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Sleep Disorders

Disorder possibly related to lack of sleep?



I don`t get much decent sleep as I wake up frequently during the night. It seems like I have nightmares or bizarre dreams all night. I don`t sleep on my back because then I get sleep paralysis. I`m so tired when my alarm clock goes off in the morning. I`ve tried a wide variety of prescription sleep meds, but they make me so groggy in the monring that its dangerous for me to drive to work and hard to function at work. I`m a single mother and I go to bed after the kids, so going to sleep earlier isn`t an option for me. I live a stressful life as I am mom and dad all in one. I try to read or do crossword puzzles before bed, but I`m usually so exhausted and tired I can`t stay awake. The daytime `disorder` that I have is random sharp pain attacks that result in numbness and weakness accompanied by confusion, `foggyness`, difficulty speaking and extreme tiredness. The pain only lasts for several minutes, the brain-related symptoms last about an hour. Then I`m fine. Avoiding stimulants such as caffiene and the like seems to reduce the frequency of attacks. This still makes everday life difficult for me although I don`t get these attacks everyday. I`ve been to a wide variety of medical specialists at a very reputable medical clinic and no doctor yet knows what this `disorder` is. Could this somehow be related to lack of sleep?


You seem quite aware that you don’t get enough sleep and you are correct to blame most of your complaints on lack of sleep.

Insufficient sleep is a common problem for many people in our current 24/7 society. While most people function fairly well on 7 hours of sleep per night, sleep duration needs are different between individuals (range from 5 to 9 hours). Insufficient sleep can cause nightmares and vivid dreams when the brain is trying to make up for short sleep by spending most of sleep time in REM (dream sleep). During REM sleep, our muscles are paralyzed, and if the characteristics or phenomena of REM sleep intrude into wake time, the person will experience the “sleep paralysis” that you mention in your question.

Excessive daytime sleepiness is a common symptom of sleep deprivation. During extended hours of wakefulness, the brain tries to take advantage of any “down” period of inactivity (including driving and solving puzzles, which are quite monotonous) to try to take a nap. Sleepy driving is a dangerous activity, not only to the driver, but also to the passengers and to other people on the road. What’s even worse, is that most people who drive while sleepy aren’t aware of how impaired they are during these activities.

Other than excessive daytime sleepiness, mental function deterioration and fogginess, sleep deprivation can result in many neurological and nervous side effects including random pains and aches. People try to push through fatigue and sleepiness by taking “wake” substances such as tea and coffee. Doing so will unmask the pain and anxiety that would not have occurred if the person was able to take a nap.

It’s also possible that a different problem could be causing your symptoms. Based on some of the symptoms you describe, the condition of narcolepsy would have to be considered. Narcolepsy is characterized by excessive sleepiness and abnormal intrusions of REM sleep phenomena into awake time. Typically, during REM sleep, our muscles are inactive (except for our breathing muscles and eye muscles) and unable to move. In individuals with nrcolepsy, this "paralysis" of muscles may occur during wakefulness (known as cataplexy, usually brought on by strong emotions) or during transitions between sleep and wakefulness (sleep paralysis). In addition, dreams may intrude upon these times as well (known as hypnagogic or hypnapompic hallucinations). Other symptoms of nrcolepsy may include poor nighttime sleep and automatic behaviors (performing tasks without being aware of what you are doing or having recall of having done it).

You also describe waking up frequently during the night. This has many possible causes, of which one of the more common is sleep apnea. A person who has sleep apnea stops breathing multiple times during the night and has many short arousals throughout their usual sleep period. Sleep fragmentation may not obvious to the person. A bed partner is more likely to notice these episodes. Risk factors for developing sleep apnea include being overweight, having a large neck, and having nasal congestion. Those with high blood pressure seem to be at high risk for having sleep apnea as well. A sleep study is necessary to diagnose and treat this disorder. And although sleep apnea is one of the most common disturbers of sleep, other sleep disorders, medical conditions, psychiatric disorders, and environmental factors can cause the quality of sleep to be suboptimal and finding those factors is important to determine how best to treat a given individual. Diagnosing these issues usually requires a careful clinical evaluation by a physician, often a sleep expert.

I need to say that not all tiredness is due to sleepiness. Fatigue is a problem of being unable to do activities that require high physical demand. People who are fatigued function well during monotonous activities and don’t usually complain of sleepiness. This does not seem to be the story as you describe it. Some causes of fatigue include depression; taking substances and medications that suppress activity; diseases of the thyroid, parathyroid, pituitary, pancreas (including diabetes), and the adrenal glands; heart, kidney and liver disease; malignancy; anemia; infections disease; connective tissue disease such as rheumatoid arthritis; and other disorders of unknown cause such as chronic fatigue syndrome. Your general doctor can help rule out many of these if they are suspected based on clinical grounds.

In short, sleep deprivation could possibly be the cause of all the symptoms that you describe. It is important that you get more sleep and, if that does not improve your symptoms, that you seek an evaluation for other sleep disorders, such as narcolepsy or sleep apnea. An evaluation by a Sleep Specialist is necessary to reach these diagnoses and to start treatment. This problem seems to affect your personal life, your safety and your livelihood, so seeking help is a good idea.

Additional information regarding sleep and sleep disorders, and a list of Sleep Centers across the country can be obtained on the American Academy of Sleep Medicine website.

Good luck, and may you have the most restful sleep.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University