Gibberish, urine, and utter chaos: What happens when you sleepwalk - Emmanuel During
Mumbling fantastical gibberish;
devouring blocks of cheese in the nude;
peeing in places that aren’t toilets;
and jumping out of windows.
These are all things people have
reportedly done while sleepwalking,
a behavior that’s mostly benign
but can be dangerous in rare cases.
It's estimated that around 18% of people
sleepwalk at least once in their lives.
So, what exactly is sleepwalking?
First, we have to understand just how
many of our daily activities
do not require our active attention.
Your prefrontal cortex is
your brain's conscious,
deliberate, decision-making control hub.
You might decide to get up and walk
using your prefrontal cortex,
but the intricate coordination
of sensory inputs and muscles
that follows 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.
And 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.
But 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.
But 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.
