Locked in Lucid Rhythms: A Case of Rhythmic Movement Disorder in Rapid Eye Movement (REM) Sleep.
Cureus June 1, 2026 Muhammad Farhan, Rafeek Kandy, Bayena Alblooshi
A man in his mid-20s with nightly head movements during sleep was diagnosed with sleep-related rhythmic movement disorder (SRRMD) after video-EEG and polysomnography excluded epilepsy and REM sleep behavior disorder. The movements were stereotyped lateral head rolling exclusively during REM sleep at about 1 Hz without loss of REM atonia. He intentionally shook his head to terminate lucid dreams. Comorbid mild obstructive sleep apnea was identified. Sequential pharmacotherapy with amitriptyline, nortriptyline, and later venlafaxine plus bupropion achieved complete resolution of rhythmic movements and excessive daytime sleepiness. At six-month follow-up, his Epworth Sleepiness Scale score improved from 22 to 3.