Rapid eye movement behaviour disorder

A 70-year-old man was referred to a specialist sleep service in December 2010 by his general practitioner at the prompting of his wife. He reported a 7–8-year history of near-nightly, increasingly severe sleep disturbance with vivid dreams which would occur in the latter half of the night. Bedclothes were often found strewn around the room, and he would wake in unusual positions. The dreams usually related to being chased or attacked, and the patient could recall them in great detail. While asleep, the patient frequently shouted in response to the dreams. Violent motor responses to the dreams were also common — the patient had kicked, punched and attempted to choke his wife while asleep, he had fallen out of bed, and he had leapt into wardrobes and onto bedside tables. The patient and his wife had suff ered injuries. He had surrounded his bed with mattresses to prevent further injury, and had taken to restraining himself to the frame of his bed with two belts strapped fi rmly around his waist and chest. He reported being aware of the violent behaviour. His wife had moved into a separate bedroom for her own safety.