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The doctor says, "A great perturbation in nature, to receive at once the benefit of sleep, and do the effects of watching!". "Perturbation" means a disturbance, and to the mind of the doctor, the disturbance in nature is the fact of sleepwalking, where one can be asleep but act as if one is awake. The perturbation in nature does not cause the sleepwalking, it IS the sleepwalking.

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Q: What 'great perturbation in nature ' could have caused lady Macbeth to walk in her sleep?
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