Sleepwalking 

Updated: Mar 11, 2019
Author: Syed M S Ahmed, MD; Chief Editor: Selim R Benbadis, MD 

Overview

Practice Essentials

A common parasomnia, non−rapid eye movement (NREM) sleep arousal disorder, is described as being characterized by either somnambulism (ie, sleepwalking) or sleep terrors. The following describes NREM sleep arousal disorder, sleepwalking type.

Signs and symptoms

The history should address the following:

  • Detailed description of the event

  • level of consciousness before, during, and after the event

  • Time of night and sleep cycle when the events occur

  • Daytime sleepiness

  • Associated injury

  • Memory of the event

  • Family history

  • Any precipitating factors

  • Current Medications, if any

Reported symptoms may include the following:

  • Episodes ranging from quiet walking about the room to agitated running

  • Attempts to “escape” dangerous situations or terrifying threats

  • Eyes that are open and have a glassy, staring appearance

  • Slow or absent responses to questioning

  • In the absence of awakening, inability to remember the event; with awakening possible embarrassment (in older children)

Sleepwalking should be differentiated from the following conditions:

  • Confusional arousals

  • Sleep terrors

Physical and neurologic examinations are typically normal in sleepwalking children.

See Presentation for more detail.

Diagnosis

Diagnosis of sleepwalking should take into account miscellaneous sleep disorders, NREM parasomnias, and rapid eye movement (REM)–related parasomnias. Relevant miscellaneous sleep disorders include the following:

  • Benign neonatal sleep myoclonus

  • Bruxism

  • Congenital hypoventilation syndrome

  • Enuresis

  • Infant sleep apnea

  • Nocturnal paroxysmal dystonia

  • Periodic limb movements

  • Rhythmic movement

  • Somniloquy (sleep talking)

Normal NREM parasomnias are characterized by the following:

  • Hypnagogic or hypnopompic imagery

  • Sleep starts or hypnic jerks

REM-related parasomnias are much less common in children than in adults.

Other problems to be considered include the following:

  • Arrhythmias

  • Dissociative states

  • Dream anxiety attacks

  • Epilepsy in children

  • Gastroesophageal reflux

  • Nocturnal asthma

  • Tonic seizures

Principles of workup include the following:

  • No specific laboratory studies are indicated in the workup of routine parasomnias

  • No imaging studies are required

  • Polysomnography (PSG), with or without multiple sleep latency testing, is reserved for the few cases in which the diagnosis is still unclear after the history and physical examination

  • Electroencephalography (EEG) may be helpful; microarousals and sleep state disorganization are often noted on EEG done during nocturnal sleep

See DDx andWorkup for more detail.

Management

General management principles include the following:

  • Reassurance is the mainstay of treatment as sleepwalking is a benign condition

  • Any environmental or predisposing factors should be identified and eliminated

  • Auditory, tactile, and visual stimuli should be avoided early in the sleep cycle

  • Parents should be instructed to lock windows and doors, remove obstacles and sharp objects from the room, and add alarms (if necessary)

  • Comforting the child and gently redirecting him or her to bed may be appropriate; attempts to confront or awaken the patient during the events may be inadvisable

  • Pharmacologic therapy typically is not indicated

  • Sleepwalking associated with sleep-disordered breathing may improve or resolve with surgical treatment of the respiratory disorder

  • For long-term management, relaxation techniques, mental imagery, and anticipatory awakenings are preferred

See Treatment for more detail.

Background

Parasomnias are sleep-wake disorders characterized by undesirable motor, verbal, or experiential phenomena occurring in association with sleep, specific stages of sleep, or sleep-awake transition phases. In the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), one common parasomnia, non-REM (NREM) sleep arousal disorder, is described as being characterized by either somnambulism (ie, sleepwalking) or sleep terrors.[1]

For patient education resources, see the Sleep Disorders Center, as well as Disorders That Disrupt Sleep (Parasomnias), Sleepwalking, and REM Sleep Behavior Disorder.

Diagnostic criteria (DSM-5)

The specific DSM-5 criteria for NREM sleep arousal disorder, sleepwalking type, are as follows[1] :

  • Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the sleep cycle, accompanied by episodes of rising from bed and walking about

  • During sleepwalking episodes, a blank, staring face; relative unresponsiveness to efforts at communication; difficulty in awakening

  • Little or no recall of dream imagery

  • Amnesia for the episode

  • The episodes cause significant distress or impairment in social, occupational or other areas of functioning

  • The symptoms cannot be explained by another mental disorder, medical condition, or the effects of a drug of abuse or medication

In addition, if warranted, the sleepwalking type can be further differentiated into 1 of 2 subtypes:

  • With sleep-related eating (SRE)

  • With sleep-related sexual behavior (sexsomnia)

It was once theorized that sexsomnia occurred in individuals acting out their dreams as a consequence of an underlying psychological condition; however, such theories have been debunked. Sexual behaviors of all types may occur during a sleep automatism, ranging from explicit sexual vocalizations to violent masturbation to complex sexual acts that may include fondling, cunnilingus, fellatio, and even vaginal and anal sex.[2]

Features of sexsomnia are analogous to those of other NREM parasomnias that occur during what is known as a confusional arousal during the deeper stages of sleep. Throughout this time, the brain is in a hybridized state in which cortical areas (which control higher thought processing and reasoning) are deactivated while more primitive functions (eg, eating and sex) remain active. Individuals are typically amnestic for the episode. Those who commit these sexual acts typically have a family or personal history of other parasomnias.

In a small number of sexsomnia cases, medicolegal issues have arisen, though the actual forensic implications remain nebulous. Several of the cases have points in common—namely, the involvement of a male perpetrator younger than 35 years, accusations of sexual assault or rape, claims of amnesia after the event, and a history of prolonged complex somnambulism. This unusual parasomnia is more common than was previously thought; many patients with the behavior were identified only after specific questions were asked.[3, 4]

In addition to SRE, the literature describes another disorder involving the consumption of food during the night or at bedtime: night-eating syndrome (NES). A clear distinction should be drawn between SRE and NES: the latter is not categorized as a parasomnia, because full consciousness is maintained during NES episodes.

Although NES was first described by Stunkard et al in 1955, no uniform definition of this disorder has yet been adopted. NES is characterized by consumption of excessive amounts of food either before bed or during nocturnal awakenings. It is up to 4 times more common in females and tends to have an onset in late adolescence.[5, 6] According to the most commonly used current definition, NES is present if patients report the following:

  • Skipping breakfast 4 or more days per week (interpreted as morning anorexia)

  • Consuming more than 50% of total daily calories after 7:00 PM

  • Difficulty in falling asleep or staying asleep 4 or more days per week

Whether NES should be differentiated from nocturnal eating syndrome is not clear in the literature. However, the terms may be usefully distinguished as follows[7] :

  • NES may be defined as morning anorexia, evening hyperphagia, and insomnia

  • Nocturnal eating syndrome may be defined as eating at night after having gone to bed

SRE, on the other hand, can be conceptualized as a binge eating disorder that incorporates the disordered arousal, confusional behavior, and amnesia of an NREM parasomnia.[8] Episodes often occur within the first 2-3 hours of sleep, with ingestion of foods (commonly high in carbohydrates) in a hurried, uncontrollable manner. In contrast to other NREM parasomnias, a fluctuation in level of awareness exists between episodes within the same night. There is relatively high comorbidity with restless legs syndrome (RLS).[9]

Pathophysiology

The parasomnias have been thought to represent not pathologic cerebral functioning but, rather, a response to central nervous system (CNS) activation that results in sleep-wake or rapid eye movement (REM)–NREM state confusion, instability, or overlap. However, studies have demonstrated differences between sleep patterns and neuronal sleep control mechanisms in individuals who have parasomnias and corresponding patterns and mechanisms in individuals who do not.

Normal sleep involves cyclic hypnic patterns throughout the night between wakefulness, NREM, and REM states. The CNS remains active during all sleep-wake states, though rapid changes are required in neural networks, rhythms, and neurotransmitters with state changes. The length of each cycle averages 50 minutes for a full-term newborn, increasing to approximately 90 minutes by adolescence.

Slow-wave sleep (SWS) normally occurs in the first 2 hypnic cycles; younger children have an additional SWS period toward the end of the sleep period. Children typically enter their deepest sleep within 15 minutes of sleep onset, and this first SWS period lasts from 45-75 minutes. This explains why it is easy to move children without rousing them soon after sleep onset.

Parasomnias occur as children are caught in a mixed state of transition from one sleep cycle to the next (eg, from NREM sleep to wakefulness). This transition state is characterized by a high arousal threshold, mental confusion, and unclear perception.

Sleepwalkers appear to have an abnormality in SWS regulation. The dissociation that occurs between body and mind sleep appears to arise from activation of thalamocingulate pathways with persisting deactivation of other thalamocortical arousal systems. The first SWS period of the night is considered to be more disturbed in somnambulistic individuals, and the entire NREM-REM sleep cycle is more fragmented. Because these disorders occur more frequently in children, these differences have been suggested as signs of CNS immaturity.

Etiology

Genetic factors

Sleepwalking occurs more frequently in monozygotic twins and is 10 times more likely if a first-degree relative has a history of sleepwalking. An increased frequency of DQB1*04 and *05 alleles is reported. DQB1 genes have also been implicated in narcolepsy and other disorders of motor control during sleep (eg, REM behavior disorder).

Environmental factors

Sleep deprivation, chaotic sleep schedules, fever, stress, magnesium deficiency, and chemical or drug intoxication (eg, alcohol) can trigger parasomnias. Various medications can also serve as triggers, including the following:

  • Sedative-hypnotics (eg, zolpidem[10] )

  • Combination of valproic acid and zolpidem[11]

  • Antidepressants (eg, bupropion[12] , paroxetine, and amitriptyline)

  • Neuroleptics (eg, lithium and reboxetine)

  • Minor tranquilizers

  • Stimulants

  • Antibiotics (eg, fluoroquinolones)

  • Antiparkinsonian medications (eg, levodopa)

  • Anticonvulsants (eg, topiramate)[13]

  • Antihistamines

Physiologic factors

The length and depth of SWS, which is greater in young children, may be a factor in the increased frequency of parasomnias in children. Conditions such as pregnancy and menstruation are known to increase frequency in patients with parasomnias.

Comorbid conditions

Medical conditions associated with parasomnias include the following:

  • Arrhythmias

  • Chronic paroxysmal hemicrania

  • Migraine

  • Fever

  • Gastroesophageal reflux

  • Nocturnal asthma

  • Nocturnal seizures

  • Obstructive sleep apnea - Children with obstructive sleep apnea or Tourette syndrome are at greater risk of having parasomnias along with their underlying disorder[14, 15]

Chronic sleepwalking, especially in adults, is frequently associated with sleep-disordered breathing. Treatment of the sleep-disordered breathing with continuous positive airway pressure (CPAP) or surgery typically improves or resolves the sleepwalking. Noncompliance with CPAP is associated with persistence or recurrence of sleepwalking. Serotonin has been postulated as the physiologic link between these 2 disorders.

Thyrotoxicosis has been associated with an increased incidence of sleepwalking,[16] and achievement of euthyroidism is associated with improvement or resolution of the symptoms. Sleepwalking may occur as an early symptom, and the onset of sleepwalking in a patient out of the normal expected age range warrants evaluation for hyperthyroidism. The mechanism for the sleepwalking is considered to be increased fatigue in combination with longer periods of NREM sleep.

Psychiatric disorders associated with parasomnias include the following:

  • Posttraumatic stress disorder

  • Panic attack

  • Dissociative states

  • Major depressive disorder

  • Obsessive-compulsive disorder

Epidemiology

United States and international statistics

Disorders of arousal are all more prevalent in children than in adults. Confusional arousals are reported in 5-15% of children. Sleep terrors have an incidence of approximately 1%. The lifetime prevalence of nocturnal wandering with abnormal state of consciousness among US adults may be as high as 29.2%.[17] ; however, the prevalence of sleepwalking disorder, marked by repeated episodes and impairment or distress, is much lower (1-5%).[1]

In Sweden, the incidence of quiet sleepwalking is reported as 40%, with a yearly prevalence of 6-17%. Only 2-3% report more than 1 episode per month, and 33% report only a single episode. In a survey of adults in the United Kingdom, 2.2% reported having night terrors, 2.0% reported sleep walking, and 4.2% reported confusional arousals.

Age-, sex-, and race-related demographics

Sleepwalking occurs most commonly in middle childhood and preadolescence, with a peak incidence in children aged 11-12 years. A Canadian study of sleep data from a cohort of 1,940 children born in 1997 and 1998 in Quebec found prevalence of sleepwalking peaked at age 10 years. Data also show that prevalence of childhood sleepwalking increases with the degree of parental history of sleepwalking: 22.5% (95% CI, 19.2%-25.8%) for children without a parental history of sleepwalking, 47.4% (95% CI, 38.9%-55.9%) for children who had 1 parent with a history of sleepwalking, and 61.5% (95% CI, 42.8%-80.2%) for children whose mother and father had a history of sleepwalking.[18]

Confusional arousals are most common in toddlers and preschool-aged children. Violent or sexual activity is more likely in adults. Sleepwalking and confusional arousals have an equal incidence in males and females. Females are more likely to sleep eat. Sleepwalking occurs more often in females during childhood but more often in males in adulthood. No racial predilection is known.

Prognosis

The NREM parasomnias are rarely associated with any significant morbidity or long-term sequelae. Although disruptive and frightening for parents in the short term, these disorders rarely cause injury (though children can strike objects during sleepwalking and occasionally become injured). The prognosis for resolution with maturation is excellent.

Sleep-disordered breathing and, to a lesser extent, RLS have been associated with sleepwalking in children, though less often than in adults. The incidence of associated sleep disorders has been reported to be as high as 61%. Prolonged disturbed sleep may be associated with school and behavioral issues. A relationship with hyperactivity is suggested but not clear.

In adolescents and adults, morbidity may be more significant. More complex motor behaviors (eg, driving a car, cooking, eating, or playing a musical instrument) have been reported. Behaviors injurious to the patient or bed partner may be associated with forensic medicine implications.

An increased incidence of psychiatric disorders such as neuroses, panic disorder, phobias, and suicidal ideations has been reported in both these groups. Sleep-disordered breathing, including a sense of choking or blocked breathing, has also been reported. The respiratory events may have a deleterious effect on sleep by increasing arousals and sleep fragmentation.

Adolescents with sleep terrors or sleepwalking have an increased prevalence of other sleep disorders, neurotic traits, and other psychiatric disorders.

Serious injury, sexual misconduct, and violent behavior occurring during somnambulism have been reported in adults, albeit rarely. Most serious injuries have occurred as a result of leaping through windows. Some apparent “suicides” have likely been the unfortunate result of a sleep behavior. The violent behavior aspect, though rare overall, appears to occur more frequently in men than in women. Such behavior toward others has occasionally been used as a legal defense.

 

Presentation

History and Physical Examination

The most common pediatric parasomnia disorders of arousal include sleepwalking, confusional arousals, and sleep terrors.[19] Parasomnia events have a predilection for occurring during deep sleep (stages III and IV, or slow-wave sleep [SWS]), are known to occur during all stages of non−rapid eye movement (NREM) sleep, and are possible at any time during the night. Because most SWS is achieved in the earlier segments of the sleep period, these phenomena are usually seen in the first one third of the sleep cycle and are rarely seen during naps.

A general medical history and sleep-related medical history are usually sufficient to permit differentiation of parasomnias from other disorders. Pertinent issues include the following:

  • Detailed description of the event

  • level of consciousness before, during, and after the event

  • Time of night and sleep cycle when the events occur

  • Daytime sleepiness

  • Associated injury

  • Memory of the event

  • Family history

  • Any precipitating factors

Nocturnal frontal-lobe seizures and some psychiatric conditions present the most difficult diagnostic dilemmas. A history of stereotypical short attacks that repeat during the night, most frequently during stage II sleep, suggests seizures rather than a parasomnia. Onset in later childhood or adolescence, persistence into adulthood, recurring nocturnal agitation, and daytime complaints such as fatigue or sleepiness are also suggestive of a seizure disorder.

Sleepwalking episodes may range from quiet walking about the room to agitated running or attempts to “escape.” Subjects may later report attempting to escape dangerous situations or terrifying threats. Typically, the eyes are open and have a glassy, staring appearance as the child quietly roams the house.

On questioning, the child’s responses are slow or absent. If returned to bed without awakening, the child usually does not remember the event. Older children, who may awaken more easily at the end of an episode, often are embarrassed by the behavior (especially if it was inappropriate).

Sleepwalking has no association with previous sleep problems, sleeping alone in a room or with others, achluophobia (fear of the dark; also referred to as nyctophobia, scotophobia, or lygophobia), or anger outbursts. Some studies suggest that children who sleepwalk may have been more restless sleepers when aged 4-5 years and may have been more restless with more frequent awakenings during the first year of life.

Differentiation from confusional arousals and sleep terrors

Episodes of confusional arousal consist of disorientation, memory impairment, and slow mentation and often are accompanied by inconsolable crying and thrashing movements in bed. This disorder is common in younger children but decreases in frequency with age. In infants, episodes manifest by crying and moving about in bed. The eyes may be closed or opened, as in sleep terrors, but the child does not appear to feel panic.

Events typically last from 3-13 minutes and range in frequency from 2 times per night to 2 times per year. Attempting to awaken the child often prolongs the course, and successful wakening by parents typically brings about an end to the episode.

Sleep terrors are the most anxiety-provoking parasomnias for parents. Episodes frequently begin with a “blood-curdling” scream, which is accompanied by the appearance of panic with wide-open eyes, tachycardia, tachypnea, dilated pupils, diaphoresis, and flushing. This may be followed by panic-driven motor activity, such as hitting the wall or running around the room. Although the behavior typically is not dangerous, it is sometimes violent enough to result in injury to the patient or others; property damage also may result.

The inability of the parent to console the child is a hallmark of the episode (which is typically shorter than confusional arousals), and amnesia for the event is usually complete. Sleep terrors usually resolve by adolescence, though the disorder occasionally persists into adulthood.

Physical and neurologic examinations are typically normal in these children.

 

DDx

Diagnostic Considerations

Recognizing the occasional case where seizures are the cause of nocturnal events is imperative. This differentiation can be made on the basis an in-depth history of the episodes. Polysomnography (PSG) may be necessary to clarify the diagnosis.

Conditions that should be kept in mind fall into 3 main categories, as follows:

  • Miscellaneous sleep disorders

  • Normal non−rapid eye movement (NREM) parasomnias

  • Rapid eye movement (REM)-related parasomnias

The relevant miscellaneous sleep disorders are not sleep state−specific. The more common ones frequently generate questions for the pediatrician, but they are generally less anxiety-provoking than the NREM parasomnias are. These disorders include the following:

  • Benign neonatal sleep myoclonus

  • Bruxism – Nocturnal bruxism occurs in 15-22% of the population, usually in stage II sleep; the bite force may be considerably stronger than during wakefulness, resulting in tooth or gum injury

  • Congenital hypoventilation syndrome

  • Enuresis

  • Infant sleep apnea

  • Nocturnal paroxysmal dystonia

  • Periodic limb movements

  • Rhythmic movement disorder - Behaviors include head banging, body rolling, or body rocking; onset is usually before the age of 9 months (prevalence is 60% at that age but only 5% at 5 years); episodes rarely last more than 15 minutes, occurring during the drowsy state just before sleep onset and occasionally extending into light sleep)

  • Somniloquy (sleep talking)

Normal NREM parasomnias are characterized by the following:

  • Hypnagogic or hypnopompic imagery (a state of feeling awake but having dreams intrude; occurs at sleep onset or offset)

  • Sleep starts or hypnic jerks (typically a myoclonic jerk at sleep onset but also, rarely, manifested as a sudden flashing light, loud cracking, snapping noise, or sudden pain)

REM-related parasomnias are caused by disruptions in the REM-to-wakefulness transition; except for nightmares, these disorders are much less common in children than in adults. REM behavior disorder, cataplexy, and wakeful dreaming are considered abnormal. Anxiety dreaming or nightmares are considered normal.

In addition to these and the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Arrhythmias

  • Dissociative states

  • Dream anxiety attacks

  • Epilepsy in children

  • Gastroesophageal reflux

  • Nocturnal asthma

  • Tonic seizures

Differential Diagnoses

 

Workup

Approach Considerations

No specific laboratory studies are indicated in the workup of routine parasomnias. No imaging studies are required.

Polysomnography (PSG), with or without multiple sleep latency testing, should be reserved for the few cases in which the diagnosis is still unclear after a careful history and physical examination. The abnormal behavior during slow-wave sleep (SWS) is generally diagnostic. Sleep deprivation can be used as a tool to induce somnambulistic episodes in the sleep laboratory.

Microarousals and sleep state disorganization are observed frequently and often noted on electroencephalography (EEG) alone, if the study is performed during nocturnal sleep. Hypersynchronous slow delta-wave activity has been observed in the sleep EEG of sleepwalkers; however, controversy remains regarding these findings on PSG.

 

Treatment

Approach Considerations

General management principles include the following:

  • Reassurance is the mainstay of treatment; the clinician should emphasize that in most cases, sleepwalking behavior is benign nature and will eventually disappear

  • An attempt should be made to identify and eliminate any environmental or predisposing factors that may be present; this may include ensuring adequate sleep, regulating the sleep cycle, and treating any underlying medical conditions (eg, gastroesophageal reflux, obstructive sleep apnea, periodic leg movements, or seizures)

  • Auditory, tactile, and visual stimuli should be avoided early in the sleep cycle; these induce events in some patients with parasomnias

  • Parents should be instructed to lock windows and doors, remove obstacles and sharp objects from the room, and add alarms (if necessary) to reduce the likelihood of injury during an episode

  • Depending on the situation, comforting the child and gently redirecting him or her to bed may be appropriate; attempts to confront or awaken the patient during the events frequently lengthen the parasomnia episode and may be met with resistance or even violence

  • Pharmacologic therapy typically is not indicated for sleepwalking

  • Sleepwalking associated with sleep-disordered breathing may improve or resolve with surgical treatment of the respiratory disorder

For long-term management, relaxation techniques, mental imagery, and anticipatory awakenings are preferred. The first 2 techniques should be undertaken only with the help of an experienced behavioral therapist or hypnotist. Anticipatory awakenings consist of waking the child approximately 15-20 minutes before the usual time of an event and then keeping him or her awake through the time during which the episodes usually occur. Ongoing reassurance should be provided at regular health maintenance visits.

 

Questions & Answers

Overview

How is NREM sleep arousal disorder, sleepwalking type diagnosed?

How are non?rapid eye movement (NREM) sleep arousal disorders characterized?

What are the signs and symptoms of NREM sleep arousal disorder, sleepwalking type

What is the focus of treatment for NREM sleep arousal disorder, sleepwalking type?

What are parasomnias?

What are the DSM-5 diagnostic criteria for NREM sleep arousal disorder, sleepwalking type?

What NREM sleep arousal disorder, sleepwalking type with sleep-related sexual behavior (sexsomnia)?

How is NREM sleep arousal disorder, sleepwalking type with sleep-related eating (SRE) differentiated from night-eating syndrome (NES)?

What is the pathophysiology of NREM sleep arousal disorder, sleepwalking type?

What is the role of genetics in the etiology of NREM sleep arousal disorder, sleepwalking type?

What is the role of environmental factors in the etiology of NREM sleep arousal disorder, sleepwalking type?

What is the role of physiologic factors in the etiology of NREM sleep arousal disorder, sleepwalking type?

Which medical conditions are associated with NREM sleep arousal disorder, sleepwalking type?

Which psychiatric conditions are associated with NREM sleep arousal disorder, sleepwalking type?

What is the prevalence of NREM sleep arousal disorder, sleepwalking type in the US?

What is the global prevalence of NREM sleep arousal disorder, sleepwalking type?

Which age groups have the highest prevalence of NREM sleep arousal disorder, sleepwalking type?

What are the sexual and racial predilections of NREM sleep arousal disorder, sleepwalking type?

What is the prognosis of NREM sleep arousal disorder, sleepwalking type

Presentation

What is the focus of clinical history for the evaluation of NREM sleep arousal disorder, sleepwalking type

How is NREM sleep arousal disorder, sleepwalking type differentiated from confusional arousals and sleep terrors?

DDX

Which conditions are included in the differential diagnoses of NREM sleep arousal disorder, sleepwalking type?

What are the differential diagnoses for Sleepwalking?

Workup

What is the role of lab tests in the workup of NREM sleep arousal disorder, sleepwalking type?

What is the role of polysomnography (PSG) in the workup of NREM sleep arousal disorder, sleepwalking type?

What is the role of EEG in the workup of NREM sleep arousal disorder, sleepwalking type?

Treatment

How is NREM sleep arousal disorder, sleepwalking type treated?