Sleepwalking in Adults: Causes, Risks, and What to Do

Most people associate sleepwalking with children, but adult sleepwalking is more common than the general public assumes. Approximately 3.6% of U.S. adults -- roughly 8.4 million people -- experience a sleepwalking episode in any given year.

What Happens in the Brain During Sleepwalking

Sleepwalking is classified as a non-REM parasomnia -- it occurs during deep slow-wave sleep (N3), not during dreaming. During a sleepwalking episode, part of the brain remains in deep sleep (the cortex, responsible for consciousness and memory) while the motor cortex partially activates, allowing movement.

This is why sleepwalkers can perform complex behaviors -- walking, eating, even driving -- with no memory of the episode. Episodes typically occur in the first third of the night when slow-wave sleep is most concentrated.

Causes of Adult Sleepwalking

Sleep Deprivation

This is the most consistent trigger. When sleep-deprived, the brain enters deep slow-wave sleep more intensely and for longer periods when sleep finally occurs (slow-wave sleep rebound). This intensification makes partial arousals -- the mechanism behind sleepwalking -- more likely. Even one to two nights of inadequate sleep can trigger an episode in those predisposed.

Genetics

Sleepwalking runs strongly in families. If one parent sleepwalks, a child has a 45% chance of sleepwalking. If both parents do, the probability rises to 60%. The genetic component appears to involve the architecture of slow-wave sleep -- particularly how easily partial arousals occur.

Medications

Sedative-hypnotic medications -- particularly the Z-drugs (zolpidem/Ambien, eszopiclone, zaleplon) -- are strongly associated with sleepwalking and complex sleep behaviors. The FDA has issued black box warnings for this drug class. Other implicated medications include some antidepressants, antipsychotics, beta-blockers, and lithium.

Sleep Apnea

Obstructive sleep apnea fragments slow-wave sleep with repeated micro-arousals as the brain rouses the body to restore breathing. These arousals can trigger sleepwalking episodes. In research studies, treating sleep apnea with CPAP therapy often resolves the sleepwalking without any other intervention.

Alcohol and Substances

Alcohol suppresses REM sleep and initially increases slow-wave sleep, then causes a rebound effect in the second half of the night. This fragmentation in the context of increased slow-wave sleep pressure creates ideal conditions for sleepwalking episodes.

Safety: The Most Important Concern

Most sleepwalking episodes are benign -- the person walks around briefly and returns to bed. But injuries do occur. Practical safety measures:

• Lock exterior doors and windows, or install door alarms
• Gate the top of stairs
• Remove hazardous objects from the bedroom floor
• Consider a motion-activated alarm that wakes the person before they leave the bedroom
• Avoid top bunks

Treatment Approaches

Treating underlying causes first: Sleep deprivation, sleep apnea, and medication side effects should be addressed before any other intervention, as resolving these often resolves the sleepwalking entirely.

Anticipatory awakening: If episodes occur at consistent times, gently waking the person 15 to 30 minutes before their typical episode time disrupts the sleep cycle and prevents it. This behavioral technique has solid clinical evidence for both children and adults.

Medication: For frequent, potentially dangerous sleepwalking, low-dose benzodiazepines or tricyclic antidepressants may be prescribed to suppress slow-wave sleep. This is generally a second-line approach after behavioral measures.

Since sleep deprivation is the dominant modifiable trigger, optimizing sleep quality is foundational. Our guide on how sleep changes with age covers why sleep architecture (including slow-wave sleep) shifts over time, which is relevant to understanding why sleepwalking can resurface in middle-aged adults. See also our related guide on sleep talking, another parasomnia with shared mechanisms.

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Frequently Asked Questions About Sleepwalking

Is it dangerous to wake a sleepwalker?

The old advice to never wake a sleepwalker is a myth. It is not medically dangerous to wake one. However, the person may be briefly confused, disoriented, or even agitated when woken abruptly. Gently guiding them back to bed without waking them is usually the most practical approach.

Why do adults suddenly start sleepwalking?

New-onset sleepwalking in adults is most commonly triggered by significant sleep deprivation, high stress, certain medications (especially sedative-hypnotics like zolpidem), fever, or the development of a co-occurring sleep disorder like sleep apnea.

Can sleepwalking be treated without medication?

Yes. For most cases, improving sleep hygiene, eliminating triggers (alcohol, sleep deprivation, certain medications), and securing the sleep environment are sufficient. Anticipatory awakening -- waking the person 15 to 30 minutes before their typical sleepwalking episode -- is a behavioral technique with good evidence.

Is adult sleepwalking linked to sleep apnea?

Yes. Sleep apnea can trigger sleepwalking episodes by causing brief arousals from deep sleep. Treating the sleep apnea often resolves the sleepwalking, particularly in adults with new-onset sleepwalking.

When should I see a doctor about sleepwalking?

Seek evaluation if: sleepwalking occurs more than once per week, episodes involve potentially dangerous behaviors, a partner observes breathing pauses or gasping, or episodes began suddenly in adulthood without an obvious trigger like new medication or acute stress.