Third Issue Newsletter

June,2002

SLEEP DISORDERS

SLEEP PARALYSIS

Sleep paralysis consists of a period of inability to perform voluntary movements either at sleep onset (called hypnogogic or predormital form) or upon awakening (called hypnopompic or postdormtal form).Sleep paralysis may also be referred to as isolated sleep paralysis, familial sleep paralysis, hynogogic or hypnopompic paralysis, predormital or postdormital paralysis.

Alright, let me describe what I experience in some of my episodes with sleep paralysis (SP). One night I was dreaming of an intruder coming up the stairs. They were heading toward my bedroom. This dream forced me to wake up instantly. Due to the fact that my atonia was in effect, I was paralyzed. Atonia shuts off the muscular function during sleep. It is like a built in protective device that we all have, so we do not act out our dreams. A lot of people suffering from severe night terrors lack Atonia while approaching REM or within the REM stage. This is also known as REM Sleep Behavior Disorder. I will address all these things later, back to the story. After realizing I could not move, instant panic set in because in my mind I was going to die. This evil intruder was going to do me much harm. It was dark in the room and I could not see anything, but I knew for a fact that there was someone in the doorway, waiting to expose my fate to me at any given time. I tried to move, I tried to call out but only got out a really strange sound that even scared me more. This is when I figured out what was happening. This was my first episode and I remember stopping the panic and telling myself that it was Sleep Paralysis and that I was not going to die. Shortly after taking some deep, relaxing breaths, my control came back and I was able to sit up. I started laughing at myself. After all the paranormal situations I have been involved in I have never been spooked. It took a simple episode of SP to scare the life out of me.

In a lot of my episodes, I experience a violent shaking. In my mind it is not me shaking, but the house is. I fell asleep on the couch one night and I was awoken by an earthquake. It was not a real earthquake, but yet another episode of SP. I did not immediately know that. I tried to call out to my wife who was upstairs, but I could only get out an unformed moan. The room was shaking violently and there was a loud humming that actually felt like my eardrums were going to burst. After a solid minute, I tried to call out to my wife again and let out another strange shriek. It actually embarrassed me, because I just figured out it was SP. Shortly after realizing this the control of my body returned.

• Inability to move the trunk or limbs at sleep onset or upon awakening
• Presence of brief episodes of partial or complete skeletal muscle paralysis
• Episodes can be associated with hypnagogic hallucinations or dream-like mentation (act or use of the brain)

NIGHT TERRORS

• Sudden onset usually between midnight and 0200
• Screams, appears frightened, little or no verbalization, may thrash violently, cannot be consoled, unaware of people or surroundings
• Autonomic activity during episode
• Dilated pupils, hyperventilating, sweating, tachycardia
• 1/3 of these individuals experience somnambulism
• disoriented for several minutes
• sleep follows in a few minutes and total amnesia in the morning
• no awareness of content of dream causing the night terror

RESTLESS LEG SYNDROME

• An urge to move the legs, often accompanied by uncomfortable sensations in the legs, usually described as a creeping or crawling feeling, but sometimes as a tingling, cramping, burning or just plain pain. Some patients have no definite sensation, except for the need to move. (The arms may also be affected, but that's much less common.)
• The need to move the legs to relieve the discomfort, by stretching or bending, rubbing the legs, tossing or turning in bed, or getting up and pacing the floor. Moving usually offers some temporary relief of symptoms.
• A definite worsening of the discomfort when lying down, especially when you're trying to fall asleep at night, or during other forms of inactivity, including just sitting.
• A tendency to experience the most discomfort late in the day and at night.

PERIODIC LIMB MOVEMENTS IN SLEEP

Are PLMS accompanied by symptoms?

Individuals with PLMS may also experience restless legs syndrome (RLS), an irritation or uncomfortable sensation in the calves or thighs, as they attempt to fall asleep or when they awaken during the night. Walking or stretching may relieve the sensations, at least temporarily (see the RLS fact sheet). However, research also shows that many individuals have PLMS without experiencing any symptoms at all. It's not unusual for the bed partner to be the one who's most aware of the movements, since they may disturb his/her sleep.

PARASOMNIAS

The term parasomnia refers to a wide variety of disruptive sleep-related events. These behaviors and experiences occur usually while sleeping, and most are often infrequent and mild. They may, however, happen often enough to become so bothersome that medical attention is required.

   Disorders of arousal, which include confusional arousals, sleepwalking (somnambulism), and sleep terrors. Experts believe the various types of arousal disorders are related and share some characteristics. These arousals occur when a person is in a mixed state of being both asleep and awake, and usually coming from the deepest stage of nondreaming sleep.This means the person is awake enough to act out complex behaviors but still asleep and not aware or able to remember these actions.

   Parasomnias are very common in young children and do not usually indicate significant psychiatric or psychological problems. Such disorders tend to run in families and might be made worse when a child is overly tired, has a fever, or is taking certain medications. They may occur during periods of stress and may increase and decrease with good and bad weeks.

Confusional arousals often occur in infants and toddlers, but may also be seen in adults.These episodes may begin with a person crying and thrashing around in bed. The individual may appear awake, confused and upset, yet resists attempts by others to comfort or console. It is also difficult to awaken a person having a parasomnia. The episodes may last up to half an hour and usually end with the person calming, waking briefly, and then only wanting to return to sleep.

Because disorders of arousal are less common in older people, adults suffering from these disorders should seek evaluation. In some cases these events are triggered by other conditions such as sleep apnea, heartburn, or periodic limb movements during sleep. A sleep specialist should evaluate the person’s behavior and medical history.

In typical childhood occurences of arousal disorders, medical evaluation is rarely needed. However, you should contact your physician if a child experiences disturbed sleep that causes;

1. potentially dangerous behavior that is violent or may result in injury
2. extreme disturbances of other household members
3. excessive sleepiness during the day. In these cases, formal evaluation at a sleep center is warranted.

Using simple safety measures can prevent serious injury to those with arousal disorders. Clearing the bedroom of obstructions, securing the windows, sleeping on the first floor, and installing locks or alarms on windows and doors will add a degree of security for the individual and the family. In severe cases, medical intervention may be needed with prescription drugs, behavior modification through hypnosis or relaxation/mental imagery.

SLEEP APNEA

NARCOLEPSY

chronic (long-lasting) neurological (affecting the brain or nerves) disorder that involves your body's central nervous system. The central nervous system is the "highway" of nerves that carries messages from your brain to other parts of your body. For people with narcolepsy, the messages about when to sleep and when to be awake sometimes hit roadblocks or detours and arrive in the wrong place at the wrong time. This is why someone who has narcolepsy, not managed by medications, may fall asleep while eating dinner or engaged in social activities - or at times when he or she wants to be awake

Recent discoveries indicate that people with narcolepsy lack a chemical in the brain called hypocretin, which normally stimulates arousal and helps regulate sleep. They also discovered that there is a reduction in the number of Hcrt cells or neurons that secrete hypocretin. This may be due to a degenerative process or an immune response. How this occurs is unknown

About one in 2,000 people suffers from narcolepsy. It affects both men and women of any age, but its symptoms are usually noticed after puberty begins. For the majority of persons with narcolepsy, their first symptoms appear between the ages of 15 and 30.

REM SLEEP BEHAVIOR DISORDER

NOCTURNAL SEIZURES