A 76-year-old man tells the nurse at the sleep disorder clinic, "I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers. Then I realize I have been hitting and kicking my wife. She has bruises." Which health problem is most likely?

A) Sleep paralysis
B) Night terror disorder
C) Sleep-related bruxism
D) REM Sleep Behavior Disorder

The scenario describes REM sleep behavior disorder in which the patient engages in violent and complex behaviors during REM sleep as though acting out his dreams. Older men have a higher incidence of this problem. Sleep paralysis refers to the sudden inability to perform voluntary movement at either sleep onset or awakening from sleep. Bruxism refers to grinding teeth during stage 2 sleep. Night terror disorder occurs as arousal in the first third of the night during NREM sleep, accompanied by feelings of panic.