Sleepless in America

Healthy rest, problem sleep, and the dreams and nightmares therein

Is This Normal?

Parents are frequently concerned about sleepwalking children.

As I slowly began to awaken, in the dim light of the bedroom I saw a small, still figure. The dark silhouette was nearly motionless and seemed to be staring directly at me. A sense of dread filled me and I hoped this was just a dream. As I rubbed my eyes it became clear that there really was a person standing there. I called out but there was no reply. I fumbled for the light. As it came on, I recognized my 5-year-old daughter standing there—eyes open, staring and motionless. She didn’t respond to my voice when I asked her if she was all right. I got out of bed and tried without success to get her to talk to me. I turned her around and led her down the hallway. She followed easily. We walked hand in hand back to her room where she easily got back into bed and seemed to fall fast asleep. The next day she seemed fine and had no memory of the previous night. I was, however, somewhat disturbed by this rather creepy experience. That sense of unease increased the next time this happened, about a month later.

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The question such a parent often asks is: Is this normal behavior? Sleep walking is actually quite common in children. Prevalence may be as high as 17% and generally peaks between the ages of 8 and 12. Most children stop sleepwalking by age 13. There is no sex difference between boys and girls with regard to sleepwalking. Sleepwalking is much less common in adults and the prevalence is around 4%. Sleepwalking can begin as early as when a child first begins to walk and as late as the seventh decade of life. When only one parent has a history of sleepwalking the rate of sleepwalking in their children increases to 45% and to 60% when both parents were sleepwalkers.

There appears to be a genetic contribution to sleepwalking although anything that disturbs deep sleep can trigger an episode. Factors that can contribute to sleepwalking include sleep deprivation, breathing problems in sleep (such as sleep apnea, an increasingly common disorder in children), travel, sleeping in unfamiliar settings and disrupted sleep schedules. Danger can occur if the child or adult falls while sleepwalking. Children have left home or climbed out of windows while sleepwalking. These behaviors can result in potentially disastrous consequences. Unfortunately there are cases of children who have frozen to death after walking away from their house or have drowned during camping trips near water. Luckily, the great majority of child sleep walkers remain safely in their homes.

Sleepwalking is a partial arousal from deep sleep that includes walking away from the bed. Very small children may crawl about in the crib. Children usually have no memory of the event. At times behaviors such as urinating in a closet or beside the toilet may occur. Waking any child from deep sleep and standing them up, for example to leave a relative’s house after they have fallen asleep, can induce sleepwalking. The most disturbing behaviors among adults include sleep driving but are also, fortunately, rare.

Sleepwalking may be thought of as a sleep state dissociation. Sleep is a complex phenomenon that requires the precise coordination of large parts of the brain. Different parts of the brain can, under certain circumstances, be in different states at the same time. Children have a much greater amount of deep sleep than adolescents or adults. Polysomnographic studies have shown that sleepwalking occurs when there are rapid arousals from deep sleep that result in a dissociated sleep state and the child is between states of slow wave (deep) sleep and wakefulness. The waking state includes walking and complex behaviors while the slow wave state includes unresponsiveness to the environment, amnesia for the event and great difficulty being aroused.

There is no association between childhood sleepwalking and psychopathology. For small sleep walking children it is usually sufficient to gently guide them back to bed where they will resume normal sleep. A child’s sleepwalking may be extremely disruptive to their Mom’s or Dad’s sleep if the child exhibits behaviors such as those described above, but it primarily becomes problematic when it persists beyond adolescence. It can be very upsetting, for example, to college roommates if someone is walking about the bedroom at night in an unresponsive state.

If self-injurious behaviors are occurring during sleepwalking it is important for parents to take safety measures such as putting up child barriers at the top of stairs to prevent injury. This also applies to adults who may need to take steps such as securing windows and making it very difficult to get to car keys if an episode of sleepwalking occurs. 

So is it normal? It does occur with some degree of frequency in children and is not associated with psychopathology. It can usually be managed relatively easily. Parents need not be unduly unnerved by sleep walking and can rest easy knowing that this disconcerting behavior is fairly normal in children and is usually not a life long problem.

 

John Cline, Ph.D., is a clinical psychologist, Diplomate of the the American Board of Sleep Medicine, a fellow of the American Academy of Sleep Medicine and a clinical professor at Yale University.

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