Dr C P Ravikumar

Understanding Sleepwalking and Sleeptalking in Children: Causes, Concerns, and Solutions

Walking
Sleepwalking and sleep talking are common sleep disturbances, particularly in children, often leaving parents feeling concerned and confused. While these behaviours are typically harmless, they can disrupt the child’s rest and occasionally present safety risks. Sleepwalking involves the child performing activities, such as walking, during deep sleep, while sleep talking refers to talking while asleep, often without the child being aware. These behaviors are more commonly observed in children than adults and generally resolve on their own as the child matures. Understanding the underlying causes and management strategies for these behaviors is crucial in ensuring the child’s safety and well-being. Sleepwalking is characterized by partial arousal during slow-wave sleep (Broughton et al., 1968). One of the primary risks associated with sleepwalking is the potential for injury, either to the sleepwalker or others, due to impaired perception. Although sensationalized cases of sleepwalking-related injuries occasionally capture public attention (Xie et al., 2016), most instances go unnoticed and are rarely reported to healthcare providers. As a result, sleepwalking is seldom recorded as a cause of significant injury, hospitalization, or death.

Causes of sleep walking and sleep talking :

Sleepwalking and sleep talking are types of parasomnias, which are sleep disorders that can be caused by a variety of factors, including genetics and environmental influences. While these behaviors may appear unusual, they are typically harmless and occur during deeper stages of sleep. Below are some common causes:

  1. Genetics: Genetics plays a significant role in sleepwalking and sleep talking. Children with a family history of sleepwalking or other parasomnias are more likely to experience these behaviors themselves. Research indicates that sleepwalking can be hereditary, and many sleep specialists report a higher prevalence of sleepwalking or sleep terrors in first-degree relatives of affected individuals. In a study of seven families, 34 out of 50 close relatives were found to have a history of sleepwalking (Cao et al., 2010).

  2. Sleep Deprivation: Inadequate or irregular sleep can trigger episodes of sleepwalking and sleep talking. When children are overtired, their brains may struggle to transition smoothly between sleep stages, increasing the likelihood of parasomnias. Ensuring a consistent sleep schedule and sufficient rest can help minimize these behaviors.

  3. Stress and Anxiety: Emotional stress, anxiety, or changes in routine can lead to sleep disturbances. Situations such as starting a new school, family changes, or even excitement about upcoming events can cause heightened activity in the child’s mind, increasing the chances of sleepwalking or talking. The link between psychological factors and sleepwalking has been debated, with some studies suggesting a connection between sleepwalking and anxiety. For instance, a study in Hong Kong found a prevalence rate of 8.5% for sleepwalking in a large psychiatric outpatient clinic (Lam et al., 2010).

  4. Sleep Disorders: Other underlying sleep disorders, such as sleep apnea, restless leg syndrome, or night terrors, can increase the risk of parasomnias. These conditions disrupt sleep, making it harder for children to experience restful, uninterrupted rest, which can lead to sleepwalking or talking.

  5. Fever or Illness: When children are ill, especially with a fever or cold, their sleep patterns may be disrupted, increasing the likelihood of sleepwalking or sleep talking. The heightened arousal during illness can make it easier for these behaviors to occur.

  6. Medications or Substance Use: Certain medications, such as sedatives, antihistamines, or those used to treat ADHD, can cause sleep disturbances. In some cases, these medications may increase the likelihood of parasomnias. It’s important to consult with a pediatrician if sleepwalking or talking starts after the introduction of a new medication. For instance, in a case series involving 389 patients using lithium, 6.9% of patients experienced sleepwalking, which was linked to the initiation of lithium treatment or the use of other psychotropic drugs (Pressman et al., 2007). However, it has been suggested that in heavily medicated patients, sleepwalking may actually be a side effect of central nervous system depression rather than typical sleepwalking.

  7. Environmental Factors: A child’s sleep environment can influence sleep disturbances. External factors such as noise, temperature, or bright lights may disrupt sleep, triggering episodes of sleepwalking or sleep talking. A calm, dark, and comfortable sleep environment is essential for improving sleep quality.

  8. Developmental Factors: Sleepwalking and sleep talking are more common in younger children, especially between the ages of 3 and 8, as their sleep cycles are still developing. During this stage, children spend more time in deep sleep (slow-wave sleep), which increases the likelihood of parasomnias.

    In most instances, sleepwalking and sleep talking in children are temporary and tend to lessen as the child gets older. However, if the episodes become frequent, intense, or pose safety risks, it is essential to consult a pediatrician or sleep specialist to exclude underlying conditions and identify suitable solutions. Sleepwalking is a relatively common condition, particularly in children. Epidemiological studies have shown that its prevalence decreases with age. While there has been growing interest in understanding the genetic factors associated with sleepwalking, the exact role of genetic inheritance in determining the risk remains uncertain but continues to be a topic of significant research.

Treatment strategies :

  • Establish a Consistent Bedtime Routine: One of the most effective strategies for reducing sleepwalking and sleep talking is implementing a consistent and calming bedtime routine.

  • Ensure Adequate Sleep: Sleep deprivation is a common trigger for both sleepwalking and sleep talking. It is essential to ensure the child gets sufficient sleep each night, typically 9-12 hours depending on their age. If the child is chronically sleep-deprived, prioritize their sleep schedule and consider earlier bedtimes.
  • Manage Stress and Anxiety: Stressful events, routine changes, or anxiety can trigger sleepwalking or sleep talking. Teaching your child relaxation techniques, such as deep breathing, meditation, or gentle stretching, can help reduce the likelihood of these behaviours. For children experiencing significant anxiety, consulting a therapist or counsellor may be beneficial in addressing the underlying emotional triggers.

  • Implement Safety Measures: If sleepwalking poses a safety risk, it is crucial to take steps to prevent injury. Consider installing safety gates on stairs, removing sharp objects or obstacles from the child’s room, and ensuring that windows and doors are securely locked. In some cases, parents may choose to gently guide the child back to bed or wake them during episodes, but this should be done cautiously to avoid confusion or agitation.
  • Parental Education and Support: Educating parents about the nature of sleepwalking and sleep talking can help alleviate anxiety and improve their responses to these behaviours. Understanding that these episodes are generally harmless and tend to decrease with age can be reassuring. Parents may also benefit from support groups or counselling to help manage the challenges of dealing with sleep-related issues.

  • Medication: Clonazepam has been shown to be effective in controlling sleepwalking and sleep talking with a low risk of tolerance, adverse effects, or dependency (Schenck et al., 1968).

Conclusion:

In most cases, sleepwalking and sleep talking in children are temporary and tend to resolve as the child grows older. However, by implementing the right strategies, parents can reduce the frequency of episodes, ensure the child’s safety, and improve their overall sleep quality. If these behaviours persist or significantly impact the child’s well-being, seeking professional advice from a paediatrician or sleep specialist is recommended for further evaluation and treatment. With patience and appropriate management, children can experience improved sleep, and parents can feel confident that they are handling these behaviours in a safe and supportive manner.

References:

  1. Broughton RJ. Sleep disorders: Disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in “dreaming sleep”. Science. 1968; 159(3819):10708. doi: 10. 1126/science.159.3819.1070 PMID: 4865791
  2. Xie Q. Naked sleepwalker found in Manchester city centre at 4amby police who returned him to his hotel after posing for a selfie. Daily Mail Australia. 2016;Monday, May 30th 2016
  3. Banerjee, D., & Nisbet, A. (2011). Sleepwalking. Sleep Medicine Clinics, 6(4), 401–416. https://doi.org/10.1016/j.jsmc.2011.07.001
  4. CaoM,Guilleminault C. Families with sleepwalking. Sleep Med 2010;11:726–34.
  5. Lam SP, Fong SY, Ho CK, et al. Parasomnia among psychiatric outpatients: a clinical, epidemiologic, cross-sectional study. J Clin Psychiatry 2008;69: 1374–82. 72. Lam SP
  6. Pressman MR. Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev 2007; 11:5–30. 37. Joncas S, Zadra A, Paquet J, et
  7. Schenck CH, Milner DM, Hurwitz TD, et al. A polysomnographic and clinical report on sleep related injury in 100 adult patients. Am J Psychiatry 1989;146:1166–73.
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