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Friday, July 25, 2014
Sleep apnea and body tremors
I have sleep apnea. Many times I wake up during the night with excessive body tremors. Many times the jerking is severe (like a complete 360 turnover in bed). This occurs even when I use the cpap machine.
Many types of movements that occur during sleep are normal. Large muscle contractions that occur during transition from wakefulness to sleep are also common, and are known as "hypnic jerks" or "sleep starts". However, there is a wide variety of movement disorders that are related to sleep or to the transition between sleep and wakefulness.
Movement disorders can be worse during wakefulness or during sleep. They can affect a certain part of the body and not other parts, and they can present as simple repetitive movements or complex elaborate behaviors. Examples of some of the movement disorders include:
- Wakefulness-related movement disorders include Parkinson's disease and Essential Tremor.
- Simple sleep related disorders that affect the legs mainly include Periodic Limb Movement disorders and Hypnagogic Foot Tremor.
- Simple movements that occur during childhood include Rhythmic movement disorders and Myoclonus of Infancy.
- Complex movements that occur during sleep may be an indication of Disorder of Partial Arousal if consciousness if preserved, or may indicate Epilepsy if consciousness is impaired during the episodes.
The tremors that you write about seem to occur during the period of transition from sleep to wakefulness; that is, it may start during sleep and may persist into wakefulness, and they seem to be quite violent to cause your whole body to change position. This could still represent hypnic jerks, especially if associated with a feeling of falling down. In hypnic jerks, it is important to ensure your sleep environment is safe. Another possibility to consider is uncontrolled sleep apnea. Significant movement in sleep can be part of the arousal response to a close airway and thus making sure your sleep apnea is being adequately treated with CPAP is important. If this is the primary issue, then no other treatment is necessary for the jerks themselves.
If you have personal of family history of seizures, if you have hurt yourself or someone else during these episodes, or if you aren't fully aware of your surrounding when these jerks happen, then you may want to consult with your Sleep Specialist to determine if further evaluation is needed and to assure your safety.
Additional information regarding sleep can be obtained on the American Academy of Sleep Medicine website. This website contains a list of Sleep Centers across the country so you can find one if you need it.
I wish you the best of sleep.
Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University