Where does sleepwalking in children come from and is it related to epilepsy?

Is your child sitting up in bed at night, wandering around the house, and not responding to calls? Many parents in this situation search for information about sleepwalking in children on various online forums, wondering whether it's a temporary developmental stage or a sign of a more serious health problem. Doubts arise especially when the question arises about the connection between sleepwalking and epilepsy in children. When analyzing the causes of sleepwalking in children, it's important to understand the origins of this phenomenon and the mechanisms behind this sleep disorder. In this article, we explain the possible causes of sleepwalking in children and suggest when consultation is recommended and which doctor to consult with your child.

Where Does Sleepwalking Come From? Causes of Sleepwalking in Children of Developmental Age

Imagine 8-year-old Maja, who an hour after falling asleep, suddenly sits up in bed, gets up and absentmindedly looks around at the toys on the floor. This is a typical image. somnambulism – disturbances in waking from the deep NREM sleep phaseWhen we wonder where sleepwalking comes from, it's worth knowing that a child then he is not fully aware of his actions, although it performs complex motor activities.

Expert advises

When we analyze the causes of sleepwalking in children, we most often talk about the immaturity of the nervous system – the brain "wakes up" partially, and the body begins to function. This is why, in most cases, the causes of sleepwalking in children are developmental in nature and disappear spontaneously with age.

Emilia Konka

Resident doctor at the Department of Congenital Defects in Metabolism and Pediatrics, Institute of Mother and Child

Statistics show that somnambulism is a common phenomenon in the pediatric populationIt is estimated that sleepwalking episodes may affect up to 15–17% of children (depending on the research, this ranges from a few to a dozen or so percent) [1]. The first incidents most often occur between 4 and 8 years of age, and the peak of occurrence falls in the period late childhood and early adolescenceAs the nervous system matures, most children outgrow this condition, and in the adult population the prevalence decreases to a few percent [1].

Sleepwalking in children – genetic causes, stress and environmental factors

When considering the causes of sleepwalking in children in more detail, one cannot ignore the role of geneticsWhat causes sleepwalking in children? If both parents sleepwalked during childhood, the risk of a child developing sleepwalking is approximately 60%. If episodes involved only one parent, the risk decreases but remains high—around 45%.

The strong importance of genetic factors is also confirmed by twin studies: in monozygotic twins, the concordance of sleepwalking is observed in about half of the cases, while in dizygotic twins it is only 10–15% [1].

Answering the question about the causes of sleepwalking in children, specialists also point to factors that intensify the symptoms:sleep deprivation, fatigue, infection with fever or strong emotions experienced during the day.

On many internet forums where parents describe sleepwalking in their children, there are stories about the intensification of somnambulism episodes after moving, changing schools or during periods of separation anxiety (e.g. going to summer camp) – and indeed Stress can be one of the important causes of sleepwalking in children.

Expert advises

It's also worth remembering that the later in childhood the first symptoms appear, the greater the likelihood of them persisting into adulthood. Therefore, although in most cases somnambulism is mild and temporary, careful observation of the child and consultation with a specialist, if in doubt, remain the best approach.

Emilia Konka

Resident doctor at the Department of Congenital Defects in Metabolism and Pediatrics, Institute of Mother and Child

Sleepwalking in children and epilepsy – how to distinguish a parasomnia from an epileptic seizure?

The phrase "sleepwalking in children and epilepsy" regularly appears in search engines and on online parenting forums. This is understandable—both sleepwalking and epilepsy can manifest as sudden, uncontrolled movements at night. However, when analyzing the relationship between epilepsy and sleepwalking in children, it is important to emphasize that these are two different disorders with different causes and completely different treatments. However, it is worth remembering that parasomnias and epilepsy may coexist in the same patient.

Approximately one-third of children with nocturnal frontal lobe epilepsy (NFLE) have a history of previous episodes of sleepwalking or night terrors [2].

Sleepwalking in children 

Somnambulism is deep sleep arousal disorder (stages 3 and 4 of NREM) and it usually appears in the first half of the night, about 1,5–3 hours after falling asleep [1]. The episode lasts several minutes, and the child's behavior can vary—from sitting up in bed to pacing around the house. In this case, when we ask what causes sleepwalking, we're talking about immaturity of sleep mechanisms, not a neurological condition like epilepsy.

Epilepsy

Epilepsy and sleepwalking is a topic that requires careful consideration. differential diagnosis.

Expert advises

Nocturnal epileptic seizures—especially those involving the frontal lobe—are typically very brief (often lasting less than a minute, rarely 2-3 minutes), but they can occur multiple times a night, including in the early morning hours. The movements associated with epilepsy are stereotypical, meaning they appear almost identical each time (e.g., sudden jerks, characteristic "pedaling" of the legs, sudden body contortions). This is an important clue when considering the relationship between sleepwalking in children and epilepsy. Epilepsy can also be associated with an aura—a brief, specific sensation preceding a seizure, which is not observed in typical somnambulism.

Emilia Konka

Resident doctor at the Department of Congenital Defects in Metabolism and Pediatrics, Institute of Mother and Child

Epilepsy and sleepwalking in children – what tests does a doctor order most often?

In clinical practice, when the question arises about epilepsy and sleepwalking in children, the basis is detailed interview regarding the time, frequency and nature of episodesIn doubtful situations, perform EEG test, and sometimes video EEG-polysomnography, which allows you to simultaneously assess the brain function and behavior of the child during sleep.

This is the so-called gold standard in determining whether we are dealing with a parasomnia (sleep disorder) or epilepsy.

Sleepwalking in children and epilepsy – “red flags” that require urgent medical consultation

Although the causes of sleepwalking in children in most cases aredevelopmental character and disappear with age, there are so-called "red flags" that should prompt an urgent neurological consultation:

• very frequent and short episodes every night, 
• their repeatable (identical) course, 
• occurring in the second half of the night or in the morning,
• injuries occurring during incidents. 

Expert advises

Correctly distinguishing between sleepwalking and epilepsy is crucial and should be made by a physician. Sleepwalking in children usually does not require pharmacological treatment, whereas epilepsy requires constant monitoring by a specialist and appropriately tailored therapy.

Emilia Konka

Resident doctor at the Department of Congenital Defects in Metabolism and Pediatrics, Institute of Mother and Child

Sleepwalking in children – which doctor should you consult?

Although sleepwalking in children is often benign and developmental, any situation that raises parental concerns should be consulted with a specialist. Which doctor should you see if your child is sleepwalking? It's best to start with a visit to your pediatrician.who will assess the situation and decide which doctor can help with a more detailed diagnosis.

Depending on the clinical picture, the child may be referred to pediatric neurologist (especially when there is a doubt: sleepwalking in children and epilepsy) or to the sleep disorder treatment clinicWhich doctor should you see if a specialist suspects that sleepwalking in children may be related to sleep-related breathing disorders—such as obstructive sleep apnea? In such a case, it may be necessary to consult a doctor. ENT consultationIn some cases, they also prove helpful. relaxation techniques and work on regulating emotional tension.

To sum up: Which doctor should you see if your child is sleepwalking? It's definitely not worth seeking a diagnosis for your child from a forum online, or among other parents. If you notice your child sleepwalking or suspect epileptic seizures, consult a pediatrician immediately. After analyzing the child's health, they will refer the parents to other specialists. 

Sleepwalking in children – treatment and effective ways to ensure safety 

Treating sleepwalking (somnambulism) in children is a process highly individualized, which depends on the patient's age, duration of the disorder, and the severity and frequency of episodes. It is worth emphasizing that in most cases, sleepwalking in children is temporary and does not require pharmacotherapy. When we analyze the causes of sleepwalking in children and consider the origins of sleepwalking in developmental age, it most often turns out that maturing the nervous system and taking care of basic environmental aspects are crucialthat help minimize episodes of somnambulism.

The main pillars of treatment for sleepwalking in children include:

1. Sleep hygiene: This is a fundamental element of managing sleepwalking in children. Maintaining consistent bedtimes and waking hours (including weekends), avoiding excessive bedtime, and maintaining a quiet, well-ventilated bedroom at a moderate temperature can help reduce episodes. In practice, disruptions to sleep rhythms are often one of the causes of sleepwalking in children.
2. Ensuring safety: If sleepwalking in children involves nocturnal wandering, the space should be prepared appropriately: remove objects/toys from the floor that could pose a tripping hazard, secure windows and doors, and avoid bunk beds. During an episode, do not abruptly wake the child—instead, calmly and carefully walk them back to bed. This is important because sudden awakenings can cause disorientation and severe anxiety.
3. Anticipatory wake-up: This behavioral method has been proven effective, especially when episodes occur at similar times. It involves gently waking the child approximately 15–30 minutes before the expected event (usually 1,5–2,5 hours after falling asleep) and maintaining the awake state for approximately 5 minutes. In many cases, this helps reduce the frequency of sleepwalking episodes.
4. Treatment of concomitant diseases: Sometimes the causes of sleepwalking in children are related to other disorders, such as sleep apnea (OSA) or restless legs syndrome (RLS). In such situations, effective treatment of the underlying cause—e.g., ENT in the case of tonsillar hypertrophy — can lead to complete resolution of sleep apnea symptoms. This demonstrates the importance of determining the cause of sleepwalking in a specific case.
5. Drug therapy: It is considered a last resort and used only for severe symptoms that pose a risk to the child's health. The most commonly recommended medications are benzodiazepines (such as diazepam, clonazepam, or alprazolam), which reduce deep sleep. Melatonin therapy is also suggested to regulate the circadian cycle, and, in rare cases, small doses of tricyclic antidepressants. The decision to use pharmacological treatment is always made by a doctor after a thorough analysis of the symptoms and causes of the child's sleepwalking.
6. Other methods: If stress is the trigger for episodes, relaxation techniques, psychotherapy, and in some cases, hypnosis can be helpful. Because sleepwalking in children can be strongly linked to emotional stress, working on stress regulation often yields very good results.

Summary: Sleepwalking in children – what is worth remembering?

Sleepwalking in children in most cases is a developmental phenomenon that disappears as the nervous system maturesWhen we analyze the causes of sleepwalking in children and consider the causes of sleepwalking in a specific case, it most often turns out that the key factors are: immaturity of sleep mechanisms, fatigue or stressAt the same time, the topic "sleepwalking in children and epilepsy" shows how important it is to carefully observe the child and quickly consultation with a doctor if your child develops disturbing symptoms, so-called red flags.

This article is for informational purposes only and does not constitute medical advice, so if you observe your child sleepwalking, do not seek advice on any online forum, but consult a doctor immediately. 

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Emilia Konka

Resident doctor at the Department of Congenital Defects in Metabolism and Pediatrics, Institute of Mother and Child