An nurse practitioner asks about a 34-year-old female with a history of erratic nighttime episodes of sudden awakening, sitting upright in bed, and screaming.

The patient’s spouse is unable to awaken her for several minutes, and then she does not remember the event. She denies having nightmares and has had a negative sleep study. She says that this issue is becoming very disruptive to her sleep and marriage.

A review of her recent monitored sleep study showed that she was sitting upright less than one hour after falling asleep. The sleep lab personnel were able to get her to lie back down. She did not remember the event, and her overall sleep study was negative for abnormalities. After consulting a neurologist, the nurse practitioner determined a diagnosis of REM sleep behavior disorder, and she was started on low-dose clonazepam at bedtime. She did very well on this medication. (197-2)