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Sleep Disorders

Physically Cannot Wake Up at Times

10/10/2008

Question:

There have been times during my life that I cannot wake up and I am aware that I cannot. I feel as though I have gotten put of bed struggling and my eyes seem to open, but I do not see things clearly and I am fighting to open them. When I do open them it pulls me right back into it. It is a struggle. They have come and gone for years. I had two after falling back to sleep the past two ams. There has been some stress in my life lately. I also at times see bright colors at night just before falling asleep that does not happen often.

Answer:

Without additional information, it’s hard to know exactly what the symptoms you are experiencing are caused by. However, it is likely that you are experiencing a form of either sleep paralysis or sleep inertia. Both can be part of normal sleep physiology or brought on by a lack of adequate sleep, stress, or a primary sleep disorder.

First, sleep paralysis:

Feeling like you cannot move when you awaken can be a frightening and anxiety producing sensation. Surprisingly, up to 15-40% of young adults experience this at least once in their lifetime and as many as 5-6% have this occur recurrently.

Sleep paralysis is usually described as the inability to perform voluntary movements either at sleep onset or upon awakening. Having it occur during naps is not unexpected. Individuals often report an inability to speak or move the limbs, trunk or head. Breathing is not affected and individuals can recall the event. The episode usually only lasts for seconds up to a few minutes and tends to resolve on its own. Occasionally, the episode will end if the person is touched or spoken to.

Episodes of sleep paralysis can be very anxiety producing. Hallucinations, whether hearing or seeing things that are not present, can accompany the event. All-in-all, the experience can be somewhat frightening. Sleep paralysis can be brought on by lack of adequate sleep, keeping an irregular sleep schedule and being under excessive stress. While most of the time sleep paralysis is not associated with other medical conditions, it can be one of the signs of narcolepsy (individuals with this condition are also very sleepy).

Sleep paralysis usually first appears in young adults and tends to disappear with aging. Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

Other medical conditions that can appear with similar symptoms to sleep paralysis include compressed nerves, cataplexy (sudden loss of muscle control in emotionally charged situations such as laughing), seizures, and panic attacks. Most of these conditions can be separated from sleep paralysis by specific factors from the medical history.

And second, sleep inertia:

Sleep inertia occurs when individuals awaken from deep or slow wave sleep and have a great deal of trouble waking up. Typically, they may seem groggy, confused or only partially awake. This may last for several minutes before there is an improvement in the level of alertness.

Sleep inertia is commonly seen in children, particularly if you try to awaken them during the night. It may be seen in adults as well, most commonly if they are sleep deprived and then nap for more than 20-30 minutes. With prolonged recovery napping, entering slow wave sleep can occur. And if an individual attempts to awaken from slow wave sleep, they will often experience the sleep inertia symptoms discussed. However, unlike sleep paralysis, they are able to move, there is no sensation of trying to awaken but feeling paralyzed, and there is often poor recall.

It is certainly possible that your symptoms represent normal sleep phenomena and should not be of concern. Getting adequate sleep and reducing stress may be enough to resolve the symptoms. However, if you are concerned about your symptoms or would like to exclude some of the other possibilities mentioned above, I recommend you discuss your problems with your Primary Care Doctor. They can then decide if referral to a Sleep Specialist is needed for further evaluation.

If you would like further information about sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. Good Luck!

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Response by:

James   Knepler, MD James Knepler, MD
Formerly, Assistant Professor
College of Medicine
University of Cincinnati