Treatment of Sleepwalking Disorder

Initial Assessment and Identification of Underlying Causes

The American Geriatrics Society and the American Academy of Sleep Medicine recommend assessing for medications that may induce sleepwalking, including tricyclic antidepressants, SSRIs, SNRIs, and MAOIs, in patients with sleepwalking disorder 1, 2

The American Academy of Sleep Medicine recommends lowering the bed mattress to the floor or using a low-profile bed to prevent fall injuries, as well as padding corners of furniture and sharp surfaces around the bedroom 3, 4
The American Academy of Sleep Medicine suggests installing window protection or heavy draperies to prevent falls through windows, and removing all firearms from the bedroom and locking them away with keys held by another person 3, 4
The American Geriatrics Society and the American Academy of Sleep Medicine recommend removing potentially dangerous objects such as bedside lamps that could be weaponized, and considering having the bed partner sleep in a separate room if violent episodes occur 1, 3, 4

The American Academy of Sleep Medicine recommends clonazepam 0.25-2.0 mg taken 1-2 hours before bedtime as the most commonly used medication for sleepwalking when pharmacotherapy is necessary, starting at 0.25-0.5 mg and titrating based on response 1
The American Academy of Sleep Medicine notes that clonazepam is effective in controlling vigorous behaviors, though mild limb movements may persist, but use with extreme caution in elderly patients due to fall risk, cognitive impairment, and inclusion on the American Geriatrics Society Beers Criteria list 1, 3, 5
The American Academy of Sleep Medicine recommends using clonazepam with caution in patients with gait disorders, dementia, or concomitant sleep apnea 4, 6

The American Academy of Sleep Medicine recommends immediately implementing environmental safety measures for all patients, and conducting polysomnography to identify underlying sleep disorders, particularly sleep-disordered breathing 3, 4
The American Geriatrics Society recommends strongly preferring non-pharmacological approaches over benzodiazepines for elderly patients or those with dementia 5