Journal of Sleep Disorders & Therapy
Open Access

Clinical Approaches to Diagnosing and Managing Recurrent Adult Sleepwalking

Emily Nadine^{* *}Correspondence: Emily Nadine, Department of Sleep Medicine, Stanford University School of Medicine, Stanford, USA, Email:

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Description

Sleepwalking is one of the most intriguing and misunderstood phenomena within the scope of sleep medicine, occupying a curious intersection of neurology, psychology and social life. Unlike the common disturbances of sleep such as insomnia or obstructive sleep apnea, which are primarily rooted in difficulties with falling asleep or maintaining adequate breathing during the night, sleepwalking represents an entirely different disruption. It is a disorder that arises not from the inability to sleep, but from the body’s failure to stay anchored in the proper stage of unconsciousness. The very idea that a person can rise from bed, navigate their environment, sometimes even perform complex tasks, all while technically asleep, has fascinated both scientists and laypeople for generations.

One of the most remarkable aspects of sleepwalking is its defiance of our intuitive sense of sleep as a passive and immobile state. To the ordinary observer, sleep is synonymous with stillness: the body is at rest, the muscles relaxed, the eyes closed and consciousness suspended. Sleepwalking dismantles that picture. A sleepwalker may get up, walk across the house, rearrange furniture, prepare food or even leave their home, all while their conscious awareness remains absent. These behaviors can vary from mild and almost harmless to severe and dangerous, depending on the environment and circumstances. There are documented cases of people who have injured themselves falling down stairs, colliding with objects, or wandering outdoors in unsafe conditions. The potential for harm is real, yet many still treat sleepwalking as a benign quirk rather than a medical disorder worthy of deeper investigation.

From a neurological perspective, sleepwalking is thought to occur during slow-wave sleep, a stage of deep non-REM sleep that is crucial for restoration and recovery. It is during this stage that the brain’s arousal systems appear to misfire, creating a partial awakening. The sleeper becomes physically mobile without fully regaining consciousness. This hybrid state of being neither fully asleep nor fully awake is what allows the body to act out behaviors that would ordinarily require conscious decision-making. However, the precise neurobiological mechanisms remain incompletely defined. Theories point to abnormal communication between the brainstem, responsible for motor control, and higher cortical regions, which govern awareness and judgment.

The prevalence of sleepwalking adds another dimension to its significance. It is most common in children, with estimates suggesting that as many as one in five may experience at least one episode, often outgrowing the condition by adolescence. In adults, it is less frequent, but when present, it often carries greater implications. Adult sleepwalking is more likely to be recurrent, associated with stress, psychiatric conditions, or comorbid sleep disorders. It may also be linked to certain medications or substances that alter sleep architecture, such as sedatives or alcohol. While many children who sleepwalk do so harmlessly, adults may face heightened risks of injury, embarrassment or social disruption. The fact that sleepwalking persists in adulthood suggests a more ingrained neurological vulnerability rather than a temporary developmental phase.

The legal ramifications of sleepwalking are perhaps the most controversial and socially impactful dimension of the disorder. There have been rare but highly publicized cases where sleepwalkers have committed violent acts during episodes, ranging from assault to even homicide. In such cases, courts face the difficult question of whether the accused should be held criminally responsible for actions undertaken in a state of unconsciousness. These debates highlight the need for both greater medical understanding and clearer legal frameworks to address the intersection of involuntary behavior and accountability.