A non-neurodegenerative REM parasomnia with immersive dreaming and dream-reality confusion: a case report
Frontiers in Sleep September 11, 2025 Nazanin Biabani, Martina Mulas, Carlotta Mutti et al. 2 citations
A 7-year history of vivid, immersive dreaming perceived as continuous with waking life, accompanied by persistent dream-reality confusion, is described in a younger individual. The patient engaged in reality-testing behaviors and reported significant cognitive fatigue. Video-polysomnography confirmed REM sleep without atonia and a dream re-enactment episode. Neuropsychiatric evaluation ruled out dissociative or psychotic disorders, and no neurodegenerative disease was observed. The case suggests a potentially distinct, non-neurodegenerative REM parasomnia phenotype, highlighting the need to expand current classifications to capture cognitive and metacognitive dimensions of REM sleep disorders. Potential mechanisms involving melanin-concentrating hormone signaling are discussed.