This chapter discusses the case of a 46-year-old female with a 5-year history of distressing, unpleasant and bizarre dreams that occurred from a few times a week to once a month, depending on her stress level. It presents the clinical history, examination, diagnosis, follow-up, general remarks and the results of the procedures performed on the patient. Nocturnal polysomnography (PSG) was carried out, and the thyroid-stimulating hormone level in plasma was determined. The diagnosis was nightmare disorder with primary snoring. The relationship between daytime stress, anxiety and nightmares was emphasized. The treatment plan centered on addressing daily stress and anxiety. Recurrent nightmares are frequent in children (20-39%) and less frequent in adults (5-8%). Nightmares also occur in patients with psychiatric illnesses such as anxiety, depression and schizophrenia, as well as in individuals with poor coping mechanisms and creative tendencies.

This chapter discusses the case of a 17-year-old girl who was admitted for the evaluation of excessive daytime sleepiness (EDS). It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. She suffered developmental delay, and was later diagnosed with mild mental retardation. Nocturnal polysomnography (PSG) and a multiple sleep latency test (MSLT) were carried out. The diagnosis was childhood-onset narcolepsy with cataplexy. The parents declined CSF testing for hypocretin. The onset of narcolepsy may occur with any of the four cardinal symptoms (excessive sleepiness, sleep paralysis, hypnagogic hallucinations and cataplexy), the most frequent being EDS. Childhood onset of narcolepsy is uncommon, but has been reported. The usual age of onset is mid- to late teens up to mid-20s. Occasionally patients may become ill after the age of 40.

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.

If the notions of dream and nightmare are centuries old, going back to ancient Egyptian and Jewish civilizations, the distinction between nightmares and parasomnias is recent. As parasomnias became distinguishable from nightmares, a possible link between such episodic nocturnal phenomena and seizure disorders was proposed. In 1999, Ohayon et al. in their epidemiological studies on sleepwalking and sleep terrors found that obstructive sleep apnea syndrome was the most common sleep disorder associated with parasomnias between the ages of 15 and 24 years. Epileptic disorders were shown to be rarely involved in abnormal behavior during non-rapid eye movement (NREM) sleep, but when sleep-related seizure disorders are present, specific seizure entities are implicated. Nocturnal polysomnography has allowed the dissociation of NREM from REM sleep abnormal behavior. The initial description of what is now known as REM sleep behavior disorder (RBD) came from Japanese researchers.