Fearful sleeping and waking

With strong encouragement from his parents and girlfriend, a young man sought help for the unusual things he was doing during the night. His sound sleep had become interrupted by a variety of behaviors that he often did not remember. Sometimes he would walk in his bedroom or around the house while not fully awake. Usually he would return to bed on his own. However, his parents recently had found him walking down the street in his underwear in the middle of the night. He complained that for years his sleep had been disrupted by very vivid and disturbing dreams. Occasionally he awakened with nightmares. Some nights he would kick, thrash, or scream, but not necessarily awaken. Sometimes he would suddenly wake up with a sense of dread, a racing heartbeat, and profuse sweating. Everyone's concern was heightened by the development of more vigorous actions emanating from his sleep. On a few occasions when spending the night with his girlfriend his sleep-related behaviors became more aggressive, on one occasion to the point where he briefly seemed to be trying to strangle her. He quickly awakened and was able to describe his sense of terror while dreaming of fighting off attackers. He felt rather distressed that he was doing things he could neither control nor recall very well, and now, that he might do something harmful.