Occasionally, patients present with the description of other REM-sleep fragmentary events as nocturnal behaviors. Patients with terrifying hypnagogic hallucinations may note recurrent scary imagery just as they are falling asleep. These events may be associated with screaming, yelling, or other frightened behavior. Patients have a clear memory for the events and can recall the visual imagery.46

Patients with recurrent sleep paralysis may also present with complaints of unusual spells. These individuals describe complete paralysis on awakening. They cannot move their extremities, and calling out may only produce a weak whisper. They can have concurrent visual imagery and a sense of impending doom or of being chased. These episodes may last seconds to minutes and can be aborted by another individual touching the patient. Patients may note that these spells are recurrent.47

A rare disorder, REM sleep sinus arrest can present as events of sudden arousal with a sense of impending doom. A sense of panic and fear can be a symptom. These patients may have histories compatible with isolated nocturnal panic attacks. Polysomnography shows sinus pauses of 2.5 seconds or longer during REM sleep. These patients need to be identified and referred for cardiac evaluation and pacemaker placement.48

Adapted from: Malow, BA, and Vaughn BV. Sleep disorders and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;255–267.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.