A non-neurodegenerative REM parasomnia with immersive dreaming and dream-reality confusion: a case report
Nazanin Biabani, Martina Mulas, Carlotta Mutti, Sean Higgins, Katarina Ilić, Joshua Benson, Ana Santic, Valentina Gnoni, Panagis Drakatos, Andrea Romigi, Alexander D. Nesbitt, Sharon L. Naismith, Carlos H. Schenck, David O’Regan, Monica Puligheddu, Ivana Rosenzweig
Frontiers in Sleep September 11, 2025 DOI: 10.3389/frsle.2025.1659300 (opens in new tab) via OpenAlex
Summary
AI-generated from the abstractA 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.
Study at a glance
| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A younger individual with 7-year history of vivid dreaming and dream-reality confusion |
| Duration | 7-year history |
| Keywords | Parasomnia Cognition Relation database Sleep system call Frith |
| Citations | 2 |
| Key finding | A non-neurodegenerative REM parasomnia phenotype characterized by immersive dreaming and persistent dream-reality confusion may exist, distinct from typical prodromal RBD. |
Abstract
Background: REM sleep behavior disorder (RBD) is characterized by loss of normal muscle atonia during REM sleep, often associated with dream enactment behaviors, and is typically a prodromal neurodegenerative condition in middle-aged and older adults. However, emerging case reports and case series suggest that not all RBD presentations follow this trajectory, particularly in younger individuals. Case presentation: A case of 7-year history of vivid, immersive dreaming perceived as continuous with waking life, accompanied by persistent dream-reality confusion, is described. The patient frequently engaged in reality-testing behaviors and reported significant cognitive fatigue. Video-polysomnography confirmed REM sleep without atonia and a concordant dream re-enactment episode. Neuropsychiatric evaluation ruled out dissociative or psychotic disorders, and no evidence of neurodegenerative disease was observed. Conclusion: This presented case illustrates a potentially distinct, non-neurodegenerative REM parasomnia phenotype that underscores the need to expand current parasomnia classifications to better capture the diverse cognitive and metacognitive dimensions of REM sleep disorders. Moreover, potential mechanisms underlying the main features of this case, including immersive dreaming and persistent dream-reality confusion, are discussed in relation to hypothesized dysfunction in melanin-concentrating hormone (MCH) signaling.