Buspirone Does Not Cause Sleepwalking
Buspirone is not associated with causing sleepwalking and may actually be an effective treatment option for non-REM parasomnias including sleepwalking. This is based on both FDA drug labeling data and emerging clinical evidence.
Evidence from FDA Drug Labeling
The official FDA prescribing information for buspirone lists "dream disturbances" as a frequent adverse effect (occurring in at least 1/100 patients), but sleepwalking is not mentioned anywhere in the comprehensive adverse event profile 11. The FDA label documents extensive safety data from over 3,500 subjects during premarketing evaluation, with systematic collection of adverse events. Central nervous system effects that were reported include:
- Frequent: Dream disturbances
- Infrequent: Depersonalization, dysphoria, hallucinations, dissociative reactions
- Rare: Stupor, psychosis
Notably absent from this comprehensive list is any mention of sleepwalking, somnambulism, or complex sleep behaviors 11.
Contrast with Medications That DO Cause Sleepwalking
This stands in stark contrast to medications known to cause sleepwalking. The 2020 VA/DoD guidelines specifically warn that nonbenzodiazepine BZRAs (zolpidem, zaleplon, eszopiclone) carry an FDA safety announcement regarding serious injuries from sleep behaviors including sleepwalking, sleep driving, and other activities while not fully awake 222. The 2008 AASM guidelines similarly note that BzRA hypnotics have been associated with disruptive sleep-related behaviors including sleepwalking 3.
A 2018 systematic review identified 29 drugs that may trigger sleepwalking, with the strongest evidence for zolpidem and sodium oxybate. The drugs fell primarily into four classes: benzodiazepine receptor agonists, antidepressants/serotonergic agents, antipsychotics, and β-blockers 4. Buspirone was not identified as a sleepwalking trigger in this comprehensive review.
Buspirone as Treatment for Sleepwalking
Paradoxically, buspirone may actually treat sleepwalking rather than cause it. A 2019 case report described a 38-year-old man with lifelong non-REM parasomnias (confusional arousals and somnambulism) who experienced "significant improvement in his symptoms immediately after starting" buspirone, with "sustained relief from symptoms" 5. The authors concluded that buspirone can be considered an effective alternative treatment for NREM parasomnias when other medications are not preferred.
Mechanism and Safety Profile
Buspirone's mechanism differs fundamentally from medications that cause sleepwalking. As a partial 5-HT1A receptor agonist, it does not enhance GABA activity at GABAA receptors—the primary mechanism implicated in medication-induced sleepwalking 46. The 2009 JAGS guidelines note that medications like TCAs, MAOIs, and SSRIs can induce or exacerbate REM behavior disorder 77, but buspirone's pharmacologic profile is distinct from these classes.
Clinical Bottom Line
If a patient on buspirone reports sleepwalking, look for alternative explanations including:
- Concurrent medications (especially zolpidem, other BZRAs, or antidepressants)
- Underlying sleep disorders (sleep apnea, REM behavior disorder)
- Alcohol or substance use
- Stress or sleep deprivation
Buspirone itself should not be discontinued based on concerns about sleepwalking, as it is not a known cause of this adverse effect and may actually provide therapeutic benefit for parasomnias 5.