Chapter 11
While You Were Sleeping: Walking, Talking, and Other Strange Nighttime Activities
In This Chapter
Defining parasomnia
Seeing your doctor
Looking at sleepwalking, confusional arousals, and sleep-related disorders
Talking your way through sleep talking
Headbanging without the rock ‘n’ roll
Cramping up
Grinding away
Sweating up a storm
You may assume that after you go to sleep, you’ll remain quietly in your bed, not moving around much the entire night. But for the millions of people who have a sleep disorder in the general class of disorders known as parasomnias, night can be a very active time. And that means their sleep quality may suffer.
People with a parasomnia may get up out of their beds and walk around the house; they may talk a blue streak, go to the refrigerator, root around and eat whatever they find, or they may thrash around and even fall out of bed. The entire time they’re still fully or partially asleep.
These people have what is known as a parasomnia, which can be further subcategorized as an arousal disorder, a sleep-wake transition disorder, or a REM sleep disorder. Although some parasomnias primarily affect children (see Chapter 14 for more information on childhood sleep disorders), many adults have parasomnias, too.
If you have absolutely no idea what a parasomnia is, don’t feel bad. Even though parasomnias are among the most common sleep disruptors, many people have never heard of them. After all, parasomnia isn’t exactly an everyday word.
In this chapter, we introduce you to the strange world of parasomnias. We cover parasomnias that produce physical behavior ranging from sitting up in bed and looking confused to leaping out of bed and jumping through a window (the dreaming person thought she was diving into a lake). An entire range of behavior between such extremes can also occur (such as teeth grinding).
We define exactly what a parasomnia is and look at the many different kinds of physical activity that can disrupt your sleep. For each disorder, we review symptoms and explain the various kinds of treatment your doctor may prescribe for your condition. In Chapter 12, we discuss parasomnias that produce an emotional response like fear, panic, or anxiety. These parasomnias can be associated with REM sleep and if they are, they’re called REM sleep disorders. However, some of these parasomnias occur at sleep transitions or out of slow wave sleep (SWS), so called because of the pattern of waves it produces on an electroencephalograph readout. See Chapter 13 for practical information about managing the day-to-day problems that may arise as a result of these unusual sleep disorders.
Figuring Out What Parasomnia Means
Parasomnias are a diverse group of sleep disorders characterized by involuntary physical activity performed while sleeping. The sleeper’s autonomic nervous system may be activated, and his central nervous system may be partially activated. As a result, he moves or behaves in a variety of char-acteristic ways.
Parasomnias are classified as
Arousal disorders
Sleep-wake transition disorders
REM sleep disorders
Other parasomnias
In this chapter and in Chapter 12, we group parasomnias according to the type of nighttime behavior they produce, and not according to which of these classifications they belong to. We give the appropriate classification in the discussion pertaining to each particular parasomnia.
Although the sleeper in the midst of a parasomnia episode may not be aware of what she’s doing, you can bet her bedmate or roommates know. Often the nocturnal activity that accompanies a parasomnia episode awakens people sleeping in the same room or same bed, even if it doesn’t actually wake the sleeper. People with parasomnias may show all the classic signs of chronic sleep deprivation, such as daytime sleepiness, irritability, mood swings, and poor judgment, plus maybe a few bumps and bruises as well, depending on what they run into while they’re cruising around in the wee hours.
Parasomnias aren’t dyssomnias or disordered sleep. Parasomnias are distinguished by the type of activity the sleeping person performs. For example, a somnambulist walks in his sleep, while a somniloquist talks in his sleep.
Some parasomnias, such as sleepwalking, are also known as arousal disorders because a partial brain activation accompanies the physical activity. If the sleeper is partially awake, she’s only awake enough to walk around or talk, not awake enough to be fully aware of what she’s doing.
Other parasomnias, including rhythmic movement disorder, are classified as sleep-wake transition disorders, because they occur during the transition from one stage of sleep to another, or during the transition from wakefulness to sleep.
What causes parasomnias?
Although doctors aren’t 100 percent sure what causes parasomnias, they do have a pretty good idea. As we explain in Chapter 1, sleep is a complex activity. During the night, people cycle continuously through the various stages of sleep, sometimes falling into a deeper sleep, sometimes rising to a higher level of alertness. In most people, this nightly performance is so finely orchestrated that they’re not even aware of it. Sleep states overlap during the transition from one stage of sleep to another, but these transitions are usually smooth and of no consequence to the sleeper.
But in people with a parasomnia, something goes amiss with the sequencing of their sleep-wake cycle. Part of their brain is aroused and may be partially awake while another part is diving into the cool, inviting depths of deeper sleep. This lack of synchronization produces odd physical behaviors, unusual because they’re behaviors people associate with wakefulness, and yet, people with certain parasomnias can be exceedingly difficult to arouse to complete awareness. If you do manage to wake them up, they’re likely to be confused, afraid, or combative; they’re still in that twilight world, not yet fully awake and yet, not really asleep either.
Like many other conditions, stress and/or fatigue can precipitate or worsen parasomnias. Parasomnias can also result from overindulging in alcohol, or as a side effect of some medications. Sleep deprivation can trigger many parasomnias. Sleep deprivation can also trigger seizures; therefore, it’s important to differentiate whether an odd nocturnal behavior is a parasomnia or the result of a seizure.
Genetic predisposition
Many parasomnias, such as teeth grinding (see the section “Grinding Your Teeth: Bruxism,” later in this chapter), are known to run in families, so a genetic predisposition could exist for developing these disorders. However, researchers have yet to identify the specific gene or genes responsible for passing on particular parasomnias.
Diagnosing and treating parasomnias
Many people aren’t aware they have a parasomnia. They may walk or talk in their sleep a few nights a month after becoming overly stressed or fatigued, or partying a bit too heartily over the weekend, but generally they don’t feel any long-term effects.
Other people experience episodes of parasomnia almost every night or even several times per night. When parasomnias interfere with your sleep quality and you start to feel sleep deprived or less able to function fully in the daytime, seek help from your doctor.
The diagnostic process is similar for all parasomnias. Your doctor may ask you to keep a sleep diary for at least two consecutive weeks before your visit. Occasionally, your doctor may ask you to keep a sleep diary for up to several months to help him develop a complete picture of your parasomnia and understand exactly how the condition is affecting you. (See Chapter 2 for more information on sleep diaries and sample sleep diary pages you may copy and use.)
Then your doctor will take a complete medical history and perform a physical exam. If warranted, he will schedule you for an overnight sleep study at a sleep lab where sleep technicians can observe your sleep and record several measures of brain and bodily functions, such as brain-wave activity, breathing, and heart rate to help determine the exact nature of your sleep disorder. After your doctor has made a diagnosis, she will develop a treatment plan to help you manage your parasomnia and improve your sleep quality.
Even though the diagnostic process is similar for all parasomnias, treat-ments vary widely according to the exact type of parasomnia you have. We list the treatment options separately under the description of each individual parasomnia.
I Was Up Last Night, but Didn’t Even Know It — Arousal Disorders
If you’ve ever awakened with a large bump or bruise and had no idea where it came from, instead of accusing your bedmate of being a midnight mugger, you may want to consider whether you have an arousal disorder.
Arousal disorders are parasomnias associated with SWS, which is a type of non-REM (NREM sleep) — the deepest sleep that usually occurs early in your sleep period (usually during the first three hours after you drift off).
When a person experiences an arousal disorder parasomnia, he may not only appear confused, but also may be in an excited state with increased heart rates and faster breathing. He may be agitated and sweaty.
Arousal disorders include sleepwalking, with or without episodes of eating while asleep, confusional arousals, and sleep terrors. With the exception of sleep terrors, which we discuss in Chapter 12, we explain all these disorders in the following sections. We also discuss sleep talking and teeth grinding, which are also classified as parasomnias even though they’re not arousal disorders.
The midnight strider — sleepwalking
Where would Hollywood be without sleepwalkers? Somnambulism, or the act of sleepwalking, has been used as a dramatic device in so many movies, stage plays, and even novels that it almost seems old hat by now. But to the thousands of adult Americans who walk in their sleep, somnambulism is anything but amusing. In fact, it can be downright dangerous, even deadly.
Sleepwalking is a series of complex behaviors initiated when a sleeper is partially aroused; part of the brain that should be “shut down” because of sleep kicks back into gear and causes the sleeper to get up out of bed and start walking around. It usually occurs during SWS in the first third of the night, but can also take place during REM sleep as morning approaches. However, sleepwalking that occurs during REM sleep is a totally different condition, is classified as a REM-related parasomnia, has different characteristics, and is treated differently.
The classic sleepwalker has little or no recall of the episode the next morning. Furthermore, he may not believe his family members or roommates when they tell him he was walking around the house at 3 a.m. Of course, he may believe the large purple lump he has on his shin from when he walked full speed into the coffee table.
Symptoms
Check out these defining characteristics of sleepwalking:
Episodes typically begin about one to three hours after sleep onset.
Episodes last from 5 to 15 minutes, more rarely up to one hour.
Sleepwalkers are in a deep state of sleep and have no awareness of or control over their activities.
There is sometimes at least a partial awareness of the environment. Sleepwalkers can perform complex behaviors (for example, unlocking a car, getting in, and starting the engine).
Eyes are open and staring, with dilated pupils, but the person isn’t awake.
Vision seems to function, but coordination is poor.
They may urinate in inappropriate places.
They may use foul language or obscenities that they don’t normally use while awake.
Sleepwalkers are not acting out their dreams; sleepwalking is a completely different state than dreaming.
They may mumble incoherently if questioned.
They’re very difficult to arouse or awaken.
Sleepwalkers don’t display normal good judgment.
Sleepwalkers’ brain wave patterns are mixed. Some brain waves are typical of those associated with people who are wake, while others are similar to those of people who are in a deep sleep.
Most sleepwalkers experience one or two episodes a month, and rarely have more than one episode a night. However, some people sleepwalk almost every night and, as a result, suffer from sleep deprivation. If you sleepwalk, regularly sustain injury, and often feel sleepy during the day, seek treatment for your condition.
Sleepwalking is more common in men than women and seems to have a genetic component; in other words, it runs in families. Adult sleepwalkers are generally more aggressive in their behavior than younger children, and, as a result, have a higher rate of injury.
Treatment
Because sleepwalkers have impaired awareness of their surroundings, other family members must ensure that the sleep environment is as safe as possible. Organize the bedroom to minimize the chance of injury. Remove unnecessary furniture and clutter to reduce the possibility of falls and tripping injuries. Pad the corners of nightstands and dressers, and remove throw rugs and loose flooring. Close and lock all doors and windows to keep the sleepwalker confined to a secure room.
If the bedroom is on the second floor of your home, or if you live in a high-rise apartment or an apartment with a balcony, take extra care to secure windows and patio doors at night to prevent the sleepwalker from falling. Unfortunately, tragedies have occurred when sleepwalkers fell out of high windows or off balconies and lost their lives.
To alert the bedmate, wind chimes in the doorway or a purse alarm attached to the sleeper can sound the alarm. If your partner has a sleepwalking episode, gently guide him back to bed. Don’t raise your voice and don’t try to awaken the sleeper. If a person awakens in a confused state and the first thing he’s aware of is someone shaking him and yelling at him, he may lash out to defend himself. So, if you don’t want to be hit, stay cool, calm, and gentle.
Treatment for adult sleepwalkers may include psychological counseling to help them deal with the anxiety and stress their condition may produce. Training in relaxation techniques may also help. Severe cases may require an antidepressant to control the symptoms.
If sleepwalking is a result of drug or alcohol abuse, the sleepwalker must first resolve those problems before any treatment for sleepwalking can be successful.
Confusional arousals
Think of confusional arousals as the redheaded stepchild of sleepwalking. People with confusional arousals experience many of the same symptoms as a sleepwalker. They sit up in bed, and they’re disoriented and confused, unaware of where they are or what’s going on. Some people say they feel almost drunk with sleep, so don’t be surprised to hear confusional arousals called sleep drunkenness.
During a confusional arousal, part of the sleeper’s brain is sleeping, and another part is awake. But, and this is a big distinction, these sleepers usually stay in bed. They don’t get up and wander around the house like sleepwalkers do.
Although confusional arousals are common in children, they’re rather rare among adults; but some adults do experience them, so we include them here.
Symptoms
Episodes of confusional arousal usually occur during the first three hours after sleep onset during a sleep stage when the person is sleeping so deeply that she is almost impossible to wake up. Here are some defining symptoms:
Episodes last from 5 to 10 minutes, but may persist up to 45 minutes.
Episodes begin with moaning, which can progress to crying out, sitting up, or moving about the bed.
Sleepers may experience more than one confusional arousal each night.
The sleeper’s eyes may be open or closed.
Sweating is common during an episode.
Confusional arousals aren’t dreams.
Sleepers have no memory of the event.
Sleepers suffer from apparent inability to recognize family members.
Arousal may be accompanied by speech, usually not understandable.
A change in your sleep environment may also trigger an episode. For example, if you’re used to sleeping in the bed with your husband and he goes out of town on a business trip, you may be more subject to a confusional arousal because your comfortable sleeping environment has been altered by his absence.
Treatment
You typically don’t need to do anything when someone has a confusional arousal except to quietly reassure him until the episode subsides. Notwith-standing what it may seem like, the sleeper isn’t in any distress or real danger like with sleepwalkers, who may injure themselves during an episode. Confusional arousals are actually tougher on a bedmate who has to witness them than they are on the sleeper. Most importantly, pay better attention to your sleep habits and make sure you establish a regular bedtime routine. Being overly tired can trigger an episode of confusional arousal.
The midnight raider — eating while sleeping
If you watch your diet carefully but always seem to mysteriously gain weight, and you notice food is disappearing from the fridge but you don’t know where it went, you may have sleep-related eating disorder. Furthermore, if you also suffer from daytime sleepiness or other signs of sleep deprivation, you may be raiding your refrigerator while sound asleep.
Sleep-related eating disorder is an unusual parasomnia that involves not only sleepwalking (so you can get to the refrigerator or pantry), but also eating while asleep. Two-thirds of patients are women, and almost half are overweight. Stress, depression, and even some medications can trigger a sleep-related eating disorder.
Researchers used to think nocturnal eating syndrome was one and the same with sleep-related eating disorder, but the terms now describe two separate conditions. They now consider nocturnal eating syndrome to be a combination of insomnia and nocturnal binging. The condition is distinct from sleep-related eating disorder in that nocturnal bingers are wide-awake and well aware of their actions while they’re eating and generally return to self-imposed starvation (anorexia) upon waking in the morning. In contrast, unless they’re suffering from a stomachache or indigestion resulting from their nighttime eating, people with sleep-related eating disorder eat normally upon arising. Because nocturnal eating syndrome isn’t a sleep disorder, we don’t address it here. For more information on nocturnal eating syndrome, visit www.anred.com/nes.html .
Sleep-related eating disorder presents a unique set of dangers for the sleeper, who always has the possibility of choking on something (remember that coordination is poor while sleeping) or sustaining bad burns or cuts because people with this parasomnia may try to prepare an entire meal even though they’re asleep. But due to their poor coordination and lack of judgment, they frequently injure themselves while “cooking.”
Of course, the midnight refrigerator raider may not exactly be into your typical gourmet fare. Look at a few documented sample “menus” people tried to eat while they were sleeping:
Cat food with cigarette butts (our personal favorite)
Neighborhood garbage (and yes, she did get sick from it)
Salad made of torn up cardboard with lighter fluid dressing
Sliced soap with raw bacon
One husband got up, saw his sleeping wife’s face and hands smeared with chocolate, then went into the kitchen to find she had eaten every single bit of Easter candy from the baskets she’d prepared for their three children the evening before. When he woke her up to tell her, she became very angry and denied eating any chocolate, even when confronted with the physical evidence. In her defense, she honestly had absolutely no memory of the incident because she consumed the chocolate while she was in a deep sleep state.
People who stringently restrict their food intake during the day may be more likely to raid the refrigerator and eat while they’re asleep. They tend to choose high-fat, high-sugar comfort foods that they avoid while awake. Experts theorize the nighttime raids may be a subconscious attempt to make up for self-imposed daytime food restrictions.
If you’re a nocturnal eater, don’t feel ashamed; you have a problem and certainly aren’t raiding the refrigerator on purpose. Experts generally consider sleep-related eating to be a reaction to particular stresses in the patient’s waking life.
Symptoms
The symptoms of sleep-related eating disorder are easy to recognize, but all too often, people overlook the obvious explanations. The following is a list of the most common to least common symptoms:
Unexplained weight gain
Food missing from refrigerator or pantry, particularly high-carbohydrate, high-sugar, high-fat comfort food, such as cookies, cakes, candy, chips, and so on
Unexplained food poisoning or food-related illness
Frequent indigestion upon arising
Unexplained morning kitchen messes when kitchen was clean at bedtime
Shame or fear that they may be “losing their minds”
Daytime sleepiness with other symptoms of sleep deprivation such as moodiness, irritability, and depression
Your doctor can document sleep-related eating disorder with an overnight study in a sleep lab (see Chapter 3), as well as with a sleep diary and information provided by bed partners or house mates (see Chapter 2). Nocturnal eaters also may have marked changes in their hormonal levels during episodes, with decreased levels of melatonin and leptin, both linked to sleep and appetite, and increased levels of the stress hormone, cortisol. Sleep-related eating disorder is more common among people with other eating disorders like anorexia, bulimia, and compulsive overeating. It also occurs more frequently in people who have another sleep disorder like sleepwalking or restless legs syndrome that already disturbs their sleep quality.
Treatment
The most helpful treatment for sleep-related eating disorder is counseling and stress management therapy along with training in relaxation techniques to help the patient more effectively manage the emotions that can lead to episodes of nocturnal eating. Patients should avoid caffeine, alcohol, and drugs because these can contribute to an increase in frequency of episodes.
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Some documented cases have linked sleep-related eating disorder with an attempt to quit smoking. If you’re a smoker who’s trying to quit and you suddenly start to gain weight even though you haven’t changed your diet, consider the possibility that you may have sleep-related eating disorder.
A doctor can successfully manage severe cases with a selective serotonin reuptake inhibitor (SSRI) antidepressant like fluoxetine. That’s a lot of fancy talk to describe a drug that not only helps to elevate mood, but also affects appetite. However, avoid sedating antidepressants because they tend to increase the frequency of episodes.
You can also try installing a really loud purse alarm on your refrigerator that sounds when you open the door during the night. The alarm wakes you up and makes you aware of your behavior. After you’re awake, you can choose to stop your behavior.
Rough Passage — Sleep-Wake Transition Disorders
Another group of parasomnias is called sleep-wake transition disorders, because they typically occur during the transition from waking to sleeping, or from one sleep stage to another, making it difficult for the sleeper to fall deeply asleep. These disorders include talking in your sleep, rhythmic movement disorder, nocturnal leg cramps, and sleep starts.
Talking in your sleep — somniloquy
According to Crystal Gayle’s hit country song, “You’ve Been Talking in Your Sleep,” and maybe you’re worried about what you might have said. But contrary to popular belief, except for the occasional amusing or out of context snippet, much of what somniloquists say doesn’t make much sense.
A somniloquy is the act of talking in your sleep or a speech made while sleeping. Most episodes of talking while asleep are very brief and consist of nothing more than a few words spoken in a monotone voice or almost grunted out. In some cases, episodes occur nightly, last longer, and are accompanied by inexplicable outbursts of anger and hostility. Some patients have even been known to sing while asleep.
As with many other parasomnias, the sleep talker has no awareness of the event, and high levels of daytime stress can bring on or worsen episodes. Sleep talking can also be associated with the onset of a high fever or show up as a symptom of another sleep disorder, such as night terrors, sleep apnea, or confusional arousal. The disorder has no real medical consequences unless it occurs so frequently that it disrupts sleep and causes sleep deprivation. It can also keep your bedmate awake, or make him or her angry if you happen to say something that perhaps you shouldn’t have, or wouldn’t have if you were awake.
Symptoms
The one and only symptom of sleep talking is talking or making sounds, intelligible or not, while you’re asleep. A person who talks in her sleep can start talking at any point in the sleep cycle. Speech during light sleep is more likely to make sense than speech uttered during deep sleep.
Depending upon what sleep stage they’re in when they start talking, sleep talkers may grunt or utter a few words, or they may give an entire speech. The sleep talker isn’t acting out a dream. In fact, you’re less likely to talk during a dream than at any other sleep stage because the temporary paralysis that accompanies the dream state inhibits talking.
Treatment
Anxiety and stress can play a big role in sleep talking. People who are under a lot of stress are more likely to talk in their sleep, as are people under treatment for an anxiety disorder. Because stress and anxiety interfere with sleep quality, experts believe they serve as precipitators for a number of parasomnias.
If you have a tendency to talk in your sleep, establish a regular bedtime, make your bedroom as comfortable and inviting as possible, and avoid heavy meals near bedtime. Also take time to practice stress management and relaxation techniques.
Headbanging and bodyrocking — rhythmic movement disorder
Rhythmic movement disorder is common in children but rare in adults; nonetheless, a very small percentage of adults do persist in this behavior. (For a complete discussion of the disorder in children, see Chapter 14.) Repetitive large muscle movements that start right before the onset of sleep and continue on into light sleep characterize this condition.
Symptoms
People who have rhythmic movement disorder usually display one of four characteristic patterns of movement (in order of most common to least common):
Headbanging
Headrolling
Bodyrolling
Bodyrocking
Treatment
Unless the movement interferes with your sleep quality or is so extreme that you injure yourself, rhythmic movement disorder doesn’t require treatment. If the disorder interferes with sleep, try cognitive behavior therapy to recognize and alter characteristic patterns of movement when they occur. (See Chapter 4 for more information on cognitive behavior therapy.) If head injury results from headbanging, wearing a helmet is prudent.
Ouch! Now I’m awake for sure! — nocturnal leg cramps
If you’ve ever been awakened because you felt like a ham-fisted giant had just tied your calf muscles into tidy bows, welcome to the not-so-wonderful world of nocturnal leg cramps.
If you touch the affected calf, you may be surprised to discover that your muscles feel very hard, almost like concrete, a measure of the power of the cramp. Needless to say, when you get nocturnal leg cramps, the pain is so intense that you’ll be wide-awake in very short order.
Studies have shown increased electrical activity in the affected muscles, but doctors still don’t know what causes nocturnal leg cramps. In some cases, it may be a fluid imbalance or a vitamin deficiency. These cramps may awaken sleepers several times a night, so timely and effective treatment is very important to maintain sleep quality.
Symptoms
Symptoms of nocturnal leg cramps include very painful contractions of the calf muscles, and sometimes of the foot muscles as well. The onset occurs during a sleep transition, and the cramps are so painful that they wake up the sleeper.
Nocturnal leg cramps are true cramps and not spasms. The muscle remains in a cramped and contracted position, which accounts for the intensity of the pain.
Treatment
Treatment for leg cramps is straightforward and easy to follow. Avoid tight bed covers, which can lead to pointing of the toes and subsequent cramps. Stretch your calf muscles for about five minutes nightly before getting into bed. If you have a cramp, pull your toes back (don’t point them), and, if necessary, put your foot on the floor and lean forward.
Bananas, apricots, nectarines, dates, grapes, or raisins
` Beans
Cabbage/broccoli family of vegetables
Oranges, grapefruit, and their juice
Pork and lamb
Potatoes and corn
Saltwater fish (for example, tuna)
Tomatoes and tomato juice
Of course, if you wake up with a leg cramp, a banana’s not going to do you much good, so here are some tips to relieve cramps immediately:
Apply a hot compress to the cramped muscles.
Massage the cramped muscles.
Stretch and flex. Lie on your back in bed, lift your legs, extend them toward the ceiling, and then point your toes to the ceiling and flex them slowly back toward your calf. Repeat this flex and stretch until the cramps stop. For an extra good stretch, grab your toes while still in this position and pull them down toward your knees. You’ll feel this stretch working in the back of the calf muscles.
Other studies have linked cramps to dehydration. Staying adequately hydrated at all times is a good idea for many reasons, so add preventing nocturnal leg cramps to the list. Finally, pregnant women, dieters, people taking diuretics, (medications that increase the amount of urine you produce) and people who’ve experienced a bout with vomiting and diarrhea may also experience leg cramps because their calcium and phosphorus levels get out of whack. If you fall into any one of these categories and you have a bout of nocturnal leg cramps, consult with your doctor for the best course of treatment.
Please help me, I’m falling — sleep starts
Have you ever started to drift off to sleep, only to wake again with a start because you felt like you were falling? You’ve just experienced what is known as a sleep start, a sudden, brief, and intense contraction of the leg and arm muscles that can make you feel off balance and in danger of falling. Sometimes it’s just a large body jerk that occurs just as you’re about to fall asleep. Whichever form it may take, sleep starts usually occur just at the point of sleep onset.
Sleep starts are benign and almost universal; almost 70 percent of sleepers can recall experiencing at least one episode.
Sleep starts can also take visual and auditory forms. In the visual form, a sleeper “sees” a blinding flash of light even though her eyes are closed. By contrast, the sleep start may be auditory, in the form of a loud, often cracking noise that seems to emanate from inside the sleeper’s own head. And finally, a rare (thankfully) form of sleep start is the “exploding head syndrome,” which is extremely frightening. Although sleep starts can be disconcerting and can certainly delay sleep onset, don’t be too concerned by them. However, if sleep starts are frequent enough to interfere with sleep, they can cause insomnia.
Grinding Your Teeth: Bruxism
Bruxism is a fairly common parasomnia in which people grind their teeth and clinch their jaws during sleep. People with bruxism share the same lack of awareness about their nighttime behavior seen in patients with others parasomnias. They may literally grind their teeth all night long, but don’t know that they’re doing it. Their teeth know it, and their bedmates certainly know. One long-suffering wife of a tooth-grinder compared it to trying to sleep with a colony of beavers chopping down wood to build a dam.
But unlike other parasomnias such as sleep talking or confusional arousals that are relatively benign, left untreated, bruxism can ruin a person’s teeth. A bruxer can actually grind his teeth down to nubs.
People with bruxism tend to have tense, type-A personalities, or chronic stress in their lives, but not always. They also tend to bite on things when they’re awake like pencils, their fingernails, and the ends of their hair. Teeth grinding affects more women than men, although researchers aren’t sure why.
Sleep start synonyms
Want to win friends and influence people? Hit them with your vast knowledge of the many terms medical science uses to describe sleep starts, including hypnagogic jerks, predormital myoclonus, and hypnic jerks. Hmm, on second thought, maybe you’d just better stick with sleep starts.
Symptoms
Check out the following list of signs (from most common to least common):
Sore or tense muscles in the face and jaw
Popping or clicking noise in the temporomandibular joint (TMJ)
New abrasions on the inside of cheeks each morning
Teeth worn down for no obvious reason
Surfaces of teeth are flat
Sensitive teeth
Facial pain or headaches
Bed partner claims you’re grinding your teeth or clicking your jaw all night long
Dislocated jaw
Treatment
If you don’t get treated for your bruxism, you’re not only risking losing your teeth, but also you can mess up your jaw muscles and create some monster headaches and earaches, too. No matter what the reason, when your bite is out of balance, your muscles work overtime in an attempt to restore the proper bite. Jaw muscles are so incredibly powerful that this constant exertion of force can actually fracture teeth or the jawbone itself.
Treatment for teeth grinding can involve many different therapies, including custom oral appliances that prevent teeth grinding and behavior modification. Patients can modify their behavior so that the tongue, teeth, and lips are maintained in more natural and comfortable positions during sleep.
Dripping with Night Sweat
Night sweats are a distressing and all-too-common problem that can disturb sleep by waking a sleeper whose pajamas and bedclothes are drenched in his own sweat. Although many people who suffer from sleep hyperhydrosis (or night sweats) also sweat too much during the day, this isn’t true of everyone.
The problem is officially classified as a proposed sleep disorder, meaning that researchers need to study the problem more.
Causes
Doctors don’t know of any cause for primary hyperhydrosis that occurs during waking hours. However, they know of several factors that contribute to the development of sleep night sweats, including diabetes, epilepsy, strokes, cerebral palsy, head injury, spinal cord injury, and even pregnancy. A familial form of the condition can be inherited.
People who have sleep apnea (see Chapter 9) frequently suffer from night sweats as a symptom of their condition, and certain anti-nausea drugs can also trigger an episode.
Symptoms
The primary symptom of sleep night sweats is excessive sweating. The disorder is classified as mild, moderate, or severe, according to how much the person sweats and whether or not the sweating interferes with sleep and requires a middle-of-the-night change of pajamas and sheets.
Treatment
Treatment for sleep night sweats depends upon identifying the underlying cause of the sweating. In most cases, after you address the cause, you can resolve the night sweats.