Forensic Sleep Medicine

Patients with sleep disorders can exhibit behavior that includes violent acts. The behavior may occur during various sleep stages, ranges in complexity, and requires an analysis of consciousness. When the behavior harms another person and criminal charges follow, expert testimony will be required to explain the physiology of the disorder and impairments in consciousness that determine criminal culpability, that is, whether there was conscious intent behind the behavior. In this chapter, sleep-related conditions associated with violent behavior are discussed, along with guidelines for presenting scientific testimony in court. These disorders include rapid eye movement (REM) behavior disorder, somnambulism and other non-REM partial awakenings, and hypersomnolence. Feigned symptoms and malingering must be ruled out, and the clinical parameters for them are discussed. While the physiology of sleep disorders has widely been known, admissibility in court is not automatic. Standards for acceptable expert testimony are discussed.