This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 73-year-old patient who complained of two recent violent dreams that resulted in significant injury. His past medical history included an anterior wall myocardial infarction, sinusitis and a remote history of tuberculosis. The patient was treated with clonazepam 1.0 mg every evening before sleep, with complete resolution of all violent dream-related behaviors over the following year. The MRI scan revealed a right subdural hematoma without mass effect, and a few small 2-3mm foci of deep white matter changes. The polysomnography (PSG) study revealed significant periodic limb movements. A follow-up assessment by a movement disorders specialist led to the diagnosis of Parkinson's disease. The patient's history and PSG analysis are classical for, and diagnostic of, REM-sleep behavior disorder (RBD), which is defined in ICSD-2 as a parasomnia associated with REM sleep.

This chapter presents the clinical history, examination, treatment, management, and the results of the procedures performed on a 27-year-old patient who was admitted for the evaluation of odd sleep-related behaviors. At the time of presentation, the patient had a consistent bedtime of 11.30 pm. Nocturnal polysomnography (PSG) with additional all-night 16-channel EEG running concomitantly with the PSG was obtained. There was no evidence of obstructive sleep apnea (OSA) with normal breathing and normal O2 saturation during sleep averaging 93% with a nadir of 90% and a desaturation index of zero. Given these results, a diagnosis of parasomnia overlap disorder was made. The ICSD-2 defines parasomnia overlap disorder as consisting of both REM-sleep behavior disorder (RBD) and a disorder of arousal. Prognosis is unknown, but careful follow-up is recommended to help with early detection of Parkinsonian disorder or other degenerative neurological disorders that are known to be associated with RBD.

This chapter discusses the case of a 54-year-oldwoman with disturbing respiratory noise during nocturnal sleep. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. EMG investigation of laryngeal muscle activity was subsequently performed during wakefulness and sleep, placing fine-wire electrodes in the posterior cricoarytenoid, cricothyroid and thyroarytenoid muscles. The specialist made a diagnosis of nocturnal inspiratory stridor based on the characteristics of the noise present only during sleep, particularly during NREM sleep. A diagnosis of REM-sleep behavior disorder (RBD) was also made due to the characteristic clinical history of violent motor behaviors during sleep associated with polysomnography (PSG) evidence of REM sleep without atonia. Tracheostomy and continuous positive airway pressure (CPAP) are effective treatments of stridor; however, they do not always prevent death in multiple-system atrophy.

This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 54-year-old man who reported that he had been having problems with his sleep for the previous 20 years. He said he had "bad dreams". A detailed neurological examination was completely normal. Cardiac and respiratory examinations were also normal. Overnight video-polysomnography (PSG) was planned. EEG showed occasional 1-second or so runs of moderate amplitude (2-5 Hz) slowing in either temporo-frontal region during early drowsiness. The episodes were thought to be frontal lobe seizures leading to a diagnosis of nocturnal frontal lobe epilepsy (NFLE). The diagnosis was NFLE with central sleep apnea (due to seizures). The differential diagnosis of these nocturnal events includes NREM-sleep-arousal parasomnias, REM-sleep behavior disorder (RBD) and psychogenic disorders. The video-PSG and the home study were very helpful in the diagnosis of this patient.