Case: 39-year-old Acting Out Dreams

00:00 In this talk, we will review the parasomnias. Let's begin with a case. This is a 39-year-old man who presents for evaluation of irregular nighttime episodes.

00:14 The patient's wife reports that for the past 6-9 months, the patient has developed episodes at night when he will punch, kick, or other behaviors at night. The patient is completely asleep during these episodes. She describes events where he will fly a plane or fight a bear and other events that sound like he is acting out his dreams.

00:37 The patient is not aware of these events. He denies neurological complaints.

00:42 There is no history of seizures. No incontinence or tongue biting. And neurologic examination is normal except for evidence of anosmia. So this patient presents with a presentation consistent with acting out dreams. So what's the most likely diagnosis? Are these sleep terrors, REM sleep behavior disorder, sleep walking, or confusional arousal? Well, this is not the typical presentation for sleep terrors.

01:11 These events are described as suspicious for REM sleep phase events. They're occurring during REM sleep and sleep terrors are non-REM events and disorders.

01:25 This is not the typical presentation of sleep walking. There is no suggestion of sleep walking or other ambulatory activities during these events. This is also inconsistent with confusional arousal. Confusional arousal are non-REM sleep- related parasomnias and this patient's event appears to be occurring during REM sleep. So this is a typical presentation of REM sleep behavior disorder. The patient presents with a condition similar to acting out dreams and this may herald future onset of Parkinson's disease. So let's talk a little bit more about the parasomnias, events that occur during nighttime, and we'll review the etiology and epidemiology, the diagnosis, and management of these patients.