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Sleep Disorders

Unable to wake up - Parasonmiosis

11/17/2010

Question:

Every 2 to 3 months I have episodes where I am unable to wake myself up from sleeping. I feel like I am in a coma as I don`t have the strength to open my eyes or call anyone for help, wake up. The episodes normally last from the time I go to sleep at night (around 9 pm) to 5pm the next day. The last episode I had lasted from 7pm on a Friday to 7:30 pm the next day. During these episodes I am completely out of touch with everything i.e. I don`t know/hear what is going on around me, I can`t get up to go to the bathroom, I cannot get myself physically out of bed, I can`t make myself move to answer the phone, I am basically incapacitated and totally debilitated until the episode passes hours and hours later. After the symptoms have passed I am totally exhausted. Other physical symptoms include nausea, dizziness, headaches and stomach aches all present while I am in this sleep state.

I can tell when I`m having an episode as I will start having what seems like hundreds of different dreams during the night that are totally unrelated to one another. During these dreams I have the nausea, dizziness, headache symptoms as well. I have very slight sleep apnea (5), depression and some anxiety. I have trouble getting myself to sleep and I do tend to worry. I have tried different things to improve my ability to sleep such as keep the same bedtime, not exercising before bed, warm bath, etc but nothing seems to work.

I`ve tried to keep tabs on what things might effect the onset of these episodes - at one point I thought it was the nausea I had. Sometimes I noticed I would loose my balance slightly - just kind of slip up, but then I realized that these things didn`t always consistently preclude an episode. One thing I did notice is that these episodes started happening after having a partial hysterectomy (about 2 years ago). The episodes were not as severe at first but now they are worse. I am anxious about these episodes of course because I don`t know what is going on/causing them, what they are doing to my body, what if I don`t wake up one of these times from an episode?

I have told my GP about this and he has requested I have another sleep study where they will do an EEG to rule out that I may be having parasomniosis (sp?) seizures during these episodes.

Can you help me with any of this?

Thank you.

Answer:

Let me first congratulate you on your good sleep hygiene practices (keeping the same bedtime, not exercising before bed, warm bath, etc). I am sorry that you are still having problems with your sleep.

The nearest parasomnia to your description of your sleepiness episodes is called Sleep Paralysis.

Sleep-related hallucinations can accompany sleep paralysis and can be prominent, vivid, dream-like mentation occurring at sleep onset (called Hypnagogic), or while waking up from sleep (called Hypnopompic). Both of these phenomena are common and affect 10% of the population.

Although sleep-related hallucinations are visual most of the time, they may take the form of tactile equivalents such as feeling tingling or numbness. "Nausea, dizziness, headaches and stomach aches" have not been described. But remember that enough emotional pain may be difficult to handle and may appear to be quite physical for you.

Time perception during these episodes is also disrupted, so a few seconds may feel quite long. However, your episodes seem much longer than that (several hours and up to a day). This is unusual and I cannot find an explanation for it other than these two suggestions:

1- There is a sleep disorder that may occur in females close to the time of the menstrual cycle. This disorder can result in prolonged episodes of sleep, is called "Catamenial Hypersomnia", and may last a few days. It's probably difficult for you to time these episodes to when your period would have occurred since you have had partial hysterectomy. Nevertheless, if your sleepiness episodes occur at monthly intervals, this may be a clue.

2- Drugs, substances, and medical conditions may precipitate or exacerbate many of the parasomnias. A careful look at your medications and over-the-counter substance intake is important. For example, most of the anti-depression medications can change sleep architecture and can make parasomnias worse or better depending on their duration of action and time of the day they are taken.

I do agree with your physician in that a repeat sleep study (with a seizure/parasomnia setup) is necessary, especially since you have history of mild sleep apnea, and this may have gotten worse over time. Please note that when setting up a date for your sleep study, you and your sleep lab scheduler need to make an effort to "catch your sleep" during one of these episodes, if it can be predicted, so that any abnormality has highest chance of being recorded. Although emotionally disturbing, many people with parasomnias learn to adapt to their disorder, and don't need any particular treatment. But because of the unusual features of your story, you certainly need the help of a specialist in Sleep Disorders. For additional information and to find a sleep center close to you, please visit the American Academy of Sleep Medicine website.

We hope this has been useful, and we wish you 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