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Volume 14 No. 05
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Accepted Papers

Case Reports

Violent Parasomnia With Recurrent Biting and Surgical Interventions: Case Report and Differential Diagnosis

Nilam Danish, MBBS1; Imran S. Khawaja, MBBS, FAASM1,2; Carlos H. Schenck, MD3
1Center for Sleep Medicine, Department of Neurology, VA Medical Center, Dallas, Texas; 2Department of Psychiatry and Neurology and Neurotherapeutics, UTSW Medical Center, Dallas, Texas; 3Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota

A case is reported of recurrent, injurious self-biting during sleep, requiring surgical interventions, in a 55-year-old obese man with a 20-year history of violent complex parasomnia, with greatly increased frequency and severity of episodes induced by work stress during the preceding 3 years. After clinical evaluation and overnight, hospital-based video-polysomnography, the cause of the chronic injurious parasomnia was deemed to be a non-rapid eye movement (NREM) sleep parasomnia comorbid with severe obstructive sleep apnea. Therapy with bedtime clonazepam and bilevel positive airway pressure was effective, with injurious parasomnia relapse occurring with cessation of either or both of these therapies. The differential diagnosis of sleep-related biting should now include NREM sleep parasomnia (with or without comorbid obstructive sleep apnea), besides previously reported cases of REM sleep behavior disorder (RBD), sleep-related dissociative disorder, sleep-related rhythmic movement disorder and anticipated cases of parasomnia overlap disorder (RBD + NREM sleep parasomnia), sleep-related biting seizures, and sleep-related eating disorder.


Danish N, Khawaja IS, Schenck CH. Violent parasomnia with recurrent biting and surgical interventions: case report and differential diagnosis. J Clin Sleep Med. 2018;14(5):889–891.

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