An empty bed in a dark bedroom with the covers peeled backSleepwalking and sleeptalking both belong to a group of behaviors called parasomnias—unusual or harmful behaviors that occur during sleep. Sleep talking is one of the most common parasomnias. A 2010 study found that 68.8% of people talk during their sleep at some point during their lives. According to the same study, 22.4% of people have sleepwalked at least once.

Both sleepwalking and sleeptalking can happen for many reasons. Sometimes they are symptoms of a mental health condition, and both may cause psychological distress and interfere with relationships, work, and even overall life satisfaction.

What Causes Sleepwalking?

Sleepwalking, known sometimes as somnabulism, happens in deep sleep when a person is very difficult to wake up. Normally, when a person sleeps, the body paralyzes skeletal muscles—the muscles responsible for walking and other complex behaviors. GABA, a neurotransmitter, is one of the primary chemicals involved in preventing sleepwalking. When GABA doesn’t work to paralyze the skeletal muscles, a person may walk, make food, or even try to drive during their sleep.

Sleepwalking is more common in children. Some research suggests this might be because the neurons that release GABA are still developing in children. Sleepwalking in children tends to peak between 8 and 12 years old. Children who sleepwalk may also have a condition called confusional arousal, which occurs when a person appears to be awake but is confused or unaware.

Though it’s difficult to wake a sleepwalking person, it’s a myth that doing so is dangerous. However, a person who is woken up from a sleepwalking episode may be confused or alarmed.

What Causes Sleep Talking?

Sleep talking, which used to be called somniloquy, is more common in children than adults. It typically happens during rapid eye movement (REM) sleep. Adults are more likely to talk in their sleep if they have depression, are experiencing a nightmare, or are under the influence of drugs or alcohol.

Is Walking or Talking in Your Sleep a Sleep Disorder?

Sleepwalking and sleeptalking are both considered sleep disorders. They are more common in people who have other sleep disorders, such as sleep apnea, insomnia, or sleep behavioral issues. Both sleepwalking and sleeptalking tend to run in families.

Sleepwalking and sleeptalking are more common in boys than in girls, though researchers don’t know why. Both tend to decrease or disappear by the age of 12, but when they don’t, a person may be diagnosed with a sleep disorder.

Sleep behavioral disorders, which cause people to do unusual things when they are asleep, are closely related to sleepwalking. For instance, a person might drive their car or attempt to have sex with their partner while sleeping. Rarely, do people even become violent in their sleep. A handful of rape defendants have successfully used a “sexsomnia” defense, arguing they did not intend to rape someone and instead were sleepwalking. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes sexsomnia as a mental health diagnosis.

Therapy can help with sleepwalking or sleep talking when these issues are due to a mental health condition or stress.

Mental Health Issues Associated with Sleepwalking and Sleep Talking

A number of mental health issues can cause sleepwalking and sleeptalking. When sleep issues are related to a mental health issue, seeking treatment for the underlying mental health condition is usually the fastest way to resolve the sleep problem.

Any mental health condition can interfere with sleep and lead to unusual behavior at night. Sleep issues are especially prevalent in people who have:

Drugs and alcohol can cause some people to talk or walk in their sleep. Due to this, people with substance abuse issues, as well as those going through drug or alcohol withdrawal, may experience sleepwalking or sleeptalking.

Medical Issues Linked to Sleepwalking and Sleep Talking

Certain medical issues have been linked to sleepwalking and sleeptalking. Those include:

Certain medications have also been linked to sleepwalking and sleeptalking. Some sleeping medications, such as Ambien and Lunesta, can cause unusual nighttime behavior. Sleep eating is one of the most common medication-related behaviors, but driving and other unusual behaviors have also been reported.

Therapy can help with sleepwalking or sleep talking when these issues are due to a mental health condition or stress. Many people also find therapy helps them deal with the challenges of parasomnias, such as sleep deprivation or conflicts with a partner oversleep. The right therapist can help you craft a healthy sleep environment, set healthy sleep goals, and get better sleep.

According to the National Sleep Foundation, therapy can help with many sleep issues. Cognitive behavioral therapy (CBT) has proven especially effective.

Sleep issues can affect an entire family. When a child sleepwalks, parents may struggle to get a good night’s sleep, and siblings may feel anxious. A spouse who sleepwalks or sleep talks can trigger sleep issues in their partner. Nighttime sleep issues, such as sexsomnia or nighttime eating, can even be a source of marriage or relationship problems. Family or couples therapy can help families manage and understand these issues.

References:

  1. Bjorvatn, B., Grønli, J., & Pallesen, S. (2010). Prevalence of different parasomnias in the general population. Sleep Medicine, 10(11), 1031-1034. doi: 10.1016/j.sleep.2010.07.011
  2. Cognitive behavioral therapy for insomnia. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia
  3. Mohebbi, A., Holoyda, B. J., & Newman, W. J. (2018). Sexsomnia as a defense in repeated sex crimes. The Journal of the American Academy of Psychiatry and the Law, 46(1), 78-85. Retrieved from http://jaapl.org/content/46/1/78.long
  4. Oliviero, A. (2008, February 1). Why do some people sleepwalk? Retrieved from https://www.scientificamerican.com/article/why-do-some-people-sleepwalk
  5. Pediatric parasomnias. (n.d.). Retrieved from https://www.childrens.com/specialties-services/specialty-centers-and-programs/sleep/programs-and-services/sleep-medicine/nightmares-sleepwalking-sleep-talking-sleep-terror
  6. Post-traumatic stress disorder (PTSD) and sleep. (n.d.). National Sleep Foundation. Retrieved from https://www.sleephealthfoundation.org.au/pdfs/Post-Traumatic-Stress-Disorder.pdf
  7. Sexsomnia: A new DSM-5 diagnosis. (2014, October 28). Retrieved from https://www.psychiatryadvisor.com/sleep-wake-disorders/sexsomnia-a-new-dsm-5-diagnosis/article/379644
  8. Sleep talking: Causes. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/sleep-talking/causes
  9. Sleep talking: What is it? (n.d.). Retrieved from https://www.sleep.org/articles/sleep-talking
  10. Sleepwalking. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/abnormal-sleep-behaviors/sleepwalking

Dear GoodTherapy.org,

My husband and I used to have a great relationship, but ever since we had a baby and he started a stressful new job, he won’t sleep with me anymore. I don’t mean just have sex, although that’s a problem too. I mean he literally doesn’t sleep with me. He stays up half the night and falls asleep on the couch more often than not. When I get up in the morning, I often end up waking him up and telling him to go to bed. It’s like we are ships passing in the night.

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This has strained our relationship so much! I miss my husband. I want to be intimate with him, but even more than that, I want to feel him next to me. I miss snuggling. I miss his warmth and his gentle presence. I sleep better when he’s with me. I cry myself to sleep a lot now, and any sleep I do get is fitful. Having to always be the one to wake up and attend to our baby (since my husband is downstairs, out of earshot) doesn’t help.

He refuses to change or even compromise. He says the stress of his job—he’s a police officer and works evenings—makes him need to “decompress” after his shifts by “vegging out” in front of the TV. He says he can’t go to bed right after work or he just lays there and tosses and turns. But that’s basically what I do if he’s not next to me.

What am I supposed to do if my husband won’t make an effort to sleep with me? I keep thinking the lack of sex will bring him back eventually, but it’s not happening so far. He’s a pretty sexual guy, so I am starting to wonder if he’s getting sex somewhere else. Ugh. As if I needed another reason to not be able to sleep! —Restless

Submit Your Own Question to a Therapist

Dear Restless,

No doubt you’re not sleeping so well these days. In addition to having a little one wreak havoc on your sleep, you have an absentee bed partner. You describe your situation as causing a great deal of distress. It’s on your mind day and night. I’m glad you reached out for help, and I hope this reply offers some points to consider.

You describe your relationship as like “ships passing in the night,” but previously you felt like you had a strong and connected marriage. It sounds like the biggest source of distress is a lack of connection and intimacy, on multiple levels. From your account, you have expressed your desires and concerns to your husband, yet they have neither been validated nor led to change in where your husband spends his time at night. It’s no surprise you are having trouble sleeping.

Talking about sensitive topics with a partner can be tricky for many reasons—among them the baggage that people bring to the communication. It is possible your husband isn’t hearing you because of things that are affecting him, which then reinforces your feeling that he isn’t present. The explanation he has given is that he feels stressed and needs to unwind. This may be accurate, but as you insinuated, you don’t know whether this is the full story. Might there be other challenges he is not comfortable discussing or isn’t able to identify? Might there indeed be an affair of some sort? It sounds like whatever his struggles are, they are affecting him on many levels, including domestic life and his emotional and physical connection to his wife.

Even though communication is hard, it will be part of the long-term solution if you want to bring about change and break this pattern. Individual therapy can assist you with meeting these goals, as can couples therapy, if your husband is open to this.

Even though communication is hard, it will be part of the long-term solution if you want to bring about change and break this pattern. Individual therapy can assist you with meeting these goals, as can couples therapy, if your husband is open to this. Both approaches can facilitate communication and identify issues that may be contributing to the state of your relationship. Regardless of which approach(es) you try, it is important to try something.

Other considerations are important to acknowledge. For one, transition periods in life are inherently stressful. Transitioning into parenthood and starting a new job can feel overwhelming, certainly. We may not know how to deal with the stress. We may resort to coping styles that are familiar to us because it may feel comfortable or easy to react in a certain way.

How has your husband typically coped with stress in the past? Some people tend to react to stress by withdrawing or disengaging. This can, of course, be hard for others who feel like they are shut out. Ultimately, how we deal with things now, whether it be big changes, new demands, or even disagreement about the importance of sharing a marital bed, affects things in the future.

Another consideration worthy of acknowledging is how you are coping. Your sleep has deteriorated, which presumably leaves you feeling less rested during the day. Many nights of poor sleep, of course, can take their toll physically and emotionally. It can affect your energy and internal resources as a caregiver to your baby.

You are caring for someone else, but what are you doing to care for yourself? When we regularly care for ourselves, we are better prepared to deal with the stresses we face, including the ones that don’t seem to make sense or seem like they are easy to resolve. It is easy to forget to take care of yourself when you are so concerned about the well-being of others. May this be a reminder about the importance of checking in with yourself and engaging in something restorative, energizing, or otherwise positive for yourself.

Kind regards,

Marni Amsellem, PhD

Adult person of color with hair pulled back lies in bed in dark, awake, looking at clock in frustrationIt’s 3 a.m. You see the clock and realize you have four hours left before your alarm sounds. You think about everything you must do the next day and how miserable it will feel doing it exhausted. You toss and turn. You try counting sheep. You’re awake, and it feels like the entire world is sleeping.

You’re not suffering alone. Nearly 60% of adults lack sufficient sleep (Jacobs, 2009). How did this happen? Let’s start by looking at root causes of sleep problems and then identify ways to address them.

Root Causes of Sleep Problems

Behavioral

Bad habits breed many of our sleep problems. Staying up too late doing projects. Playing on the phone or computer. Responding to text messages or emails at all hours of the night. Engrossing oneself in a television show, particularly one with disturbing content, can negatively impact sleep. All these behaviors teach the brain that nighttime is a great time to be awake. The fear of missing out (i.e., FOMO) on an important post or text can keep our brains combing through social media or emails for hours.

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Environmental

Having a dark, quiet, and comfortable place to sleep promotes rest. The glow of an energy-efficient light bulb, computer screen, TV, or phone can stimulate the wake center of the brain (“Blue Light Dark Side,” 2017). Environmental disturbances including noisy neighbors, a snoring partner, or a playful pet in bed can make it challenging to catch some Z’s. Having a bed that is too firm or provides inadequate support can leave you tossing and turning. Sleep can also feel elusive when the temperature is too hot or cold.

Emotional Distress

Stress, anxiety, and depression can adversely impact sleep (Jacobs, 2009, van Mill et al., 2013). When our brains perceive some type of threat (e.g., a meeting with a difficult coworker tomorrow, loss of a loved one), it activates the limbic system. This system controls the brain’s emergency response signal. It sends chemicals into our bodies which prepare us to fight or flee danger. We cannot fight of flee if we’re asleep, so the limbic system shouts, “Stay awake!” This response is wonderful if we’re being chased by a bear, but it creates problems when we need to rest. The limbic system can become particularly sensitive and activated when one has experienced a traumatic event.

Beliefs About Sleep

Negative thoughts about sleep, such as, “I’ll never sleep well again … I am not going to sleep tonight … If I don’t sleep, I am going to fail my test/perform poorly at work,” can perpetuate sleep problems (Jacobs, 2009). Additionally, beliefs that one must have sleep medication to sleep can interfere with the body’s ability to sleep on its own.

Substance Use

Caffeine, nicotine, and alcohol can negatively affect sleep (Lichstein, 2000). In addition to the common sources of caffeine (e.g., coffee, soda, and energy drinks), we also need to consider hidden sources. Certain protein bars, decaf coffee, chocolate, and some over-the-counter medications contain caffeine. A review of major sleep studies suggests alcohol users may fall asleep faster, but the second half of sleep will be poorer compared to those who don’t drink (Ebrahim, Shapiro, Williams, & Fenwick, 2013). Both prescribed and illegal substances can leave one feeling wound up, depending on amount and frequency of use. Common contributors include stimulating antidepressants, anti-hypertensives, bronchodilators, diuretics, beta blockers, and corticosteroids (Litchstein, Gellis, Stone, & Nau, 2006).

Health Conditions

Individuals with the following physical conditions commonly experience sleep problems: heart disease, asthma, lung disease, gastrointestinal disorders (e.g., heart burn), kidney disorders, endocrine disorders (e.g., hypothyroidism), diabetes, HIV infection, fibromyalgia, menopause, and cancer (Parish, 2009).

Ways to Address Root Causes

Behavioral

Creating a bedtime routine can play a vital role in getting good sleep. My grandmother followed the same routine every night. She would take a bath, put on her pajamas, feed her cat, turn down her bed, make a cup of tea, read for an hour, and then go to bed. She did this every night and never complained of poor sleep. Bedtime routines teach our brains it is time to go to sleep. Tips for a good bedtime routine include:

  1. Avoid blue light (e.g., TV, smartphone, computer) approximately one hour before you want to fall asleep.
  2. If you shower or bathe at night, do so at least one hour prior to bedtime. You could have trouble falling asleep if your body temperature is too warm.
  3. Cover the clock once your bedtime routine starts. Go to bed when your body feels tired (e.g., eyelids are heavy, head is drooping) as opposed to when a certain time shows on the clock. If you lay in bed awake more than 30 minutes, your brain could associate your bed with wakefulness instead of sleeping.
  4. Wake up at the same time every day, even on weekends. You may feel groggy the first several days. However, sticking with this wake time teaches the body to go to sleep earlier and faster.
  5. Do something relaxing and enjoyable before bedtime, such as reading a light-hearted book, knitting, or coloring. If you can’t think of something relaxing to do, consider listening to a guided relaxation recording. You can find many free ones online.

It may seem like you’ll never have a good night’s sleep again, but there is hope. Addressing the root causes of sleep problems and enlisting support can lead to better sleep.

Environmental

Create a comfortable sleep space. If possible, keep electronics such as TVs, computers, and smartphones out of the bedroom. Consider room-darkening shades or curtains if your room is exposed to bright light. A sleep mask is also an inexpensive alternative. If your bed is uncomfortable, explore options for supportive bedding. A new mattress can be expensive, but mattress toppers can be found for a fraction of the cost and make a positive difference in the coziness of one’s bed. A supportive pillow can also provide great comfort. If intermittent noise keeps you awake at night, consider a white noise machine, fan, and/or earplugs. If your partner is snoring, consider sleeping in a separate location (if possible) until your sleep is back on track.

Emotional Distress

Consider establishing care with a therapist if emotional distress is playing a role in poor sleep. Often, sleep improves over the course of therapy. Enlisting the support of caring others, such a friends and family members, can be helpful when you’re trying to regulate your sleep. For example, it could be helpful to ask for support with implementing some of the strategies discussed in this article. It can be frustrating when well-intentioned others ask, “How did you sleep last night?” when you’re having sleep problems. It may be beneficial to ask them to support you in ways which feel more helpful—for example, having them ask, “How can I support you right now?” or sending a funny meme or encouraging quote.

Beliefs About Sleep

Reframing our thoughts about sleep problems can help reduce the of suffering of sleeplessness. Some helpful sleep thoughts include:

Substance Use

Stopping caffeine use can help if you’re having trouble sleeping. If giving it up completely feels too intimidating, try limiting use to the morning or decreasing the amount (e.g., half-caffeinated coffee). Scrutinizing labels on food and over-the-counter medicines can help you make informed choices about the amount of caffeine you consume. Talk to your primary care physician or a therapist if you are using illegal/nonprescribed drugs to learn how they impact sleep and to obtain support with stopping use. If insomnia is a side effect of a prescribed medication, talk with your prescriber about ways to manage this.

Health Conditions

Consider scheduling a checkup with your doctor, particularly if you have not had a physical within the past year. Your doctor can determine if lab work or other testing would be helpful in ruling out physical causes for sleep problems. If you have a preexisting condition but continue to experience sleep problems, scheduling an appointment with your provider to discuss concerns could help.

Conclusion

Most importantly, be kind to yourself. Talk to yourself as you would a friend who can’t sleep: “I know this is tough. You’re taking steps to sleep better, and it will improve in time.” It may seem like you’ll never have a good night’s sleep again, but there is hope. Addressing the root causes of sleep problems and enlisting support can lead to better sleep.

References:

  1. Blue light has a dark side. (2017, December). Harvard Health Letter. Retrieved from https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side
  2. Ebrahim, I. O., Shapiro, C. M., Williams, A. J., & Fenwick, P. B. (2013). Alcohol and sleep I: Effects on normal sleep. Alcohol Clinical and Experimental Research, 37, 539–549. doi:10.1111/acer.12006
  3. Jacobs, G. D. (2009). Say good night to insomnia. The 6-week program proven more effective than sleeping pills. New York, NY: St. Martin’s Press.
  4. Lichstein K. L. (2000). Secondary sleep problems. In K.L. Lichstein & C.M. Morin (Eds.), Treatment of late-life sleep problems (297-319). Thousand Oaks, CA: Sage.
  5. Lichstein, K. L., Gellis, L. A., Stone, K. C., & Nau, S. D. (2006). Primary and secondary insomnia. In S. R. Pandi-Perumal & J. M. Monti (Eds.), Clinical pharmacology of sleep (133-152). Basel, Switzerland: Birkhauser Verlag.
  6. Parish, James M. (2009). Sleep-related problems in common medical conditions. Chest, 135(2), 563–572. doi:001: lO.1378/chest.08-0934
  7. van Mill J. G., Hoogendijk W. J., Vogelzangs N., van Dyck R. & Penninx, B. W. (2010). Sleep problems and sleep duration in a large cohort of patients with major depressive disorder and anxiety disorders. The Journal of Clinical Psychiatry,71, 239–46. doi: 10.4088/JCP.09m05218gry
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