Clinical Intake — Parasomnia

A 42-year-old male presents with an 8-month history of violent nocturnal movements—thrashing, kicking, and vocalizations confirmed by his bed partner, with one episode resulting in physical injury to his spouse. He endorses marked daytime somnolence (Epworth score 16/24), loud habitual snoring, and two near-miss drowsy-driving incidents. BMI is 34.1. Conservative management with escalating nightly melatonin has yielded no benefit. Clinical assessment by Dr. Patel raises concern for a parasomnia with violent REM-associated behavior; no prior formal nocturnal diagnostic study has been performed. Dr. Patel recommends further specialist evaluation to characterize the underlying disorder.