Dreaming and parasomnias – a case with severe parasomnia overlap disorder and its treatment

Dreams are experiences during sleep that are internally generated by the brain. Dreaming is a common phenomenon during normal sleep and may occur in all sleep stages. The brain is active during sleep, but perceptual connection to the environment is mostly turned off. However, the content of dreams can be affected by both external and internal stimuli. Dream recall is associated with higher frequency brain activity during sleep, typical of REM sleep and arousals. During parasomnias, dream experiences may be disturbed, behaviourally manifested or mixed with waking reality. Parasomnias are sleep disorders characterized by incomplete transitions between sleep and wake. Abnormal motor, sensory or behavioural manifestations of parasomnias occur at sleep onset, within sleep or during arousal from sleep. Various sensory stimuli may be able to disturb sleep causing arousals or partial awakenings typical of parasomnias. Differential diagnosis of parasomnias includes patient report of recalled and enacted dream content, timing and age at onset of parasomnia episodes, witnessed sleep behaviour, and polysomnographic findings about the sleep stage and the mechanism of episodes. In adults, parasomnias may have a significant negative effect on well-being and even violent consequences. A patient case with severe parasomnia overlap disorder and its treatment is presented.