1298 Endless Nights: Epic Dreaming and Response to Cyproheptadine

Abstract Introduction Epic dreaming, though not formally defined in major sleep medicine guidelines, is recognized in clinical practice as unusually vivid, mundane, and immersive dreaming that unfolds in prolonged, elaborate, narrative-rich sequences. Patients often report dreaming continuously throughout the night, frequently involving relentless or repetitive activity, such as endlessly walking, that leaves them feeling drained upon awakening. Clinically, epic dreaming is significant because it frequently accompanies fragmented, non-restorative sleep and marked daytime fatigue, even when objective sleep evaluations are unremarkable. Given its rarity and the absence of standardized criteria, formal treatment guidelines are lacking. Report of case(s) We present the case of a 47-year-old male with generalized anxiety disorder and asthma with a long-standing history of nightly epic dreaming, describing vivid, immersive dreams often centered on unsuccessful attempts to resolve a problem. These dreams lasted throughout the night, triggered two to three awakenings, and left him exhausted, struggling to resume sleep, and markedly fatigued during the day. He denied alcohol or recreational drug use. Notably, several relatives—including his brother, maternal cousin, and maternal aunt—reported similar dream patterns. A prior home sleep apnea test was unremarkable. Trials of anxiolytics and melatonin were ineffective, and prazosin provided only minimal benefit before being discontinued due to orthostatic dizziness. At the initial visit, cyproheptadine 4 mg nightly was started and a referral for CBT-I placed. The dose was gradually increased to 12 mg nightly. At one-month follow-up, he reported a meaningful reduction in dream frequency and intensity, improved sleep continuity with only one nighttime awakening, and less daytime fatigue. Although epic dreaming persisted, it was largely confined to the latter part of the night and was considerably less draining than before. Conclusion Epic dreaming presents as vividly immersive, narrative-rich dreaming that can lead to significant sleep disruption and daytime fatigue. Sustained dreaming has been reported to occur in both REM and non-REM sleep. This case demonstrates that cyproheptadine may provide meaningful symptomatic improvement, potentially through its known effects on suppressing REM and enhancing slow-wave sleep. The occurrence of similar dreaming patterns in multiple relatives raises the possibility of a familial predisposition and underscores the need for further research. Support (if any)