When the Sleeper Becomes the Photographer: Recurrent Smartphone Photography During NREM Parasomnia-A Case Report.

Disorders of arousal from non-rapid eye movement (NREM) sleep are characterized by complex behaviors arising from incomplete awakenings. These behaviors can occasionally involve sophisticated motor actions and interactions with the environment. We report an apparently previously unreported case of a patient who repeatedly took photographs with a smartphone during somnambulistic episodes. A woman with lifelong NREM parasomnia presented with frequent sleepwalking episodes that worsened after the onset of irregular shift work. During clinical evaluation, she reported that she occasionally took photographs during nocturnal episodes. She subsequently provided 77 smartphone photographs taken between 2018 and 2026. Twenty-seven images were completely dark, whereas 50 photographs contained identifiable objects. Many photographs showed poor framing, motion blur, prominent light sources, or light-shadow contrasting patterns. In several images, the patient's hand appeared within the frame, suggesting directed attention toward specific objects. The timestamps of the photographs clustered during the first half of the night sleep, typical for periods of NREM parasomnia occurrence. The patient was able to partially recall the dream content of the photo shooting episodes. In-lab video-polysomnography demonstrated repeated awakenings from N3 sleep, supporting the diagnosis of a disorder of arousal. This case illustrates an apparently previously unreported form of goal-directed behavior during sleepwalking. Although the photographic behavior was not directly documented during video-polysomnography, the temporal pattern, clinical presentation, and objective photographic evidence support its occurrence during parasomnia episodes. The findings provide insight into the interaction between dream mentation, environmental stimuli, and complex motor behavior during incomplete arousal, and suggest that highly automatized technology-mediated behaviors may become incorporated into the behavioral spectrum of NREM parasomnias.