were thought to trigger episodes, linking somnambulism to broader notions of lunacy or celestial forces affecting the mind and body. These views persisted in medical and theological texts, where sleepwalking challenged the Aristotelian boundary between conscious and unconscious states, sometimes leading to fears of or divine punishment. By the 19th century, sleepwalking began entering psychiatric discourse, with Étienne Esquirol classifying it in 1838 as a variant of within his framework of mental maladies. In Des maladies mentales, Esquirol described somnambulism as an ecstatic or trance-like state arising from nervous excitation, akin to hysterical symptoms involving altered consciousness and automatic behaviors. This psychiatric lens moved away from purely attributions, viewing it instead as a disorder of the will and imagination, often observed in sensitive or overwrought individuals. In the Romantic era, cultural myths further romanticized sleepwalking as states or "nocturnal ," blending medical curiosity with artistic fascination. Figures like depicted somnambulism in literature as a liminal condition evoking mesmerism and revelations, reflecting debates on activity during . Pre-20th-century prevalence relied on anecdotal reports in diaries, personal correspondences, and literary works, such as 17th- and 18th-century tales of noctambuli performing complex tasks unconsciously, without systematic epidemiological study. These narratives, often sensationalized, underscored the phenomenon's mystery and peril but provided little quantitative insight into its occurrence.

Scientific Advancements

In the early , advancements in (EEG) revolutionized the understanding of sleep architecture and its relation to sleepwalking. Alfred Loomis and colleagues in the 1930s pioneered continuous EEG recordings, identifying distinct stages of non-rapid eye movement (NREM) sleep characterized by high-amplitude slow waves, which later became foundational for recognizing that sleepwalking episodes typically arise from deep NREM sleep stages 3 and 4. By the 1950s and 1960s, further EEG studies confirmed this linkage, distinguishing sleepwalking from REM-related phenomena and emphasizing incomplete arousals from as a core mechanism. A pivotal classification emerged in the 1970s when Henri Gastaut and collaborators formalized sleepwalking as a , grouping it with other NREM arousal disorders based on polygraphic recordings that captured motor behaviors during without full awakening. This work shifted perceptions from psychiatric or epileptic origins to sleep-specific dysregulations, influencing subsequent diagnostic frameworks. From the 1980s onward, genetic research initiated systematic investigations into familial patterns, with early studies demonstrating a strong hereditary component through pedigree analyses showing autosomal dominant with incomplete for sleepwalking and related night terrors. These findings laid the groundwork for identifying susceptibility loci, such as on 20q, and specific alleles like *05 associated with increased risk. Concurrently, the (ICSD) evolved to refine categorization; the 2014 ICSD-3 edition consolidated sleepwalking, confusional arousals, and sleep terrors under "disorders of arousal" (DOA), emphasizing shared NREM origins and partial arousals for standardized . Recent milestones from 2023 to 2025 have illuminated underlying brain connectivity issues in sleepwalking. Functional MRI (fMRI) and (PET) studies revealed enhanced beta-band connectivity between and cingulate regions during episodes, suggesting dysregulated thalamocortical networks that permit complex behaviors without conscious awareness. Further investigations have highlighted deficits in sympathetic "fight-or-flight" responses, with sleepwalkers exhibiting parasympathetic dominance and blunted accelerations prior to arousals, potentially contributing to uninhibited motor output. Treatment approaches have evolved from early psychological interventions to evidence-based protocols. Hypnosis trials in the late , such as post-hypnotic suggestions to awaken at onset, demonstrated sustained in reducing for up to five years in small cohorts. Modern management incorporates (PSG) for precise diagnosis and monitoring, often guiding targeted therapies like scheduled awakenings. Emerging trials, particularly in pediatric DOA, show promise in stabilizing sleep architecture and decreasing rates by advancing onset, though larger randomized studies are ongoing.

Cultural Representations

In Literature and Arts

Sleepwalking has long captivated artists and writers, serving as a dramatic device to delve into the human psyche. In William Shakespeare's Macbeth (1606), the in Act 5, Scene 1 features wandering the castle at night, compulsively rubbing her hands as if to cleanse them of blood, a vivid manifestation of her guilt over King Duncan's murder and subsequent crimes. This portrayal underscores somnambulism as a symptom of psychological torment, where the conscious self yields to unconscious revelations of . The scene's enduring impact lies in its exploration of fractured identity, with Lady Macbeth's trance-like state blurring the boundaries between waking rationality and nocturnal . In modern literature, sleepwalking appears in psychological horror to amplify themes of inner conflict and dread. King's screenplay for Sleepwalkers (1992) evokes nocturnal wandering through its titular creatures, nomadic beings who prowl under cover of night, blending literal movement with metaphorical disconnection from human norms. In opera and drama, sleepwalking often romanticizes or pathologizes emotional turmoil. Vincenzo Bellini's La Sonnambula (1831) presents somnambulism through the innocent , whose nighttime escapade into a rival's chamber sparks jealousy and near-tragedy but resolves in a celebration of fidelity, portraying sleepwalking as an endearing quirk rather than a curse. This opera idealizes the condition as a for misunderstanding and reconciliation. Conversely, Giuseppe Verdi's (1847) adapts Shakespeare's scene with heightened pathos, depicting Lady Macbeth's somnambulism as a descent into madness driven by unassuageable guilt, her "Una macchia è qui tuttora!" conveying the soul's torment in a state of involuntary confession. Nineteenth-century plays and operas frequently employed sleepwalking to probe moral culpability, using the somnambulist's unwitting actions to externalize characters' internal divisions. Visual arts of the eighteenth and nineteenth centuries rendered sleepwalking as a symbol of the subconscious, capturing its eerie detachment. Henry Fuseli's oil painting Lady Macbeth Sleepwalking (c. 1784), housed in the Musée du Louvre, shows the figure gliding forward with a lantern, her eyes fixed in a vacant gaze that conveys both vulnerability and haunting obsession. Fuseli's earlier The Nightmare (1781) complements this by visualizing nocturnal oppression through a incubus perched on a sleeping woman, evoking the subconscious fears that parallel somnambulistic wanderings. These works prefigure psychoanalytic interpretations, using distorted forms and dim lighting to illustrate the intrusion of repressed thoughts into the physical realm. Thematically, sleepwalking in and arts frequently metaphorizes divided and moral conflict, portraying the somnambulist as a vessel for the self's hidden layers. In Victorian-era representations, it symbolized liminal states where rational control dissolves, revealing potential for both peril and , as the body acts independently of the mind's oversight. This duality—innocence in repose versus unconscious transgression—highlights tensions between agency and inevitability, often critiquing societal constraints on the psyche.

In Modern Media

Sleepwalking has been a recurring motif in 20th- and 21st-century films and television, often portrayed as a catalyst for suspense, horror, or comedy, though these depictions frequently diverge from clinical realities. In Alfred Hitchcock's psychological thriller Vertigo (1958), the theme emerges metaphorically through nightmarish sequences involving disorientation and unconscious actions, influencing later works that blend sleep disorders with psychological turmoil. More directly, the animated series The Simpsons explores sleepwalking comically in the episode "Crook and Ladder" (2007), where Homer Simpson, under the influence of a sleep aid, performs absurd and destructive acts like starting fires while somnambulant, highlighting the trope's use for humor amid chaos. In contemporary horror, the South Korean film Sleep (2023) depicts a newlywed's violent sleepwalking episodes escalating into thriller territory, with the husband unknowingly endangering his family, drawing on real parasomnias but amplifying peril for dramatic effect. Modern perpetuates urban legends of sleepwalkers unwittingly committing crimes, rooted in sensationalized real cases that blur the line between and fact. Tales of individuals driving long distances or assaulting others during episodes, such as the 1987 case of Parks who fatally attacked his mother-in-law while somnambulant, have evolved into cautionary stories shared online and in popular discourse, emphasizing unknowing culpability. These legends persist in contemporary narratives, like the BBC-documented accounts of sleepwalkers traveling 20 kilometers to commit stabbings, fostering a cultural of the "innocent monster" who acts without awareness. Media portrayals often exaggerate sleepwalking's association with violence, contrasting sharply with medical evidence that such behaviors are rare and typically provoked rather than spontaneous. Films like the 2024 thriller Sleep transform somnambulism into a slasher premise, where uncontrolled actions lead to gruesome outcomes, perpetuating stereotypes of inherent danger despite studies showing violence only when triggered by external stimuli. This sensationalism, evident in horror genres linking sleepwalking to thrillers, amplifies public fears while ignoring clinical contexts, such as the disorder's prevalence in non-violent forms like simple ambulation. In contrast, real-world data from sleep disorder analyses indicate that unprovoked aggression is a myth, with most incidents involving confusion rather than intent. Recent trends from 2023 to 2025 reflect a shift toward science-based media that demystifies sleepwalking, aiming to reduce associated stigma through educational content. Podcasts like A Spark of Science (2024 episode) and the Sleep Science Podcast delve into the neuroscience of parasomnias, explaining episodes as non-volitional brain states during non-REM sleep to counter violent misconceptions. Documentaries and series, including PBS's Vitals: Sleepwalking: When Good Sleep Goes Bad (updated discussions in 2023), feature experts like neuroscientists discussing triggers and management, promoting awareness that the condition affects up to 4% of adults without inherent peril. Similarly, Andrew Huberman's 2024 guest series with sleep researcher Matthew Walker on Huberman Lab addresses parasomnias scientifically, emphasizing environmental safety over fear to foster empathy for those affected.

As a Defense in Court

Sleepwalking has been invoked as a form of automatism defense in criminal proceedings, positing that the defendant's actions were involuntary and thus lacking the requisite intent () for criminal liability. This defense is grounded in the principle that unconscious or automatic behavior during a episode negates voluntary conduct, potentially leading to if established as non-insane automatism in applicable jurisdictions. To succeed, the defense typically requires robust medical , including a documented history of non-violent sleepwalking s, (PSG) to confirm the presence of a such as non-REM , and video recordings demonstrating characteristic behaviors like confusion upon awakening or persistence of patterns. Expert testimony from sleep specialists is essential to interpret this , emphasizing the absence of prior violent acts during s and ruling out external triggers like intoxication. The criteria aim to verify that the was authentic and not feigned, often drawing on diagnostic standards from the . Proving the defense presents significant challenges, as the burden of proof lies with the —often to a high standard such as beyond a or clear and convincing evidence—and courts demand differentiation from simulation or conscious action. Conflicting expert opinions frequently arise, complicating admissibility under evidentiary rules like the in the U.S., where scientific reliability is scrutinized. Additionally, if self-induced factors like alcohol contribute, the defense may be barred, heightening the risk of rejection. Acceptance of the sleepwalking defense varies internationally: in the UK and some jurisdictions, it is often categorized as insane automatism under precedents like R v Burgess, resulting in a special rather than outright and potential commitment to treatment. In contrast, recognizes it as non-insane automatism per , allowing full exoneration if proven. U.S. courts exhibit state-by-state variability, with many accepting it as a viable automatism claim when supported by , though persists due to the infrequency of verifiable cases.

Notable Historical Cases

One of the earliest recorded instances of sleepwalking being invoked as a legal defense occurred in 1846 in the United States, during the trial of Albert Tirrell for the murder of his mistress, Maria Bickford. Tirrell claimed he was sleepwalking when he slit her throat in a , and the acquitted him, marking the first documented success of such a defense in a case. A landmark case in came in 1992 with , where Kenneth Parks drove 23 kilometers to his in-laws' home, fatally assaulted his mother-in-law, and injured his father-in-law while allegedly sleepwalking. Expert testimony, including evidence from Parks's identical twin brother who shared a history of somnambulism, supported the automatism defense; the upheld his , affirming sleepwalking as non-culpable. In the United States, the 1997 case of Scott Falater highlighted challenges to the defense. Falater stabbed his wife Yarmila 44 times and held her underwater in their backyard pool, claiming ; despite expert witnesses, the jury rejected the sleepwalking argument due to evidence of coherent post-act behavior, convicting him of first-degree murder. In the 2020s, appeals in U.S. cases have increasingly incorporated and spectral EEG analysis of (PSG) data to bolster claims, though success remains limited without corroborating behavioral evidence. Acquittals based on sleepwalking defenses are rare, often hinging on factors like absence of video evidence, prior history, and exclusion of intoxicants. Pivotal elements include the lack of motive and immediate post-event disorientation, as seen in successful verdicts. In recent years, defenses have continued to appear in court. In February 2025, Australian prosecutors dropped murder charges against Ilknur Caliskan, who allegedly stabbed her husband while in September 2023, after a at a Sydney clinic supported a -related automatism claim. Similarly, in State v. Wilson ( Court of Appeals, April 2025), the defendant raised a sexsomnia defense (a related ) in a case but was convicted following expert testimony challenging the claim.

References

  1. https://www.mayoclinic.org/diseases-conditions/sleepwalking/symptoms-causes/syc-20353506
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC5104520/
  3. https://medlineplus.gov/ency/article/000808.htm
  4. https://www.ncbi.nlm.nih.gov/books/NBK559001/
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC8232850/
  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC9584583/
  7. https://pubmed.ncbi.nlm.nih.gov/20525541/
  8. https://www.uptodate.com/contents/disorders-of-arousal-from-non-rapid-eye-movement-sleep-in-adults
  9. https://emedicine.medscape.com/article/1188854-overview
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC6755928/
  11. https://www.neurology.org/doi/10.1212/WNL.0000000000000889
  12. https://pmc.ncbi.nlm.nih.gov/articles/PMC6558250/
  13. https://pubmed.ncbi.nlm.nih.gov/23450499/
  14. https://aasm.org/adult-sleepwalking-is-serious-condition-that-impacts-health-related-quality-of-life/
  15. https://www.mayoclinicproceedings.org/article/S0025-6196(23)00410-X/fulltext
  16. https://my.clevelandclinic.org/health/diseases/14292-sleepwalking
  17. https://www.safetyandhealthmagazine.com/articles/study-examines-risks-of-sleepwalking
  18. https://aasm.org/new-study-in-the-journal-sleep-finds-that-violent-behavior-that-occurs-during-disorders-of-arousal-is-provoked/
  19. https://www.psychologytoday.com/us/conditions/sleepwalking
  20. https://www.verywellmind.com/sleepwalking-and-mental-health-5217894
  21. https://www.nbcnews.com/health/body-odd/suicide-while-sleepwalking-real-nightmare-flna1c9386935
  22. https://www.channelnewsasia.com/singapore/woman-sleepwalking-fall-death-toilet-window-coroner-inquiry-ruth-dalumpines-dulfo-2681046
  23. https://www.ncbi.nlm.nih.gov/books/NBK526132/
  24. https://www.nature.com/articles/s41467-024-48337-7
  25. https://www.sciencedirect.com/science/article/abs/pii/S1389945714004110
  26. https://pubmed.ncbi.nlm.nih.gov/25708721/
  27. https://www.sciencedirect.com/science/article/abs/pii/S1388245715000681
  28. https://pmc.ncbi.nlm.nih.gov/articles/PMC5946932/
  29. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.680596/full
  30. https://pmc.ncbi.nlm.nih.gov/articles/PMC11770889/
  31. https://onlinelibrary.wiley.com/doi/10.1111/ene.70008
  32. https://www.sciencedirect.com/science/article/am/pii/S1556407X23000863
  33. https://pmc.ncbi.nlm.nih.gov/articles/PMC12021398/
  34. https://pubmed.ncbi.nlm.nih.gov/9008515/
  35. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2281574
  36. https://pubmed.ncbi.nlm.nih.gov/7426840/
  37. https://www.researchgate.net/publication/8424653_HLA_and_genetic_susceptibility_to_sleepwalking
  38. https://pubmed.ncbi.nlm.nih.gov/26951409/
  39. https://www.news-medical.net/health/Sleepwalking-A-Neuroscientific-Exploration-of-Midnight-Roaming.aspx
  40. https://www.medrxiv.org/content/10.1101/2025.09.17.25335508v1.full-text
  41. https://pmc.ncbi.nlm.nih.gov/articles/PMC8595666/
  42. https://pmc.ncbi.nlm.nih.gov/articles/PMC2917078/
  43. https://pmc.ncbi.nlm.nih.gov/articles/PMC3030226/
  44. https://emedicine.medscape.com/article/1188854-clinical
  45. https://www.medrxiv.org/content/10.1101/2025.09.17.25335508v1.full.pdf
  46. https://link.springer.com/article/10.1007/s40675-025-00334-y
  47. https://www.sleepfoundation.org/parasomnias/sleepwalking
  48. https://pubmed.ncbi.nlm.nih.gov/28363449/
  49. https://pmc.ncbi.nlm.nih.gov/articles/PMC2775419/
  50. https://my.clevelandclinic.org/health/diseases/12133-parasomnias--disruptive-sleep-disorders
  51. https://www.latimes.com/science/sciencenow/la-sci-sn-sleepwalking-genetic-runs-in-families-20150505-story.html
  52. https://www.racgp.org.au/afp/2017/august/assessment-and-treatment-of-sleepwalking-in-clinic
  53. https://www.medlink.com/articles/sleepwalking
  54. https://www.mayoclinic.org/diseases-conditions/sleepwalking/diagnosis-treatment/drc-20353511
  55. https://pmc.ncbi.nlm.nih.gov/articles/PMC3902885/
  56. https://www.hopkinsmedicine.org/health/conditions-and-diseases/parasomnias-sleepwalking
  57. https://pubmed.ncbi.nlm.nih.gov/9212552/
  58. https://www.healthline.com/health/sleep/what-is-anticipatory-awakening-therapy
  59. https://link.springer.com/article/10.1007/s40675-016-0049-9
  60. https://pmc.ncbi.nlm.nih.gov/articles/PMC10591847/
  61. https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.128.6.778
  62. https://emedicine.medscape.com/article/1188854-treatment
  63. https://www.sciencedirect.com/science/article/pii/S1389945718300996
  64. https://www.psychdb.com/sleep/parasomnias/1-nrem-sleep-disorder/sleepwalking
  65. https://pmc.ncbi.nlm.nih.gov/articles/PMC3066770/
  66. https://pmc.ncbi.nlm.nih.gov/articles/PMC3467644/
  67. https://www.fusionsleep.com/blogs/2016/5/26/sleepwalking-in-children
  68. https://www.sciencedirect.com/science/article/abs/pii/S1389945720303725
  69. https://jcsm.aasm.org/doi/10.5664/jcsm.27356
  70. https://www.sciencedirect.com/science/article/pii/S0967586823003466
  71. https://www.sciencedirect.com/science/article/abs/pii/S1389945721005864
  72. https://e-logos.vse.cz/pdfs/elg/2014/01/17.pdf
  73. https://www.loebclassics.com/view/aristotle-parva_naturalia_sleep_waking/1957/pb_LCL288.317.xml
  74. https://pmc.ncbi.nlm.nih.gov/articles/PMC8734948/
  75. https://static1.squarespace.com/static/5962766303596e1794b57057/t/598b635ef14aa1659209f761/1502307166965/sleepwalking-through-history.pdf
  76. https://pubmed.ncbi.nlm.nih.gov/24162746/
  77. https://archive.org/details/mentalmaladiestr00esqu
  78. https://dash.harvard.edu/bitstream/handle/1/12282302/Storey_py_2014.pdf?sequence=1
  79. https://www.researchgate.net/publication/232818962_Somnambulism_and_Trance_States_in_the_Works_of_John_William_Polidori_Author_of_The_Vampyre
  80. https://pmc.ncbi.nlm.nih.gov/articles/PMC2413168/
  81. https://pmc.ncbi.nlm.nih.gov/articles/PMC4918987/
  82. https://www.cambridge.org/core/books/parasomnias-and-other-sleeprelated-movement-disorders/introduction/07882325E59A238B588C06B7ED162CA2
  83. https://pubmed.ncbi.nlm.nih.gov/25367475/
  84. https://pmc.ncbi.nlm.nih.gov/articles/PMC12528200/
  85. https://pubmed.ncbi.nlm.nih.gov/2007894/
  86. https://emedicine.medscape.com/article/1188854-workup
  87. https://www.sparknotes.com/shakespeare/macbeth/section8/
  88. https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1484&context=gradreports
  89. https://stephenking.fandom.com/wiki/The_Sleepwalkers
  90. https://www.npr.org/2010/07/02/128247329/innocence-rewarded-bellinis-la-sonnambula
  91. https://pubmed.ncbi.nlm.nih.gov/25684300/
  92. https://artsandculture.google.com/asset/the-sleepwalking-lady-macbeth-johann-heinrich-fussli-1741-1825/XAHdxFo2UiA4QQ?hl=en
  93. https://smarthistory.org/henry-fuseli-the-nightmare/
  94. https://www.sleephealthjournal.org/article/S2352-7218(17)30196-1/fulltext
  95. http://d-scholarship.pitt.edu/23798/1/R_Wigginton_Dissertation_ETD_copy_1.pdf
  96. https://time.com/collection/100-best-movies/6295260/vertigo-1958/
  97. https://simpsons.fandom.com/wiki/Crook_and_Ladder
  98. https://variety.com/2023/film/news/sleep-movie-cannes-magnolia-magnet-releasing-1235657689/
  99. https://listverse.com/2021/02/08/top-10-messed-up-things-people-have-done-while-sleepwalking/
  100. https://www.sciencefocus.com/the-human-body/the-minds-of-sleepwalking-killers
  101. https://www.polygon.com/movies/457288/sleep-movie-2024-review/
  102. https://pmc.ncbi.nlm.nih.gov/articles/PMC1978391/
  103. https://open.spotify.com/episode/75S5sfImom6gUIeQ1bn4zR
  104. https://www.pbs.org/video/sleepwalking-when-good-sleep-goes-bad-jb2w8h/
  105. https://www.hubermanlab.com/episode/guest-series-dr-matt-walker-the-science-of-dreams-nightmares-lucid-dreaming
  106. https://psychiatryonline.org/doi/full/10.1176/appi.ajp.161.7.1149
  107. https://www.apa.org/pubs/books/Sleepwalking-Criminal-Behavior-and-Reliable-Scientific-Evidence-Intro-Sample.pdf
  108. https://pmc.ncbi.nlm.nih.gov/articles/PMC3671340/
  109. https://www.researchgate.net/publication/26302348_Sleep-related_automatism_and_the_law
  110. https://bclawreview.bc.edu/articles/1053/files/63b823517970b.pdf
  111. https://dsc.duq.edu/cgi/viewcontent.cgi?article=1017&context=dclj
  112. https://pubmed.ncbi.nlm.nih.gov/18533572/
  113. https://www.thelawyer.com/sleepwalking-and-the-criminal-law/
  114. https://academic.oup.com/book/24646/chapter/187995952
  115. https://sleepforensicmedicine.org/case-studies/sleep-walking/
  116. https://decisions.scc-csc.ca/scc-csc/scc-csc/en/item/907/index.do
  117. https://abcnews.go.com/US/sleepwalking-killer-scott-falater-wracked-guilt-murdering-wife/story?id=75468448
  118. https://pmc.ncbi.nlm.nih.gov/articles/PMC3869061/
  119. https://www.theguardian.com/australia-news/2025/feb/04/ilknur-caliskan-victoria-murder-charges-dropped-claim-husband-killed-in-sleep-parasomnia-ntwnfb
  120. https://law.justia.com/cases/oregon/court-of-appeals/2025/a181487.html
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