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Complex behaviors arising from the sleep period may result in violent or injurious consequences, even death. Those resulting in death may be erroneously deemed suicides. A series of case examples and review of the pertinent literature are provided to increase awareness of the possibility that some apparent "suicides" are the unfortunate, but unintentional, consequence of sleep-related complex behaviors and therefore are without premeditation, conscious awareness, or personal responsibility. The correct cause-of-death determination in such cases may have profound social, religious, and insurance implications for surviving friends and family members.

It is common practice to forcibly awaken patients from an all-night polysomnographic study prior to performance of a multiple sleep latency test (MSLT); either for reasons of protocol or for the convenience of the laboratory personnel. We report a case of a young woman who, by formal sleep study criteria, received the erroneous diagnosis of narcolepsy due to the effects of severe sleep deprivation, and document that the effects of prior sleep deprivation require more than one night of ad libitum sleep. Forced awakening prior to MSLT may permit sleep deprivation or delayed sleep phase syndrome to masquerade as narcolepsy or idiopathic central nervous system (CNS) hypersomnia.