While scientists have made strides in understanding sleepwalking and night terrors, including finding that familial cases start earlier and are more severe, the fundamental question of why some people develop these behaviors remains unanswered.
A comprehensive review published in the Journal of Sleep Research examines the current state of parasomnia research and outlines the challenges that lie ahead for scientists trying to unlock these nighttime mysteries.
The Hereditary Puzzle
Sleepwalking is one of the most commonly inherited sleep disorders, yet DNA studies remain surprisingly scarce. Recent research by Battiato and colleagues in 2025 found that familial cases of disorders of arousal, which include sleepwalking and night terrors, differ significantly from sporadic cases.
"Familial disorders of arousal start earlier in life and are more severe than sporadic cases," the researchers found, suggesting that genetic factors play a substantial role in determining not just whether someone develops these conditions but how severely they are affected.
Despite this strong hereditary pattern, scientists have struggled to identify specific genes responsible. Unlike some other sleep disorders, researchers have not yet developed an animal model for sleepwalking or night terrors, which has limited their ability to study the underlying mechanisms.
Mental Health Connections
A large-scale study published in Psychiatry and Clinical Neurosciences examining data from 370,000 patients with sleep disorders found a significant association between self-reported parasomnias and psychiatric illness.
The research suggests that sleepwalking and related conditions may serve as indicators of depression and anxiety, though the nature of this relationship remains unclear. Whether parasomnias contribute to mental health problems, result from them or share common underlying causes is still being investigated.
Disorders of arousal may be considered as indicators of depression and anxiety, opening new avenues for understanding the connection between sleep and mental health.
New Tools for Diagnosis
One area of clear progress is in diagnostic technology. Researchers are developing new home-based devices that could make studying parasomnias easier and more accessible.
Current diagnostic tools under development include:
- Advanced actigraphy devices that track movement patterns during sleep
- EEG headbands that monitor brain activity outside the laboratory
- 2D infrared cameras that can record nighttime behaviors
- 3D time-of-flight cameras with automatic analysis capabilities
These technologies could help researchers gather data from patients in their natural sleep environments rather than in artificial laboratory settings, potentially capturing behaviors that might not occur during a single night in a sleep clinic.
Communicating With Sleepwalkers
Research published in the journal Sleep in February 2025 examined an intriguing question: Can we communicate with sleepwalkers during their episodes?
The study, titled "Talking to sleepwalkers? Response to communication efforts in disorders of arousals," explored whether individuals experiencing sleepwalking episodes could respond to verbal prompts or questions.
Understanding whether and how sleepwalkers can interact with their environment during episodes could provide insights into the nature of consciousness during these states and potentially lead to new intervention strategies.
The Classification Challenge
Parasomnias encompass a range of conditions that occur during different stages of sleep. Disorders of arousal, including sleepwalking and night terrors, occur during non-REM sleep, while conditions like REM sleep behavior disorder occur during the dreaming stage of sleep.
Night terrors typically involve sudden arousals with intense fear, rapid heart rate and often loud screaming, usually without any memory of the episode. Sleepwalking involves complex behaviors like walking or performing routine tasks while partially asleep, typically during deep sleep.
Despite decades of research, scientists still do not fully understand why some people develop these behaviors while others, sleeping in the same environments and with similar genetics, do not.
What Patients Can Do
For those living with parasomnias or caring for family members who experience them, experts recommend several safety measures:
- Securing the sleep environment by locking doors and windows
- Removing sharp objects or obstacles from bedrooms and hallways
- Installing alarms or bells on doors to alert family members
- Maintaining consistent sleep schedules, as sleep deprivation can trigger episodes
- Avoiding alcohol and certain medications that can increase risk
- Consulting a sleep specialist, particularly for frequent or dangerous episodes
The Road Ahead
As research continues, scientists hope to develop better treatments for parasomnias. Current management focuses primarily on safety measures and addressing triggers, as no medications are specifically approved for sleepwalking or night terrors.
The development of animal models, advances in genetic research and new diagnostic technologies may eventually unlock the mysteries of why some brains produce these unusual nighttime behaviors. Until then, the question of why we sleepwalk remains one of sleep medicine's most fascinating unsolved puzzles.
