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Sleep Disorders

Anger

10/15/2007

Question:

This morning me and my mother had a big fight about a lot of things and I don`t remember any of it. She woke me up and I said some really mean things that I would NEVER say. I woke up and was instantly angry, got up had a huge fight about many personal things, and I really hurt her feelings. But I honestly don`t remember any of it. I go back to bed and when I wake up later I thought everything was normal till I seen my mother crying? This is the second time that this has happend and I`m very confused. Is this normal or what`s going on? I`m not doing it on purpose! HELP ME PLEASE

Answer:

Without additional information, it's hard to know exactly what could be causing your complaints, though it is possible you could be showing signs of a parasomnia. Parasomnias are a group of sleep disorders characterized by undesirable physical events or experiences that occur when falling asleep, during asleep or upon arousal from sleep. There are a number of different parasomnias, ranging from sleepwalking and sleep terrors to behaviors associated with dreams to a number of other sleep-related behaviors (such as eating during sleep, bedwetting, etc.). The type of behavior you are describing most likely represents a parasomnia called a confusional arousal, though REM behavior disorder (RBD) could also be considered.

Confusional arousals result in mental confusion or confusional behavior during or after arousals from sleep. The behavior can range from slow speech and decreased responsiveness to questions to very inappropriate behavior that can include shouting, resistive behavior and even violent behavior. The individual may appear to be awake during the episodes, which usually last minutes, though can last for hours. Typically, there is no recall of the event by the individual.

Confusional arousals tend to occur when individuals are awakened from slow wave sleep, also known as deep sleep. This 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. However, in individuals who have a delayed sleep phase (go to bed late) or are young in age, slow wave sleep can be seen in the early morning hours. Factors that may increase the likelihood of an individual having confusional arousals include a family history of this sleep problem, shift work resulting in shifting sleeping schedules, lack of adequate sleep, stress, anxiety and depression. Using alcohol, illicit drugs, certain medications and having other sleep disorders may bring on confusional arousals on any given night in those at risk for this condition.

Typically, younger individuals will "grow out" of this problem, though occasionally episodes persist and need specific treatment. Avoiding factors that can bring on the problem is important and, in some cases, medication can help to suppress the episodes.

The other sleep-related disorder that could cause our symptoms is REM behavior disorder (RBD). RBD is an uncommon condition in which individuals lose the muscle paralysis that usually accompanies REM sleep and thus may act out their dreams. This tends to occur later in the night and, unlike confusional arousals, most individuals have some recall of what they were doing. Depending on the nature of the dream state, the behavior can often lead to injuries from falling out of bed, running into walls or furniture or hitting objects. It is more commonly seen in middle to older aged men, but can occur in women as well.

It would be a good idea to talk to your primary care physician about your problem. A referral to a Sleep Specialist will be likely be needed for further evaluation, which will probably include a sleep study, depending on specific factors in your history. If a sleep disorder is diagnosed, then treatment can be offered that should help to control your problem.

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:

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