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Sleep Disorders

Difficulty waking up

02/19/2007

Question:

About 4 times a month I have to struggle to wake up. I feel myself trying to get my eyes open and my limbs moving and it is a fight not to fall back asleep, sometimes I struggle so hard to wake up, I have actually thrown myself out of the bed. This is worrisome as I am 73. This problem started about 10 years ago and I thought it was because of the sleeping meds I was taking so I quit taking them. What happens to me to put me in this inbetween state between waking and sleeping and how can I solve it.

Answer:

It's not clear to me from your question whether you are just feeling very sleepy and not refreshed upon awakening or if you actually feel like you cannot move (i.e. are paralyzed) when trying to wake up. Since it is not clear, I will discuss both issues nonrestorative sleep and “sleep paralysis.” Not feeling rested after a night of adequate sleep can be frustrating. There are a number of potential factors that can make an adequate night’s sleep feel unrefreshing, many of which have to do with factors or conditions that may interrupt or fragment sleep. Some possible causes of nonrestorative sleep include:

As you can see this can be a complicated problem. If nonrestorative sleep is your primary problem, determining how best to treat this really depends on obtaining more information so that appropriate treatments can be recommended. All of these conditions can be treated if they are properly diagnosed and thus discussing your concerns with your doctor would be a good place to start.

On the other hand, if you feel like you are “paralyzed” or unable to move upon awakening, then this is a separate issue that has different considerations. Sleep paralysis is usually described as the inability to perform voluntary movements either at sleep onset or upon awakening. Individuals often report an inability to speak or move the limbs, trunk or head. Breathing is not affected and individuals can recall the event. The episode usually only lasts for seconds up to a few minutes and tends to resolve on its own. Occasionally, the episode will end if the person is touched or spoken to.

Surprisingly, up to 15-40% of young adults experience this at least once in their lifetime and as many as 5-6% have this occur recurrently. Sleep paralysis usually first appears in young adults and tends to disappear with aging. It would be somewhat unusual to have this symptom develop as an older adult.

Episodes of sleep paralysis can be very anxiety producing. Hallucinations, whether hearing or seeing things that are not present, can accompany the event. All-in-all, the experience can be somewhat frightening. Sleep paralysis can be brought on by lack of adequate sleep, keeping an irregular sleep schedule and being under excessive stress. While most of the time sleep paralysis is not associated with other medical conditions, it can be one of the signs of narcolepsy (individuals with this condition are also very sleepy). Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

Other medical conditions that can appear with similar symptoms to sleep paralysis include compressed nerves, cataplexy (sudden loss of muscle control in emotionally charged situations such as laughing), seizures, and panic attacks. Most of these conditions can be separated from sleep paralysis by specific factors from the medical history.

If you are concerned about your symptoms or would like to exclude the other possibilities mentioned above, 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. Another website with plenty of patient-friendly information is Sleep Education.com. Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University