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Sleep Disorders

I sleep too deeply

02/06/2007

Question:

I am a 28 year old male who for as long as I can remember have slept very deeply. Through grade school my parents had to lift me out of bed to get me to wake up. From high school through graduate school I had to set numerous alarms to get me to wake up, but in the mornings I would often wake up on the floor on the other side of the room because I would turn off an alarm and go right back to sleep. This has become a bigger issue now that I am married with a small child. I sometimes don`t hear the baby crying and my wife has to prod me (often for extended periods) to wake me up. I was sleep deprived during graduate school, but this problem remains even when I am well rested. I fall asleep immediately when my head hits the pillow and am essentially comatose all night. I have found that if I have 2 cups of coffee right before bed, I still go to sleep just fine but I have the ability to wake up when needed during the night. I am sure that this solution is not likely to be workable long-term. I am wondering if there is anything I can do to fix this (before my wife goes crazy). Any help you can provide will be helpful.

Answer:

What you are describing is likely a case of “Sleep Inertia”. Sleep inertia is the term used for extreme difficulty with arousing or awakening from sleep and is often seen in younger adults.

Our sleep transitions through several distinct sleep stages that recur throughout the night. Depending on the stage of sleep that an individual is in, there are differences in the level of stimulus, such as noise, needed to awaken them. Typically, one is slower to arouse with a longer reaction time and less recollection if aroused from a stage of sleep called slow wave sleep. Slow wave sleep, also known as deep sleep, is concentrated in the first portion of the night, and decreases with subsequent sleep cycles until it is usually not present by the morning time. Arousal from other stages of sleep typically occurs quicker and the person achieves a functional degree of alertness and attention faster than when awakened from slow wave sleep. Sleep inertia describes this slower transition from slow wave sleep to full alertness. In some people, this inertia may be severe and may have additional manifestations. In such case, it may be called a “confusional arousal”. There may be a familial predisposition in both of Sleep Inertia or Confusional Arousal.

Your sleep inertia is severe and disruptive but is likely to be a limited problem that will not progress. The portion of sleep spent in slow wave decreases with age, and you should have less of this problem over time. However, other factors that affect sleep may increase the amount of slow wave sleep and these include sleep deprivation and multiple sleep disruptions. If you experience sleep disruption on a given night, you are likely to undergo an increase in slow wave sleep (called rebound slow wave sleep) on the next sleep episode and thus may be more prone to experiencing sleep inertia. Certain medications or caffeine may change your sleep architecture and result in reduced slow wave sleep, and may make you easier to arouse from sleep.

Since sleep inertia is typically self limited and benign, it is not recommended that affected individuals take medications for this problem. Conservative measurements and awareness by family is often adequate. Avoiding jobs or situations that cause sleep disruption is recommended. A regular sleep wake schedule, allowing for adequate sleep time, is critical. It is conceivable that you may be able to awaken easier in the early morning hours than the initial portion of the night.

If your symptoms persist despite these maneuvers, it could be possible that another sleep disorder may be present making it difficult for you to awaken in the morning. If you remain concerned about your symptoms or would like to exclude other possibilities for your symptoms, I recommend you discuss your problems with your primary care doctor. They can then decide if referral to a Sleep Specialist is needed for further evaluation.

If you would like further information about sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University