From mumbling fantastical gibberish to devouring blocks of cheese in the nude, sleepwalking can manifest in a variety of peculiar behaviors. Although mostly benign, sleepwalking can occasionally lead to dangerous situations. It’s estimated that around 18% of people sleepwalk at least once in their lives. But what exactly is sleepwalking?
To understand sleepwalking, we first need to recognize how many of our daily activities do not require our active attention. The prefrontal cortex, our brain’s conscious, deliberate, decision-making control hub, might decide to get up and walk, but the intricate coordination of sensory inputs and muscles that follow does not require any attention. Instead, it’s mostly executed by a network of specialized nerve cells along the lower part of the brain and spinal cord, sometimes called “central pattern generators.” These areas govern automatic movements and basic actions related to survival.
People with a REM sleep behavior disorder may enact their dreams while they’re in REM sleep, usually keeping their eyes closed. However, this is a separate condition. Sleepwalking arises from a very different stage of sleep—the deepest stage of non-REM sleep, which is called “slow-wave sleep.” In this state, the cortex, including the prefrontal cortex, is essentially turned off.
When someone is roused from this stage, they’ll usually appear groggy before either dozing off again or becoming fully conscious. For that moment, though, they’re in an intermediate state straddling sleep and wakefulness. A sleepwalking episode is, essentially, an extreme, prolonged version of this. When sleepwalking, the prefrontal cortex remains inactive, so the person doesn’t possess executive, deliberate control over their actions. But other parts of their brain are active. And, as we know, the body is capable of a lot without involving the prefrontal cortex.
Sleepwalkers avoid obstacles, walk, and speak—though it’s often nonsense. Most sleepwalkers can do basic things, operating in a peaceful, unemotional, dreamless state. In rare cases, sleepwalkers perform more complex tasks like cooking and driving. They’re occasionally guided by physical urges, like eating or pursuing sexual activities. Some episodes involve the brain’s fight or flight system, during which the person might suddenly perceive an imminent danger, and vocalize, cry, or even jolt out of bed and run away. These episodes, called “sleep terrors,” are more common in young children and usually result naturally.
Indeed, sleepwalking is generally more common in children, perhaps because the brain areas that control the transition between sleep and wakefulness are still developing. However, the exact mechanisms that cause sleepwalking remain unclear. Many cases appear to run in families, while others are more mysterious. Anything that could lead to partial awakening is thought to increase the likelihood. This includes factors that promote deeper slow-wave sleep—like sedatives, hot sleep environments, and operating on too little sleep—or things that disrupt sleep— like stress and other sleep disorders, such as sleep apnea and restless leg syndrome.
Doctors will usually evaluate these factors and promote habits that aid in healthy sleep, such as exercise, stress management, and a consistent and sufficient sleep schedule. They’ll also often recommend safety measures, like hiding dangerous items, installing door alarms, and securing windows. If this doesn’t help, they’ll consider certain medications. However, many of the available treatments for sleepwalking haven’t yet been rigorously studied, so how they work and how effective they are is not entirely clear.
So, what should you do if you encounter a sleepwalker? A common misconception is that rousing a sleepwalker causes irreparable harm. Fortunately, this is not true. However, trying to forcefully wake them can cause confusion and distress. The best practice seems to be to gently guide them back to bed; and, if they resist, to simply ensure they’re safe until the episode resolves.
Imagine you are a sleepwalker. Create a short skit or role-play where you simulate a sleepwalking episode. Include actions like walking, mumbling, or performing simple tasks. This will help you understand how sleepwalkers can perform activities without conscious control. Perform your skit for the class and discuss what you learned about the automatic nature of these actions.
Draw a diagram of the human brain and label the prefrontal cortex and the central pattern generators. Use different colors to indicate which parts of the brain are active and inactive during sleepwalking. This visual representation will help you grasp the neurological aspects of sleepwalking.
Research a real-life case of sleepwalking and present your findings to the class. Include details about the person’s actions during the episode, any underlying causes, and how the situation was handled. This will give you a deeper understanding of the variety of behaviors and potential dangers associated with sleepwalking.
Create a sleep hygiene plan that includes tips for promoting healthy sleep habits. Consider factors like exercise, stress management, and a consistent sleep schedule. Share your plan with the class and discuss how these habits can help prevent sleepwalking episodes.
Divide into two groups and hold a debate on the effectiveness of different sleepwalking treatments. One group will argue for non-medical interventions like lifestyle changes and safety measures, while the other group will argue for medical treatments. This will help you critically evaluate the pros and cons of various approaches to managing sleepwalking.
Sleepwalking – A sleep disorder characterized by walking or performing other complex behaviors while asleep. – My sister used to sleepwalk when she was younger, and we would often find her wandering around the house in the middle of the night.
The prefrontal cortex – The anterior part of the frontal lobes of the brain, involved in complex behaviors such as decision-making and moderating social behavior. – Damage to the prefrontal cortex can result in impaired judgment and decision-making abilities.
Sensory inputs – Information received through the senses, such as sight, hearing, taste, touch, and smell. – The brain processes various sensory inputs to create our perception of the world around us.
Muscles – Soft tissues in the body that enable movement by contracting and relaxing. – Weightlifting helps to strengthen and tone the muscles in the arms and legs.
Central pattern generators – Neuronal networks in the spinal cord or brainstem that produce rhythmic motor patterns, such as walking or swimming, without requiring continuous sensory input. – Central pattern generators are responsible for generating the coordinated movements involved in activities like walking or running.
REM sleep behavior disorder – A sleep disorder in which a person physically acts out their dreams during REM sleep, often including vivid and violent movements. – Individuals with REM sleep behavior disorder may unintentionally punch or kick while dreaming, potentially causing injury to themselves or their sleep partners.
Non-REM sleep – The stage of sleep that does not include rapid eye movement (REM) and is typically associated with deep sleep, restorative processes, and the consolidation of memories. – Non-REM sleep is characterized by slower brain waves and reduced muscle activity.
Slow-wave sleep – A stage of deep sleep characterized by slow brain waves (delta waves) and a state of decreased activity in the body. – Slow-wave sleep is essential for physical and mental restoration.
Sleep terrors – A sleep disorder characterized by episodes of intense fear, screaming, and flailing while asleep, often accompanied by a lack of memory of the event upon awakening. – Sleep terrors can be distressing for both the individual experiencing them and their sleep partner.
Causes and treatment of sleepwalking – The reasons behind sleepwalking can vary and may include genetic factors, sleep deprivation, stress, or certain medications. Treatment may involve improving sleep hygiene, addressing underlying conditions, and, in severe cases, medication. – A sleep specialist can help determine the causes and appropriate treatment options for individuals experiencing sleepwalking episodes.
