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Tuesday, December 10, 2013
Sleep Talking and Constantly Tired
I have been told for a while now that i have been talking in my sleep. Not just words here and there, but full conversations that last from a couple minutes to a couple hours. My boyfriend tells me that i will wake up when i hear him walk into the room and i will sit up as if i am wide awake. I will then hold a conversation with him (longest was about 2 hours). When i wake up i am exhausted and have no memory of the conversation. He says it happens every night and it has come to the point where he sleeps on the couch so he doesnt wake me. Is there anything i can do to stop sleep talking? It is only 9:30am and i am already EXHAUSTED. I just want to be able to sleep a full night.
Thank you for the question and we apologize for the delay in getting you an answer. It seems you have 2, possibly 3, issues that are related to your sleep and may or may not be related to each other. You appear to have problems with daytime exhaustion/fatigue, a problem with sleep talking and then a lack of recall of talking at night. I’ll address the daytime exhaustion/fatigue first.
In terms of the daytime fatigue, the first thing is to make sure you are sleeping enough hours. Most individuals should have a minimum of 6-7 hours though most need 7-8 hours of sleep to feel fully rested. I would make sure you are getting at least 8 hours of sleep every night if you are not already doing this to ensure that lack of sleep, or chronic partial sleep deprivation, is not the cause of your fatigue. If you are sleeping 8 or more hours a night and are still sleepy, then you should talk to your doctor. Issues that need to be considered include medications that can make you tired, medical conditions not related to sleep that can cause fatigue (such as low functioning thyroid or depression), and primary sleep disorders (such as obstructive sleep apnea, which is one of the more common sleep disorders). Individuals with sleep apnea also have symptoms of snoring, fragmented sleep, unrefreshing sleep and daytime sleepiness. There are other sleep conditions, such as narcolepsy and idiopathic hypersomnia, that can cause daytime sleepiness. It is important to have a doctor evaluate your fatigue if it is interfering with your daily activity and bothersome to you.
Sleep talking, also known as somniloquy, is not an uncommon problem, especially in children. While we don’t know exactly how common talking in sleep is, it is estimated to occur in about half of all children and in about 5% of adults.
Sleep talking can range from infrequent quite sounds to full spoken sentences to singing and shouting. Often, the speech cannot be understood and may sound like mutterings or gibberish. The cause of talking in sleep is not entirely known. Most of the time, the cause of this sleep behavior can not be linked to any identifiable underlying problem or disease. And in most cases, the problem is not serious and tends to resolve over time or with aging. However, in some cases, it has been found to be associated with other sleep-related disorders, such as sleep walking, REM behavior disorder (an unusual disorder in which individuals tend to act out their dreams while asleep), sleep-related epilepsy, post-traumatic stress disorder, sleep apnea, and the nighttime sleep eating syndrome (eating while asleep). In addition, in adults who begin sleep talking in adulthood (in other words, they did not do this as a child), there may be a higher rate of psychiatric disorders. However, most adults who talk in their sleep do not have these problems. Stress, alcohol and medications may lead to sleep talking as well.
The prolonged episodes of sleep talking that you describe are somewhat unusual and make me wonder if you may be suffering from confusional arousals.
Confusional arousals are not very common (3-4% of the population) and usually occur mostly in younger individuals, especially children. They typically occur when a person is woken up from a deep sleep during the early part of the night. However, similar events have been described during spontaneous waking in the morning. During these episodes, a person may react inappropriately to his or her environment. Sleep-talking is common during confusional arousals. Most episodes last a few minutes. However, some episodes last as long as 30-40 minutes or longer.
These episodes may be caused by underlying sleep disorders or neurological disorders. For example, sleep apnea, which causes breathing disturbance during sleep, can precipitate and worsen confusional arousals. Nocturnal partial seizures are seizures that occur only during sleep and may mimic these events. Drugs, substances, and medical conditions may precipitate or may exacerbate many of these underlying sleep disorders. Many people with confusional arousals don’t need any particular treatment. It’s possible this problem may resolve with time.
The management of your problem requires further history, an examination and possibly some sleep investigations. This type of evaluation often starts with your primary care physician, but may require the help of specialist in Sleep Medicine.
Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University