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Sleep Disorders

Trouble arousing from sleep/conversing in slp

12/10/2007

Question:

Hello, I`m a 29 yr male nursing student. I am very busy with school and work. I have an very erratic sleep pattern, (3-4 hrs and 8-9hrs) depending on school load and work. My wife has tried to wake me in the middle of the night, and she says that I have a full conversation with her and then appear to go back to sleep. She thinks I`m ignoring her, but I have no recollection of this happening. I have trouble awakening in the morning, so much so that I had to get an alarm that shakes my pillow and wakes the neighbors with its siren. I read something about sleep inertia. Is it possible that I can have a full conversation, or get up and do something and not remember? I need help. It`s driving her crazy and ruining our relationship. Thanks in advance.

Answer:

Based on the information you provided in your question, it's likely that you have 2 separate but related sleep problems. The first is that you are suffering from partial sleep deprivation due to your erratic sleep pattern. The second is that you are probably having episodes of sleep inertia or "sleep drunkenness" when awakened in the middle of the night. The two are likely related in that your erratic sleep schedule may well be contributing to worsening of the sleep inertia and difficulty awakening.

Sleep inertia or sleep drunkenness refers to periods of confusion following awakening from the regular sleep or from a nap. This impairment may be severe, lasting from minutes to hours and occurs when there is gradual disengagement from sleep to wakefulness. Also, short-term memory seems to be unreliable near sleep onset. Not remembering the ringing of your alarm clock is very similar to forgetting a telephone conversation or some news that you were told in the middle of the night.

The underlying mechanism is believed to be state-dissociation. During state dissociation the brain is partially awake and partially asleep. The brain is awake to perform such complex behavior as holding a conversation or turning off alarm clocks, but asleep enough that the person does not realize what they are doing. Sleepiness and worsening of sleep inertia can be caused by:

Sleep inertia may be more pronounced if one is awaken from deep sleep, or slow wave sleep. This stage of sleep occurs most frequently in the young and decreases with aging. However, with sleep deprivation, or erratic sleep schedules, slow wave sleep "rebound," or increased time spent in slow wave sleep may occur. As such, your irregular sleep schedule may be predisposing you to developing sleep inertia when attempts to awaken you are made.

Growing research suggests that adequate sleep is important for the process of functioning and health. Studies have found that individuals that are sleep deprived tend to perform poorly in test situations, have reduced concentration and tend to be more irritable and anxious. Chronic partial sleep deprivation can also affect our ability to learn and thus can have a significant impact on school and job performance.

We are really just now beginning to understand the wide ranging impact that lack of adequate sleep can have on our health and well-being. Recent research has shown, in pretty convincing fashion, that insufficient (lack of enough) sleep can contribute to significant weight gain. This appears to be due to changes in hormones that control appetite and cravings for certain foods. Weight gain, in turn, can lead to other medical problems, such as diabetes, hypertension, sleep apnea, etc. While not as clear, chronic lack of sleep by itself may contribute directly to the development of hypertension. As mentioned above, another area of concern is the impact that insufficient sleep has on vigilance, ability to concentrate and daytime sleepiness.

To improve your situation, I recommend you start with getting adequate regular sleep. You need to establish a regular sleep schedule that allows for enough sleep time. You should also discuss with your wife that awakening you in the middle of the night to have meaningful conversations is not in either of yours best interest and should be avoided.

If your problem is not improved with the above measures, then I recommend you discuss it with your doctor. An evaluation by a Sleep Specialist may be necessary to determine how best to manage your sleep issues.

For additional information regarding sleep and sleep disorders, visit the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck, and sleep well.

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Response by:

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