Idiopathic rapid eye movement sleep behavior disorder is characterized by vocalizations and complex motor behaviors during sleep. We report a case of a 44-year-old male with a 20-year history of dream enactment behavior that was incidentally captured on a polysomnogram during an evaluation for obstructive sleep apnea. Genetic testing found the patient had a homozygous deletion for one of the five tandem repeats in exon 18 of the PER3 gene. This case highlights a potential genetic basis for idiopathic rapid eye movement sleep behavior disorder.