1177 The Patient Who Never Stopped Dreaming
Sleep April 20, 2024 Shalini Gupta, A. Avidan
A 74-year-old man with REM sleep behavior disorder, visual hallucinations, and new cognitive deficits perceived the world as a persistent dream-like state for two years, describing objects as unreal, cartoon-like, and distorted. Polysomnography confirmed REM sleep without atonia. The authors argue that people with dementia with Lewy bodies experience a spectrum of sleep disorders and complex visual hallucinations reflecting impaired sensory integration during the transition from mild cognitive impairment to dementia. They contend that sleep clinicians must recognize visual-spatial processing disorders in any patient presenting with sleep-related hallucination, as these may be stigmatized or misattributed to REM sleep behavior disorder.