Editing Sleepwalking (section)

==Diagnosis==
[[Polysomnography]] is the only accurate assessment of a sleepwalking episode. Because this is costly and sleepwalking episodes are usually infrequent, other measures commonly used include self-, parent-, or partner-report. Three common diagnostic systems that are generally used for sleepwalking disorders are [[International Classification of Diseases]] (ICD-10),<ref name="ICD-10">{{Cite book|last=Zivetz|first=Laurie|url=https://apps.who.int/iris/handle/10665/37958|title=The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines|date=1992|url-status=live |archive-url=https://web.archive.org/web/20220218073157/https://apps.who.int/iris/handle/10665/37958|archive-date=18 February 2022|publisher=World Health Organization|language=en|isbn=9789241544221|oclc=26553093|location=Geneva, Switzerland|hdl=10665/37958}}</ref> the [[International Classification of Sleep Disorders]] (ICSD-3),<ref name="ICSD-3">{{Cite journal|last=Sateia|first=Michael J.|date=1 November 2014|title=International classification of sleep disorders-third edition: highlights and modifications|url=https://pubmed.ncbi.nlm.nih.gov/25367475/|url-status=live |archive-url=https://web.archive.org/web/20220128145132/https://pubmed.ncbi.nlm.nih.gov/25367475/|archive-date=28 January 2022|journal=Chest|volume=146|issue=5|pages=1387–1394|doi=10.1378/chest.14-0970|issn=1931-3543|oclc=986580999|pmid=25367475}}</ref> and the [[Diagnostic and Statistical Manual]].<ref name="DSM-V">{{Cite web|title=Diagnostic and Statistical Manual of Mental Disorders (DSM–5)|url=https://www.psychiatry.org/psychiatrists/practice/dsm|archive-url=https://web.archive.org/web/20220218083732/https://www.psychiatry.org/psychiatrists/practice/dsm|archive-date=18 February 2022|access-date=2022-02-18|website=www.psychiatry.org}}</ref>

The Diagnostic and Statistical Manual defines two subcategories of sleepwalking, although sleepwalking does not need to involve either behaviours:
* sleepwalking with sleep-related eating.
* sleepwalking with sleep-related sexual behavior ([[Sleep sex|sexsomnia]]).<ref name="DSM-V" />

Sleep eating involves consuming food while asleep. These sleep eating disorders are more often than not induced for stress related reasons. Another major cause of this sleep eating subtype of sleepwalking is sleep medication, such as Ambien for example (Mayo Clinic). There are a few others, but Ambien is a more widely used sleep aid.<ref>{{cite web|last=Staff|first=Mayo Clinic|title=Sleep-related Eating Disorders|url=https://www.mayoclinic.org/diseases-conditions/sleep-related-eating-disorder/basics/definition/con-20037290|publisher=Mayo Clinic|access-date=5 May 2014}}</ref> Because many sleep eaters prepare the food they consume, there are risks involving burns and such with ovens and other appliances. As expected, weight gain is also a common outcome of this disorder, because food that is frequently consumed contains high carbohydrates. As with sleepwalking, there are ways that sleep eating disorders can be maintained. There are some medications that calm the sleeper so they can get longer and better-quality rest, but activities such as yoga can also be introduced to reduce the stress and anxiety causing the action.<ref>{{cite web|last=Clinic|first=Cleveland|title=Sleep-Related Eating Disorders|url=https://my.clevelandclinic.org/neurological_institute/sleep-disorders-center/disorders-conditions/hic-sleep-related-eating-disorders.aspx|publisher=Cleveland Clinic|access-date=5 May 2014}}</ref>

=== Differential diagnoses ===
Sleepwalking should not be confused with alcohol- or drug-induced blackouts, which can result in amnesia for events similar to sleepwalking. During an alcohol-induced [[blackout (drug-related amnesia)]], a person is able to actively engage and respond to their environment (e.g. having conversations or driving a vehicle), however the brain does not create memories for the events.<ref name="Wetherill 2016">{{Cite journal |doi=10.1111/acer.13051 |pmid=27060868 |pmc=4844761 |title=Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies |year=2016 |last1=Wetherill |first1=Reagan R. |last2=Fromme |first2=Kim |journal=Alcoholism: Clinical and Experimental Research |volume=40 |issue=5 |pages=922–935}}</ref> Alcohol-induced blackouts can occur with blood alcohol levels higher than 0.06&nbsp;g/dl.<ref>{{Cite journal |doi=10.15288/jsa.2003.64.547 |pmid=12921196 |title=Fragmentary and en bloc blackouts: Similarity and distinction among episodes of alcohol-induced memory loss |year=2003 |last1=Hartzler |first1=Bryan |last2=Fromme |first2=Kim |journal=Journal of Studies on Alcohol |volume=64 |issue=4 |pages=547–550}}</ref> A systematic review of the literature found that approximately 50% of drinkers have experienced memory loss during a drinking episode and have had associated negative consequences similar to sleepwalkers, including injury and death.<ref name="Wetherill 2016" />

Other differential diagnoses include [[rapid eye movement sleep behavior disorder]], confusional arousals, and [[night terror]]s.

=== Assessment ===
An assessment of sleepwalking via [[polysomnography]] poses the problem that sleepwalking is less likely to occur in the sleep laboratory, and if an episode occurs, it is usually less complex than what the patient experiences at home.<ref>Blatt, I., Peled, R., Gadoth, N., & Lavie, P. (1991). The value of sleep recording in evaluating somnambulism in young adults. Electroencephalography & Clinical Neurophysiology, 78, 407–412.</ref><ref>Joncas, S., Zadra, A., Paquet, J., & Montplaisir, J. (2002). The value of sleep deprivation as a diagnostic tool in adult sleepwalkers. Neurology, 58, 936–940.</ref><ref>Kales, A., Soldatos, C. R., Caldwell, A. B., Kales, J. D., Humphrey, F. J., 2nd, Charney, D. S., & Schweitzer, P. K. (1980). Somnambulism. Clinical characteristics and personality patterns. Archives of General Psychiatry, 37, 1406–1410.</ref> Therefore, the diagnosis can often be made by assessment of sleep history, time-course and content of the sleep related behaviors.<ref>Hublin, C., Kaprio, J., Partinen, M., Heikkila, K., & Koskenvuo, M. (1997). Prevalence and genetics of sleepwalking: A population-based twin study. Neurology, 48, 177–181.</ref> Sometimes, home videos can provide additional information and should be considered in the diagnostic process.<ref>Kavey, N. B., Whyte, J., Resor, S. R., Jr., & Gidro-Frank, S. (1990). Somnambulism in adults. Neurology, 40, 749–752.</ref>

Some features that should always be assessed include:<ref>{{Cite book|url=https://oxfordhandbooks.com/view/10.1093/oxfordhb/9780195376203.001.0001/oxfordhb-9780195376203-e-027|title=Parasomnias II|last1=Zadra|first1=Antonio|last2=Pilon|first2=Mathieu|date=2012-03-01|publisher=Oxford University Press|doi=10.1093/oxfordhb/9780195376203.013.0028}}</ref>
* Age of onset
* When the episode occurs during the sleep period
* How often these episodes occur (frequency) and how long they last (duration)
* Description of the episode, including behavior, emotions, and thoughts during and after the event
* How responsive the patient is to external stimuli during the episode
* How conscious or aware the patient is, when awakened from an episode
* If the episode is remembered afterwards
* The triggers or precipitating factors
* Sleep–wake pattern and sleep environment
* Daytime sleepiness
* Other sleep disorders that might be present
* Family history for NREM parasomnias and other sleep disorders
* Medical, psychiatric, and neurological history
* Medication and substance use history
The assessment should rule out differential diagnoses.