A 58-year-old man comes to the ·office accompanied by his wife | Surgery collections Videos and quizez 2021

A 58-year-old man comes to the ·office accompanied by his wife, who is concerned about his abnormal behavior during sleep. Several years ago she first noticed that he would occasionally shout and jerk his arms and legs while remaining asleep. Over the past year, these episodes have become more frequent, occurring 3-4 nights a week, and his movements have become more violent. The episodes typically occur at least 2 hours after he has fallen asleep. Sometimes he kicks and punches his wife as if he were defending himself from attack. The patient has fallen out of bed on occasion and once knocked over the nightstand. His wife is afraid that he will inadvertently injure himself or her. The patient has no history of irritable, aggressive, or violent behavior during the day or any history of sleep difficulties; however, his dreams have become more intense and he has frequent nightmares of being attacked. He has a history of hypertension that is well controlled. Physical examination is unremarkable.