Sleepwalking and sleep terrors are non-rapid eye movement (NREM) parasomnias – unwanted events that occur when the brain partly awakens from deeper sleep. Sleepwalking may involve sitting up, walking, speaking, or performing other actions with limited awareness. During a sleep terror, a person may scream, appear intensely frightened, breathe rapidly, or have a racing heart while remaining difficult to wake or comfort. Memory of a sleepwalking or sleep terror episode is often limited.

These parasomnias are much more common in childhood than adulthood. Sleep terrors often begin in the preschool years, while sleepwalking commonly appears later in childhood. Episodes usually become less frequent as the brain and nervous system mature, although sleepwalking can continue into adolescence or adulthood.

Children may sit up, cry, run, speak, or move through the home while appearing awake, but they remain confused and unresponsive. Unlike a child who wakes from a nightmare, a child having a sleep terror is usually difficult to comfort and may not remember the event the next morning. Also, nightmares generally occur in the early morning hours, when REM sleep is more dominant. In contrast, sleep terrors usually occur in the first part of the night, in the hours just after going to sleep when deep non-REM sleep is more dominant.

Children also depend on adults to recognize triggers and protect their surroundings. An episode may be brief, but its effects can extend across the whole 24 hours by disrupting household sleep, increasing caregiver worry, or contributing to next-day sleepiness and difficulty concentrating.

Symptoms to watch for include:

• Sitting up, staring, mumbling, or appearing confused during sleep
• Walking, running, dressing, eating, or trying to leave the room or home
• Screaming, crying, sweating, rapid breathing, or a racing heart
• Being difficult to wake or comfort
• Pushing away a caregiver or becoming more agitated when restrained
• Returning to sleep quickly and remembering little or nothing afterward

While getting a medical evaluation is important, there are ways parents can help protect their child immediately by creating a safe sleep environment for sleepwalking or night terrors. 

When a child has a sleep terror or sleepwalking episode, it is best to remain calm and try to guide them gently back to bed. Children will generally not engage in conversation and may not respond to verbal directions, but it may help to reassure them in a calm, soft voice. Don’t try to restrain a child or try to wake them during an episode, unless it is necessary to protect their safety, as this can lead to more agitation. Speaking with a pediatrician can provide additional advice for supporting a child appropriately for their age.

Family history can increase vulnerability. Episodes may also become more likely with insufficient sleep, irregular sleep schedules, fever, illness, stress, travel, noise, pain, or a full bladder. Conditions that repeatedly interrupt sleep – including obstructive sleep apnea – may contribute. Some medications can also affect sleep and should be reviewed with a pediatrician when appropriate.

Most children outgrow sleepwalking and sleep terrors, and medication is rarely needed. Management focuses on keeping children safe during episodes and reducing factors that can trigger them.

Helpful approaches include:

• Maintain a consistent sleep schedule: Make sure your child gets enough sleep and follows regular bedtime and waking routines. Insufficient sleep can increase the likelihood of episodes.
• Identify possible triggers: Keep a sleep diary to record when episodes occur and whether they follow illness, stress, or changes in sleep routines.
• Create a safe sleep environment: Keep walkways clear and secure windows and doors if your child sleepwalks. Avoid upper bunk beds when episodes create a risk of falls.
• Address other sleep problems: Conditions such as obstructive sleep apnea can disrupt sleep and contribute to episodes. Treating these conditions may help reduce their frequency.
• Consider scheduled awakenings: If episodes occur frequently at predictable times, a healthcare professional may recommend gently waking your child shortly before an episode usually begins.

Medication is generally reserved for severe or potentially dangerous episodes that do not improve with other approaches. A pediatric sleep specialist can help determine whether additional treatment is appropriate.

With consistent sleep routines and appropriate safety measures, most families can manage these episodes while children gradually outgrow them.

Seek medical evaluation if episodes are frequent, worsening, cause injury, or involve leaving the house, unusual stiffening or jerking, or occur mainly in the second half of the night. Also discuss loud snoring, breathing pauses, marked daytime sleepiness, or new developmental or neurological concerns with the child’s pediatrician.

Diagnosis is usually based on a sleep and health history. A sleep diary, caregiver description, and safely recorded video may help. A clinician may recommend an overnight video sleep study when the pattern is atypical or another condition is suspected.

• Nightmares can cause fear and awakening, but they usually occur later in the night/early morning hours and are more likely to be remembered 
• Confusional arousals may cause sitting, crying, or disorientation without walking or intense fear
• Nocturnal seizures can involve sudden, brief, movements that may occur repeatedly during one night
• REM sleep behavior disorder, nocturnal panic attacks, trauma-related nightmares, medication effects, and obstructive sleep apnea can also resemble or trigger nighttime events

Any type of sleep disruption for a child deserves careful evaluation and support – as consistent sleep is an essential part of childhood development and overall health.

This page focuses on pediatric sleepwalking and sleep terrors. In adults, new, frequent, unusual, or unsafe episodes may require evaluation for medications, other sleep disorders, seizures, or neurological conditions. For a fuller description of the adult disorder, see Sleepwalking and sleep terrors in adults.