Somnambulism or sleepwalking refers to the act of walking or moving around while still asleep and is a fascinating and intriguing mental health issue that remains a topic of interest to many scholars and lay people alike. Perhaps, conceive of a person who appears to be asleep and has no control over their body movements as they go through their different activities. This process takes place during non-REM stages of sleep which means that people are not completely unconscious during this activity. 

A study shows that sleepwalking is not a rare phenomenon and is more prevalent in children than in adults. It is most common in childhood and has been noted to reach its highest propensity between four and eight years of age. The overall prevalence is not constant and depends on the specific population sample that is investigated The recent one-year prevalence of sleepwalking was significantly higher among children (5. 0%) than among adults (1. 5%).

It applies mostly to children and reduces as people grow to adolescence and adulthood. In adolescence, boys and girls are affected alike; however, after adolescence, the incidence is somewhat more in males. Another fact about sleepwalking is that it is hereditary to some extent. Family history is another factor that influences the likelihood of the condition, as people with family members who sleepwalk are at an increased risk of the disorder. 

Sleep is categorized into stages; there are the REM (rapid eye movement) and NREM (non-rapid eye movement) stages. Sleepwalking mainly occurs during NREM sleep; however, it is most common in the stages that are characterized by slow-wave activity, stages 3 and 4. During these stages the brain is less sensitive to the stimuli, and the individual is only partially awake, which creates a propensity for complicated activities to transpire.

It is a dynamic process which is a network of various subcortical and cortical areas of the brain. There is some evidence that there may be a dysregulation of cortical-subcortical activity, where some regions of the brain that mediate motor behaviors might become activated whereas the cognitive areas may be in a state of sleep. This can lead to the execution of motor activities in a non-conscious manner. 

Based on various research, it has been identified that sleepwalking has genetic factors since monozygotic twins have a higher prevalence of somnambulism than dizygotic twins. In general, DQB1 genes have been implicated, especially in the occurrence of sleep-related motor disorders such as sleepwalking; Whites with the DQB1*0501 gene tend to sleepwalk in their lifetime than those without this gene. Third, sleepwalking also has another mode of inheritance: an autosomal dominant pattern with reduced expressivity.

Antibiotics, anticonvulsants, antidepressants, benzodiazepines, lithium, antipsychotics, SSRIs, quinine, beta-blockers and TCAs may induce non-epileptic sleepwalking events in persons with no history; zolpidem is associated with non-epileptic sleepwalking events. Sleep deprivation for more than 24 hours can provoke sleepwalking in predisposed individuals, this leads to further complication. 

It typically exhibits a positive outlook for most individuals. Nonetheless, in certain instances, it may result in physical injuries (such as falling from elevated surfaces or inadvertently passing through glass barriers) and socially awkward predicaments.  

Age Group 

Childhood to Adolescence: Sleepwalking is common in children and mostly affects kids aged between 4 and 8 years and may last up to adolescence. It is most frequent when a person is between these two ages and then subsides in subsequent decades. Sleepwalking is not only observed in children but also in adults, even though the cases can be a few. 

Basically, caregivers in the healthcare facilities may investigate an individual’s history of sleep patterns, present and past sleeping complaints, history of sleepwalking or other sleep problems. It is understood that presence of certain risk factors might be hereditary and family background may be helpful in collecting such data.

They may also perform a physical examination that is aimed at evaluating neurological responsiveness, muscle strength and presence of any traumas. A patient may get advised to get a sleep study that assists to record electrical activity of the brain, eye movements, muscle tone and leg movements during stages of sleep and even arousals, as well as the heart rhythm. 

• Mental Health Conditions: Some other psychological disorders such as anxiety, depression, post-traumatic stress disorder can be attributed to sleepwalking. 
• Neurological Conditions: People who have certain neurological states, including epilepsy, are reported to experience sleepwalking more frequently. 

• Abrupt Onset: On some occasions, children may start sleepwalking and there are no earlier signs of sleep problems in the child. One may be a non-sleepwalker all their lives, then they may start sleepwalking at some point in their lives. 
• Stress-Related: Disturbances such as stress, anxiety, or irregular programs may be the main reasons as to why one starts sleepwalking. The acuity of presentation may entail the acting out of sleepwalking drills during the periods of increased stress. 

• Lifestyle and Sleep Hygiene: It is also important to note that there are measures that can be taken to reduce or prevent sleepwalking as much as possible and these include practicing good sleep hygiene. They include setting for the specific time for sleep, creating comfortable sleep environment and avoiding activities that can stimulate the brain before sleeping.
• Safety Measures: When experiencing sleepwalking, there are ways to avoid accidents during such episodes. This could include relocating of wares in the bedroom, tying cords or moving any sharp objects out of the range of the sleepwalker’s reach, securing the doors and the windows, and using a baby gate at times. 
• Stress Reduction: Stress and anxiety are some of the factors that can cause a person to have increased episodes of sleepwalking. Psychoeducation of stress management including the part of relaxation, mindfulness and yoga can be reduce the frequency and severity of the episodes.
• Cognitive Behavioral Therapy (CBT): CBT can address the core psychological factors believed to cause sleepwalking. A therapist would be able to assist one in defining the triggers and appropriate methods of handling them. 
• Medication: The more frequently prescribed drugs are benzodiazepines, especially Clonazepam, that might possibly prevent sleepwalking. 

Psychiatry/Mental Health

• Install Alarms: It can be useful to employ alarm systems that can sound or motion detectors that can notify you when the sleepwalker begins to stir. These alarms can warn you early and enable you to step in. 
• Night Lights: These should be placed in halls, bedrooms and even the bathroom so that people will be able to see something during the night. This may assist in saving the sleepwalker from falling while moving around the house at night. 
• Safety Gates: In this case, the sleepwalker is likely to be moving around the house; hence, using gates in front of stairs or any other dangerous area is helpful. 
• Remove Hazards: Any objects that could be a threat to the child or baby such as sharp objects, heavy objects or other objects that may easily break should be either rearranged or placed out of reach. 

Neurology

• Clonazepam: It might be prescribed if sleepwalking is so severe, or potentially hazardous, or if it causes considerable distress. It may be taken before the sleep time. 
• Gabapentin: Several reports indicate that gabapentin may be effective in altering sleep outcomes or managing some sleep issue. It can also be taken before sleep hours. 

Neurology

• Cognitive-Behavioral Therapy (CBT): CBT may be useful to treat any stress or anxiety causes that may exist in patients that are suffering from sleepwalking. A therapist can assist in effectively diagnosing them and avoiding triggers at the same time. 
• Hypnosis: Hypnosis is occasionally used as a therapy when people suffer from sleepwalking and need help with this disorder. However, the results may differ for different individuals. 

Neurology

• Improve Sleep Hygiene 
• Try to go to bed at the same time each night and wake up at the same time each morning. 
• Never take caffeine, alcohol and any other stimulating product before going to bed 
• Choose a right and suitable mattress for your body posture and sleeping position. 
• Cognitive Behavioral Therapy (CBT) 
• CBT can assist in changing the disbelief and possibility of sleepwalking and decrease stress/anxiety that leads to sleepwalking. 
• Medication 
• Prescription medicines like benzodiazepines, some types of antidepressants, and melatonin can be given in severe or frequent conditions. 
• Safety Measures 
• Avoid creating risk factors around the sleeping area, it is advised to lock doors/ windows while using alarms.