Sleepwalking and Night Terrors: Practical Management Strategies for Families and Adults

What Exactly Are Sleepwalking and Night Terrors?

Sleepwalking and night terrors aren’t just weird dreams or bad habits-they’re real medical events that happen while you’re asleep. These are types of parasomnias, which are abnormal behaviors that occur during sleep transitions, mostly in deep non-REM sleep. You might sit up, walk around, scream, or even try to run out the door-all while completely unaware. When it’s over, you usually have no memory of it. That’s the scary part for families: watching someone you love go through this without being able to wake them up properly.

These episodes are most common in kids between ages 3 and 8. About 1 in 5 children will sleepwalk at least once, and 1 in 10 will have night terrors. Most outgrow it by puberty. But adults can have them too-and when they do, it’s often a sign something else is going on, like sleep apnea, stress, or even a neurological issue.

How Are They Different From Nightmares?

People often mix up night terrors and nightmares, but they’re completely different. Nightmares happen during REM sleep, the dreaming stage, usually in the second half of the night. You wake up scared, remember every detail, and can talk about it. Night terrors? They happen in the first 90 to 120 minutes after falling asleep, during deep slow-wave sleep. The person might scream, thrash, sweat, and have a heart rate that spikes to 140 beats per minute. But they won’t remember any of it. You can’t reason with them during an episode. Trying to wake them usually makes it worse.

Sleepwalking is similar-it happens in deep sleep, not REM. But instead of screaming, the person gets up and moves. They might open cabinets, walk to the kitchen, or even try to drive. Some people have been known to leave the house. And again, they wake up confused, with no idea how they got there.

Why Do These Episodes Happen?

It’s not about being ‘stressed out’ or having bad dreams. The real trigger is sleep pressure. When your brain hasn’t had enough deep sleep-or when it’s interrupted-your body can get stuck in a weird halfway state. You’re not fully awake, but your motor system is partially active. That’s when walking, talking, or screaming happens.

Things that increase the risk:

• Not getting enough sleep (especially under 7 hours for adults)
• Irregular sleep schedules
• Fever or illness
• Sleep apnea or restless legs syndrome
• Family history (if a parent sleptwalked, the child has a 45% higher chance)
• Certain medications, like sedatives or antidepressants

Adult-onset parasomnias are especially concerning. If someone starts sleepwalking or having night terrors after age 25, it’s a red flag. It could mean an underlying condition like epilepsy, Parkinson’s, or severe sleep apnea. That’s why doctors recommend a sleep study if it starts in adulthood.

Safety First: What to Do Right Now

Before you try anything else-fix the environment. Most injuries from sleepwalking are falls, cuts, or wandering outside. Simple changes cut risk by 75%.

• Lock all doors and windows. Use alarms that beep when opened-those cost under $30 and are sold at hardware stores.
• Remove sharp objects, glass, or heavy items near the bed.
• Put the mattress on the floor if the person is prone to falling out of bed.
• Install gates at the top of stairs.
• Keep car keys, tools, and weapons locked away.
• Use a baby monitor or motion sensor to alert you if they get up.

One parent in Perth told me their 6-year-old started walking to the front door every night. They installed a door alarm, and within two weeks, the episodes dropped by 80%. No meds. Just safety.

What Actually Works to Reduce Episodes

There are three proven, non-drug methods that help most people.

1. Scheduled Awakenings

This is the most effective trick for kids. Figure out when the episode usually happens-say, 1:30 a.m. Wake the person up gently at 1:00 a.m., keep them fully awake for 5 minutes, then let them go back to sleep. Do this every night for 7 to 14 days. Studies show it works in 70-80% of cases. The theory? You’re interrupting the deep sleep cycle before the brain gets stuck.

2. Sleep Extension

Most kids and adults with parasomnias are sleep-deprived. Even 30 extra minutes of sleep a night can cut episodes in half. Try going to bed 15 minutes earlier for a week, then another 15 the next week. Keep a sleep diary to track changes. One adult I spoke with went from 7.2 to 8.5 hours of sleep and stopped sleepwalking entirely after 8 weeks.

3. Consistent Routine

Your body loves predictability. Go to bed and wake up at the same time every day-even on weekends. Keep the bedroom cool (60-67°F), dark, and quiet. Avoid screens for an hour before bed. Skip caffeine after 2 p.m. These aren’t just ‘good sleep tips’-they’re medical interventions for parasomnias.

When to See a Doctor

You don’t need to rush to a specialist for every episode. But call a sleep doctor if:

• Episodes happen more than twice a week
• There’s violence, aggression, or self-injury
• The person leaves the house or drives during an episode
• Confusion lasts more than 15 minutes after waking
• It starts in adulthood
• It’s affecting school, work, or relationships

Doctors may recommend a sleep study (polysomnography) to rule out sleep apnea or seizures. Video monitoring during sleep is the only way to confirm it’s a true parasomnia and not something else.

Medications: Are They Necessary?

Meds are rarely the first step. Only 5-10% of cases need them. But when they’re used, two options show results:

• Clonazepam (a benzodiazepine): Works in 60-70% of cases. But it can cause drowsiness, dependency, and tolerance in as little as 3 months. Used only for severe, frequent episodes.
• Melatonin: A safer option. Helps regulate sleep cycles. Studies show 40-50% reduction in episodes, especially in kids. Dose is usually 3-6 mg, taken 30 minutes before bed.

Newer options like daridorexant (an orexin blocker) are showing promise in trials, with fewer side effects than clonazepam. But they’re not yet widely prescribed for parasomnias.

What Doesn’t Work

Don’t waste time on these:

• Shouting or shaking the person during an episode-it can cause panic or aggression.
• Trying to reason with them-they’re not conscious.
• Home remedies like essential oils or herbal teas-no evidence they help.
• Waiting it out without safety changes-this is how injuries happen.

Also, don’t assume it’s ‘just a phase.’ While most kids outgrow it, untreated parasomnias can lead to anxiety, poor school performance, or even accidents. Early action matters.

What Parents and Partners Should Know

If you’re living with someone who has night terrors or sleepwalks:

• Stay calm. Don’t react with fear or anger.
• Guide them gently back to bed. Don’t force them to wake up.
• Keep a log: time of episode, duration, what they did, possible triggers (illness, stress, late bedtimes).
• Don’t blame yourself. This isn’t caused by bad parenting or poor discipline.
• Find support. Online groups like the Sleepwalking Foundation have real stories from families who’ve been there.

One mom told me she felt guilty for years until she learned 90% of night terrors resolve by age 13. Knowing that gave her peace.

The Future of Treatment

Technology is stepping in. The Nightware system, approved by the FDA in 2022, uses an Apple Watch to detect heart rate spikes that signal an impending night terror. It plays a soft sound to gently interrupt the episode before it fully starts. In trials, it cut episodes by 35%.

Apps like Sleepio now offer guided cognitive behavioral therapy for parasomnias (CBT-P), delivered over 8 weeks via smartphone. One study showed a 48% drop in sleepwalking episodes.

And genetic research is uncovering links-like variants in the DEC2 gene-that explain why some families are more prone. This could lead to personalized treatments down the line.

Final Takeaway

Sleepwalking and night terrors aren’t something to ignore. But they’re also not something to panic about. Most cases, especially in kids, improve with simple changes: more sleep, a safer room, and a steady schedule. For adults, it’s a signal to check for other sleep disorders. Medication is rare. Safety is everything. And with the right approach, these episodes can fade away-without drugs, without trauma, and without long-term damage.