Should You Be Worried if You Sleepwalk or Sleep Talk?

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I was a sleepwalker as a child.

When I was 8 or 9 years old, my parents would tell me stories of the funny and bizarre things I did -- and I had no recollection of having engaged in such behaviors. Why would I try to walk to the swingset at 1 a.m. ? (Thank goodness we had an alarm that went off!) Why did I always have to sleep on the bottom bunk at sleepover camp? Why did I tend to mumble incoherent things as I was aimlessly walking around at night? It was my fascination with this disconnect between mind and body that sparked my interest in sleep medicine.

What exactly are sleepwalking and sleep talking?

Sleepwalking and sleep talking are two sleep disorders that fall under a much broader diagnostic category known as “parasomnias.” Parasomnias can range from simple talking during deep sleep to violently acting out a nightmare during REM sleep. The specific diagnosis depends on the time of night when you have the nighttime symptoms.

Although many people think that sleepwalking and sleep talking are the result of acting out a dream or speaking what is on your mind, the cause is actually quite the opposite. The mechanism behind why we sleepwalk and sleep talk is the same in both disorders, as they occur during deep, slow-wave sleep. We cycle in and out of slow-wave sleep all night long but tend to spend the most time in this stage during the first third of the night (which is when most episodes of parasomnia happen). Since they happen due to the same reason, many people (such as myself as a child!) engage in both behaviors either at the same time or different times throughout the week.

During slow-wave sleep, the conscious brain is shut off while the body is still able to move. Most sleepwalkers have little to no recollection of having done so unless someone tells them. Activities tend to resemble things that are routinely done, but look much more clumsy at night when the brain is asleep. Episodes can last from a few seconds to upward of 30 minutes and range from simple to complex behaviors such as walking, unlocking doors, cooking and driving.

The nighttime discussions of someone who engages in sleep talking can have a huge variety, ranging from mumbling a few incoherent words or sentences to engaging in a long, complex narrative. At times, the content can be completely random but may also be related to past or present daytime experiences. Decoding the message is usually impossible and completely unnecessary. Sleep talking happens outside of conscious awareness -- it isn’t even admissible in court!

What can cause sleepwalking and sleep talking to happen?

Many things can disrupt slow-wave sleep and trigger an episode. The most common culprit involves poor sleep hygiene and not getting enough sleep on a regular basis. Using electronics just before bedtime, having alcohol, drugs or nicotine within three hours of bedtime and keeping an inconsistent sleep-wake schedule can all increase the likelihood of episodes.

Sleepwalking and sleep talking can be hereditary, so keep an eye out for it if there’s a family member who engages in these nighttime behaviors. Medications including antidepressants and newer sleep aids, as well as medical disorders like sleep apnea, can trigger events. Stress, anxiety and depression have all been linked to higher rates of sleepwalking and sleep talking, as well.

These behaviors are rather common in children, but they typically outgrow them (which is exactly what happened with me by age 10). I often see parents who are worried that there’s something medically or psychiatrically wrong with their child because of such episodes. If it happens only occasionally and without any harm, there’s really no cause for concern, as the child will likely outgrow the issue.

If sleepwalking and/or sleep talking happens frequently, disrupts the family dynamic, puts one at harm or is overly embarrassing, one should definitely seek guidance from a sleep specialist. If an adult experiences frequent and/or dangerous sleepwalking or sleep talking episodes (with little or no history of it as a child), a consultation with a sleep specialist is warranted to rule out any medical or psychiatric triggers.

What reduces the risk and incidence of sleepwalking and sleep talking?

Treatment recommendations range from simple to complex and are the same for both disorders. Listed below are the most common things you can do to reduce the risk.

1. Get enough sleep! Sleep deprivation is a major cause of sleepwalking. Keeping inconsistent sleep-wake schedules and losing sleep for one or two nights can lead to an episode. Make sure you get enough sleep every night and keep a steady sleep-wake schedule every night, even on the weekends. Again, sleepwalking and sleep talking can be hereditary. I have a 5-year-old son, and he tends to sleepwalk if he has to go to bed late for some reason. When he gets enough sleep, he doesn’t sleepwalk. As a result, I make it a priority that he regularly gets to bed on time.

2. Avoid screens before bed and during the night. Screen time from electronics can significantly disrupt sleep and make it harder to fall asleep. With later sleep times come more sleep deprivation, and a greater risk of episodes.

3. Avoid exercise, alcohol and nicotine within three hours of bedtime. All of these can make it hard to fall asleep or disrupt slow-wave sleep.

4. Keep the home environment safe. There is no “one size fits all” solution -- just try to reduce the risk of injury in light of the episodes. Gates at the top of staircases or doorways, mattresses on the floor or even using alarms can help alleviate anxiety about harm.

5. Don’t engage with the sleepwalker/sleep talker mid-episode. This can actually prolong an event! Gently guide the sleepwalker back to bed without awakening.

6. Manage stress and depression. Try relaxation exercises and mindfulness meditation and, if necessary, seek the help of a mental health professional.

7. Avoid sleep aids. As these can bring on episodes, don’t use any sleep aids until you are given the green light from a sleep physician.

If none of the above work for you or your child, consider seeking the help of a sleep specialist. Medication isn’t usually a first-line treatment, but if the sleepwalking or sleep talking is disruptive to others, embarrassing or is potentially harmful, a sleep specialist can advise on the appropriate treatment. A medical professional can also identify or rule out what might be causing the episodes and provide more specific suggestions and treatment options.

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