Sleepwalking

Sleepwalking, like night terrors and sleep talking, usually occur about 2 hours after a child has fallen asleep. Like these other mild sleep disturbances, sleepwalking often takes place at the end of the first cycle of deep non-REM (rapid eye movement) sleep, but before the child is completely awake. This strange mixed state allows the child to act as if he were awake in some ways but not in others. He can walk, even open a door, or use the bathroom. But he isn't aware of what he is doing. He can't assess the possible danger of what he is doing. He won't understand much of what is said to him and won't remember anything.

Sleepwalking is common, though less so than sleep talking. Any child who has learned to walk can start sleepwalking. It is a good reason to use a crib as long as safely possible. The crib says, "This is where you belong." Although a toddler can "cruise" along inside the crib as often as every 3-4 hours, he can't really hurt himself—as long as he can't climb out!

But as he gets older, sleepwalking can be a threat to his safety. I had an 8-year-old patient who let himself out of the house and walked out into the street in his sleep! There's not much that a parent can do about sleepwalking in a child (unless it is due to emotional stress, usually only in children 6 or over), except to be sure the child is safe, and to avoid making matters worse. Parents should take the following steps:

• Install a hallway night-light.
• Install a soft alarm bell on your child's door to alert you when he's on the roam.
• If he's in a bunk bed, switch him to the bottom bunk, of course.
• To protect a sleepwalking child from falling, his floor should not be cluttered.
• Windows should be locked if there is any chance he could open them and climb out.
• Stairways should be closed off or gated, and access to other dangers-including the front door-should be blocked.
• When your child is found walking, any attempt to restrain him may agitate him. Often, you can lead him gently back to bed. This won't interrupt his sleep pattern. Waking him will. Waking him can also lead to embarrassment.
• Since sleepwalking and other sleep disturbances that occur during a mixed sleep-awake state are more likely to occur in older children (over 6) when they are under stress, it is important not to embarrass him or put him under more pressure, either at night or in the daytime. Embarrassing him is pressure too.

Don't talk about the sleepwalking during the day except to:

• explain to him your safety measures: the bottom bunk bed, picking up toys and other objects on his bedroom floor, the hall light, or the alarm; and
• reassure him that many children go through periods of sleepwalking and that you can make it safe for him. Most children outgrow sleepwalking.
• Be sure he gets all the sleep he needs—at naptime and at night. This may be the best protection against sleep walking.

Frequent sleepwalking in older children (usually over 6 years old) is much more likely to be a sign of psychological stress. Even if such a child's stress does not seem obvious, psychological assessment and treatment are called for.

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