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Friday, December 13, 2013
Breathing, Sleeping and More
During the night, in the process of waking up i suffer from feeling as if I can`t move how i want to or breathe. It feels as if my arms are being held down and all i can do is writher around until it goes. This happens as least once a night or every other day. I also experienced something different the other day; whilst i had a nap in the day I felt if something was shaking in my head and it got harder and started to hurt until i woke up, and then i feel as if it didn`t happen. I dozed off again and this happened continuously. I am a fit individual and exercise 4 to 5 times a week, but i also experience heart palpulation during the night when i am sleeping as well as when i exercise occasionally. I don`t know if this would be connected to what i feel when I sleep.
From your description, you appear to have a sleep disorder that fits into the category of “Parasomnias.” Parasomnias are a group of disorders characterized by undesirable physical events or experiences that occur during entry into sleep, within sleep or during arousal from sleep. There are a number of different parasomnias, ranging from sleepwalking and sleep terrors to behaviors associated with dreams to a number of other sleep-related behaviors (such as eating during sleep, bedwetting, etc). The causes of most parasomnias are not entirely known.
Your description suggests the possible parasomnias of sleep paralysis and/or sleep-related hallucinations. Although 10% of the population may experience one type of parasomnia in their lifetime, only a few have it as frequently as you (every other day). Sleep paralysis as well as sleep-related hallucinations can result in seeing things and hearing sounds that are not there. Sleep paralysis can result in the feeling that you are paralyzed and can’t breathe deeply or move other than your eyes. It can even make someone feel that there are “loud bangs” in their head just to realize that there is no problem soon after waking up. Although pain is not one of the manifestations, the fact that the pain in your head disappeared immediately after waking up makes me think that it must have not been a headache, per se.
There are many reasons for parasomnias. Some occur without any trigger, but in some cases, an underlying sleep problem is the cause, and the parasomnia is only one of the manifestations. Some of the primary sleep problems that can make a parasomnia worse may be:
- Sleep deprivation, whether by choice or by social demands, can result in a lack of adequate dream sleep. Thus, when the individual goes to sleep, the mind goes directly into dream sleep and tries to stay in the dream state for longer periods than usual. In dream sleep, we are normally paralyzed other than our eyes and breathing muscles. Since dream sleep can occur when falling asleep or near times of awakening, dream-like hallucinations and feelings of paralysis can result.
- Sleep breathing disorders result in sleep fragmentation. The most common type of sleep disordered breathing is “sleep apnea”. The fragmentation of sleep and intermittent arousals lay the ground for sleep and wake confusion resulting in all sorts of parasomnias.
- Narcolepsy and Cataplexy are primary disorders of dream sleep. With narcolepsy and with cataplexy, dream sleep intrudes onto wakefulness and results in many of the parasomnia pictures. These are not as common as sleep deprivation and sleep apnea.
- Sleep-related seizures are uncommon, but should be considered if the parasomnia symptoms worsen, or if they have special characteristics that can be discussed separately if needed.
Medications and recreational substances that affect the structure of sleep can result in fragmentation of sleep and in a change in sleep structure proportions, which can also lead to parasomnia symptoms. If you find that increasing your sleep duration to 8 hours per night does not change the way you feel, then an evaluation by a sleep specialist should be considered. This is important because your symptoms occur frequently. If you are diagnosed with a parasomnia and no cause can be found, then its manifestations can be suppressed by the use of medications. Although these medications are well tolerated in general, they are best prescribed by a sleep specialist because they can alter the way you sleep, as well. Please note that the American Academy of Sleep Medicine website contains a list of Sleep Centers across the country so you can locate one near you if you need it.
I hope this is of benefit to you and I wish you best of sleep.
Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University