1345 Home Camera Technology as Collateral in the Evaluation and Management of Treatment-Refractory REM Sleep Behavior Disorder

Abstract Introduction REM Sleep Behavior Disorder (RBD) is characterized by loss of REM atonia and dream enactment behaviors, which can result in significant injury risk. While polysomnography (PSG) is the gold standard for diagnosis, in-lab studies may not always capture the full extent of nocturnal behaviors. Home camera technology offers a novel, accessible means to document and assess sleep-related behaviors in the patient’s natural environment, potentially enhancing diagnostic accuracy and management. Report of case(s) A 51-year-old female presented with a three-year history of severe insomnia and violent parasomnias, including yelling, kicking, and falling out of bed. Her sleep was highly fragmented, with sleep onset often delayed until 3:30 AM and frequent abrupt awakenings associated with dream enactment. PSG confirmed REM without atonia and dream enactment behaviors, but the most compelling evidence of the frequency and severity of her behaviors was provided by home video recordings (Ring camera), which captured multiple episodes of dream enactment and injury risk. The patient’s management was further complicated by chronic insomnia and iron deficiency (ferritin 11 ng/mL despite oral supplementation). Multiple pharmacologic and behavioral interventions—including clonazepam, melatonin, hypnotics, orexin antagonists, and cognitive behavioral therapy for insomnia—were unsuccessful. The care plan included transition to intravenous iron, continued safety interventions, and ongoing medication optimization. Home video documentation was instrumental in risk assessment, guiding treatment adjustments, and engaging the patient and her caregivers in safety planning. Conclusion This case highlights the value of home camera technology as collateral information in both the diagnosis and ongoing management of RBD. Video documentation provided objective evidence of dream enactment behaviors, informed risk assessment, and supported individualized safety interventions. Integration of home camera technology into clinical practice may improve diagnostic confidence, facilitate tailored interventions, and promote safety in patients with severe parasomnias. Support (if any)