Case 30 - Fighting in sleep  pp. 208-216

Fighting in sleep

By Lynn V. Kataria and Bradley V. Vaughn

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Clinical history

Mr J. was a 42-year-old man who presented with a 2-year history of events of yelling and fighting in his sleep that were brought to his attention by his wife. She described the events as him yelling out and then striking the headboard repetitively with his fist. The events were typically in the first half of the night and lasted for approximately 10–30 seconds after which he resumed sleep. Mr J. had no memory of the events and he was initially unsure that the events had really happened until he awoke with a bruised hand. He denied any associated dream recall or feeling of threat. Mrs J. began sleeping in a separate bed due to concern that she might be injured. The morning following an event, Mr J. felt mildly tired, but had no other daytime complaints. Initially, the events occurred approximately every 2 months, but later the frequency was once per week. His wife noted that Mr J. was under significant stress at work and she was concerned that these events were related. On more specific questioning, his wife noted that the patient's eyes were closed during the events. A loud noise or a sudden arousal did not provoke the events. Otherwise, the patient was a relatively quiet sleeper and did not snore. She denied that he had leg kicking, thrashing or other night-time episodes. During the daytime, the patient denied sleepiness or symptoms suggestive of cataplexy, sleep paralysis or seizures.

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