Sleepwalking and Sleep Terrors

What it is

These are events that arise from the deepest, dreamless stage of sleep, known as non-REM or slow-wave sleep, which is heaviest in the first third of the night. During an episode the brain is caught between deep sleep and waking: the body can move and act, but the person is not conscious and forms no memory. This is why a sleepwalking child can have their eyes open, walk around and even talk, yet be impossible to reason with and remember nothing in the morning.

Two main forms exist. In sleepwalking, the person rises and moves about, sometimes doing complex things, with a blank or confused manner. In sleep terrors, the person suddenly sits up or screams in apparent intense fear, with a racing heart and rapid breathing, looking terrified but not actually awake and not responding to comfort. Sleep terrors are quite different from ordinary nightmares, which happen later in the night, involve a remembered dream, and leave the person fully awake.

What it can feel like, especially for families

For the person who has them, there is usually nothing to feel: no memory, no distress in the moment. The experience falls almost entirely on the family, and it can be frightening. Parents describe a child screaming inconsolably yet not recognising them, or finding a child wandering the house, eyes open, unreachable. Watching a sleep terror is often more distressing for the parent than for the child, who is peacefully asleep again within minutes and remembers nothing.

The most useful thing to understand is that the child is not in danger from the fear itself and is not awake to be comforted. The instinct to wake them is best resisted, since waking from deep sleep mid-episode causes more confusion; gentle guidance back to bed is enough.

How common is it

These events are common in childhood and become much less frequent with age. A large share of children sleepwalk at least once, and a meaningful proportion have sleep terrors, with both peaking in the early school years and usually fading by adolescence as the pattern of deep sleep matures. They are far less common in adults, and new onset in adulthood is more likely to need investigation.

What causes it

There is often a genetic tendency; these events run in families. Episodes are made more likely by anything that deepens sleep or fragments it: not enough sleep, irregular schedules, fever and illness, a full bladder, stress, and in adults alcohol or certain medicines. Untreated sleep apnoea or restless legs can also trigger them by repeatedly disturbing sleep. Importantly, in children these events are not a sign of psychological disturbance or trauma; they are a normal quirk of a developing sleep system in most cases.

How it is diagnosed

The diagnosis is usually clear from the description: dramatic events early in the night, no memory afterwards, and the characteristic features of each type. A clinician asks about timing, what happens, family history, sleep schedule and possible triggers. A sleep study is not usually needed for typical childhood episodes, but it is considered when events are frequent, injurious, begin in adulthood, or when another sleep disorder such as apnoea is suspected of triggering them.

How it is treated

For most children, no medical treatment is needed; the events are outgrown. The priorities are safety and good sleep. Safety means securing the environment: locking outside doors and windows, removing obstacles and hazards, and using a ground-floor bedroom or a stair gate where sleepwalking risks a fall. Good sleep means ensuring enough of it and keeping a regular schedule, since overtiredness is a major trigger. Where episodes happen at a predictable time, gently rousing the child briefly a short while before the usual episode can interrupt the pattern. Treating any underlying sleep apnoea, restless legs or stress reduces episodes. In the uncommon cases that are frequent, dangerous or persist into adulthood, a specialist may consider medication.

Sleepwalking and night terrors in the African context

Sleepwalking and night terrors are common in children and usually harmless, but they can be frightening to witness, and in many settings here a child who walks, screams, or thrashes in the night is feared to be possessed, bewitched, or spiritually attacked, which adds fear to what is in fact a normal part of childhood for many. The episodes happen in deep sleep, the child is not truly awake and will not remember them, and most children simply grow out of them. The reassuring messages are that this is usually not a sign of illness or anything spiritual, that the main task is keeping the child safe, and that help is worth seeking only if episodes are frequent, dangerous, or persist.

Helping a child

A calm, safety-first response is what matters most.

• During an episode, try not to wake the child; gently guide them back to bed and keep them safe.
• Make the sleeping area safe, securing windows, doors, and stairs and removing hazards, since injury is the main risk.
• Keep a regular, calm bedtime and enough sleep, since tiredness and irregular sleep trigger episodes.
• Reassure yourself and the child that this is common and not spiritual or a sign of illness, and that they will likely grow out of it.
• Seek advice if episodes are frequent, dangerous, or continue into the teens. Our find a therapist page can help.