Case history
Case history #1
At the insistence of his wife and daughter, a 70-year-old white man presents with abnormal sleep behavior. The wife reports that the patient punches her vigorously and shouts loudly in his sleep. The patient believes that the problem stems from acting out dreams in which he is chased by a group of men and has to defend himself when cornered by "throwing punches at them." After a severe episode in which he dived out of bed and sustained a forehead laceration, he decided to tie himself to the bed and his family insisted that he see his physician. His examination reveals decreased facial expression, some cogwheel rigidity and bradykinesia of the upper extremities (right greater than left), and shuffling of gait. Polysomnography with additional forearm EMG electrodes noted rapid eye movement (REM) sleep without atonia. The patient was diagnosed with REM sleep behavior disorder and Parkinson disease.
Case history #2
A 30-year-old man presents with his wife, who complains that he walks in his sleep. She reports that about 1 to 2 hours into sleep she is woken up by her husband leaving the bed and walking around the room. This happens once or twice a month. On 2 occasions he tripped on furniture in the room. She reports that she has been unable to abort these episodes by redirecting him and talking to him because he seems to be dazed and unresponsive. The patient himself goes back to bed and falls asleep after about 10 minutes of aimless wandering around the room. The patient has no recollection of any of these events. However, he does report that sleepwalking is extremely common in his family, and when he was younger he was observed walking in his sleep more commonly than at present. The patient underwent polysomnography which did not show sleep apnea or epileptiform abnormalities. The patient was diagnosed with sleepwalking and improved with bedroom environment safety measures, avoiding sleep deprivation, and cognitive behavioral therapy.
Other presentations
Parasomnias may be transient and have no significant consequences on the patient's sleep health. In other cases they are severe or persistent enough to cause significant sleep disruption and distress or injury to the patient or bed partner.
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