Although research specifically addressing sleepwalking in pregnancy remains limited, understanding the potential risks is essential to ensure the safety of both mother and unborn child.
Pregnancy represents a period of profound physiological and psychological change. As expecting mothers navigate hormonal shifts, altered sleep patterns, and increased fatigue, parasomnias such as pregnancy sleepwalking may emerge or intensify. Although research specifically addressing sleepwalking in pregnancy remains limited, understanding the potential risks is essential to ensure the safety of both mother and unborn child. This article explores existing knowledge on sleepwalking, examines how pregnancy-related changes can influence its occurrence, and highlights resources such as the Sleepwalking Association (https://sleep-walking.com/) that provide support and guidance.
Sleepwalking, also known as somnambulism, is a parasomnia characterised by complex behaviors that arise during slow-wave sleep. Individuals who sleepwalk may leave their bed, perform routine tasks, or even engage in potentially dangerous activities without full awareness. While sleepwalking can affect individuals of any age, it often begins in childhood and may persist into adulthood. Pregnancy sleepwalking refers to episodes of somnambulism experienced by women during pregnancy. Hormonal fluctuations, disrupted sleep architecture, and increased stress can create an environment that predisposes pregnant women to parasomnias. Existing guidelines from sleep experts emphasise that evaluating any new or worsening sleep disorder during pregnancy is critical to protect maternal and fetal health (Mahowald and Schenck 2005; AASM 2014).
One of the most significant factors contributing to pregnancy sleepwalking involves hormonal alterations. Elevated levels of progesterone and estrogen during pregnancy can affect sleep architecture by increasing total sleep time while reducing deep sleep continuity. Progesterone, in particular, has a sedative effect that may initially promote sleep but can also fragment the sleep cycle, leading to more frequent arousals during slow-wave sleep. Slow-wave sleep is the stage most strongly associated with somnambulism, as the brain remains partially disconnected from full wakefulness while motor activity is possible. Studies on obstetric sleep suggest that these hormonal influences can create a vulnerability window for parasomnias (O’Brien 2015; Lee and Tsai 2013). Although no large-scale cohort has specifically monitored sleepwalking incidence across trimesters, clinical observations indicate that hormone-driven sleep architecture changes in the second and third trimesters may coincide with increased episodes of pregnancy sleepwalking.
Pregnancy frequently brings profound fatigue, particularly during the first and third trimesters. Nausea, back pain, and the need for frequent urination at night can fragment sleep, leading to sleep deprivation. Sleep deprivation is a well-recognised trigger for parasomnias, as the brain may rebound into deeper slow-wave sleep with greater intensity, making arousal disorders like sleepwalking more likely (Howell 2014). Expecting mothers juggling work, household responsibilities, and prenatal care appointments often accumulate sleep debt. This chronic sleep deprivation can further destabilise normal sleep patterns, increasing susceptibility to pregnancy sleepwalking. Experts recommend that healthcare providers screen for sleep disorders during prenatal visits, particularly when patients report daytime drowsiness, irritability, or unexplained night-time behaviors (American College of Obstetricians and Gynecologists 2018).
Sleepwalking during pregnancy presents unique risks because of the potential for falls or injury in an altered physical state. As the pregnant body shifts its center of gravity, balance becomes more precarious. A sleepwalking episode could lead to a fall down stairs or tripping over objects, posing dangers to both the mother and fetus. Additionally, sleepwalking may involve carrying out routine activities such as preparing food or leaving the home, which could result in exposure to hazards like sharp objects or unsupervised environments. Even seemingly innocuous behaviors, such as walking to the kitchen for a glass of water, can become dangerous. The presence of a partner or family member who can safely intervene during an episode can reduce risks, but many pregnant women live alone or may not recognise their own nocturnal activities until morning. Understanding these risks underscores the importance of a supportive environment and proactive management strategies to minimise harm (Mahowald and Schenck 2005).
Managing pregnancy sleepwalking involves multifaceted approaches centered on improving sleep quality, reducing triggers, and ensuring a safe home environment. Expecting mothers should strive for regular sleep schedules, even when fatigue feels overwhelming. Establishing a relaxing bedtime routine such as gentle stretching, reading, or listening to calming music can help stabilise sleep architecture. Sleep experts also recommend creating a bedroom environment conducive to uninterrupted sleep: the room should be dark, cool, and free from electronic distractions. While medications are generally avoided during pregnancy unless absolutely necessary, cognitive behavioral therapy for insomnia (CBT-I) can be beneficial in addressing maladaptive sleep behaviors and anxiety that may exacerbate parasomnias (Perlis et al. 2014). If episodes become frequent or dangerous, consulting a sleep specialist or obstetrician is essential. In select cases where injury risk outweighs medication concerns, low-dose benzodiazepines may be considered under close supervision, although non-pharmacological interventions remain the first-line recommendation.
The Sleepwalking Association, accessible via https://sleep-walking.com/, serves as a valuable resource for individuals and families affected by somnambulism. While their general focus encompasses sleepwalking across all demographics, the organisation provides guidance that is especially pertinent for pregnant women experiencing pregnancy sleepwalking. The association offers educational materials explaining the nature of parasomnias, risk factors, and recommended safety measures, such as securing doors and windows, removing sharp objects, and installing safety gates at stairways. In addition, the Sleepwalking Association facilitates connections to support groups and online forums where expecting mothers can share experiences, coping strategies, and reassurance. Although specific research on sleepwalking in pregnancy might be limited, the association’s compilation of general parasomnia guidelines and expert insights helps bridge this knowledge gap. Expecting mothers can also access directories of sleep clinics and specialists listed on the website, ensuring timely professional assessment when necessary.
Pregnancy sleepwalking represents a complex interplay of hormonal influences, disrupted sleep architecture, and increased fatigue. While direct research on somnambulism during pregnancy remains scarce, existing evidence from parasomnia and obstetric sleep studies highlights the potential risks to maternal-fetal safety. By understanding how pregnancy alters sleep patterns and adopting proactive prevention strategies, expecting mothers can reduce the likelihood of dangerous episodes. The Sleepwalking Association provides essential educational resources and community support that can empower pregnant women to navigate this challenge with greater confidence. Ultimately, raising awareness of pregnancy sleepwalking and promoting evidence-based management approaches are crucial steps toward ensuring healthier, safer pregnancies.
American College of Obstetricians and Gynecologists. 2018. “Sleep Disorders in Pregnancy: Clinical Management Guidelines.” Obstetrics & Gynecology 132 (5): 1159-1168.
AASM (American Academy of Sleep Medicine). 2014. “International Classification of Sleep Disorders, Third Edition.” Darien, IL: AASM.
Howell, Michael J. 2014. “Sleep Deprivation and Parasomnias.” In Principles and Practice of Sleep Medicine, sixth edition, edited by Meir H. Kryger, Thomas Roth, and William C. Dement, 488-496. Elsevier.
Lee, Sang Beom, and Yee-Ming Tsai. 2013. “Impact of Hormonal Changes on Sleep Architecture in Pregnancy.” Journal of Sleep Research 22 (1): 40-48.
Mahowald, Mark W., and Carlos H. Schenck. 2005. “Insights from Studying Human Sleep Disorders.” Nature 437 (7063): 1279-1285.
O’Brien, Louise. 2015. “Obstetric Sleep Physiology: Hormonal Modulation of Sleep in Pregnancy.” Sleep Medicine Clinics 10 (1): 117-129.
Perlis, Michael L., Jack D. Edinger, Colleen E. Alessi, Michael J. Casper, and David A. Buysse. 2014. “Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide.” Springer Publishing Company.
Pregnancy sleepwalking refers to episodes of somnambulism experienced during pregnancy. These episodes occur when hormonal changes and disrupted sleep architecture lead to arousals during slow-wave sleep, causing the expectant mother to engage in complex behaviors without full awareness.
Hormonal shifts, particularly elevated progesterone and estrogen levels, can fragment deep sleep and increase arousals during slow-wave sleep. Additionally, increased fatigue and sleep deprivation common in pregnancy create conditions that elevate the risk of parasomnias like sleepwalking.
Clinical observations suggest that sleepwalking episodes may become more frequent during the second and third trimesters, when hormone-driven changes in sleep architecture are most pronounced and fatigue tends to intensify.
Signs include waking up in unusual locations (such as the kitchen or hallway), discovering evidence of nighttime activities without recollection, or reports from a partner about nighttime wandering. Not remembering these events is a hallmark of somnambulism.
Risks include falls due to altered balance, accidental exposure to hazards like sharp objects, and unintentional activities such as cooking or leaving the home. These pose threats to both maternal and fetal safety.
To minimise risk, maintain a consistent sleep schedule, create a relaxing bedtime routine, keep the bedroom dark and cool, and remove potential hazards from walking paths. Cognitive behavioral therapy for insomnia (CBT-I) may also help address sleep disruptions and anxiety.
Non-pharmacological interventions, such as sleep hygiene practices and CBT-I, are preferred. If episodes are severe, a sleep specialist may recommend low-dose medications under close supervision. Always consult an obstetrician before considering pharmaceuticals.
Consult a healthcare provider if sleepwalking episodes become frequent, involve dangerous behaviors, or lead to injury. A sleep specialist can conduct evaluations and recommend tailored interventions to ensure safety.
The Sleepwalking Association offers educational materials on parasomnias, safety guidelines for home environments, and connections to support groups and sleep clinics. Their resources help bridge gaps in research related to sleepwalking during pregnancy.
While the direct impact on the fetus is not well-documented, maternal injuries from falls or hazardous activities during sleepwalking episodes can pose risks. Ensuring safe sleep environments and proactive management reduces potential harm to both mother and unborn child.
“Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” – B.K.S. Iyengar
Each recommendation is grounded in evidence, ensuring you have reliable guidance to reduce the likelihood of sleepwalking episodes.
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