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Friday, March 7, 2014
Mini seizures during sleep
I suffer from severe insomnia, and find that when I get to sleeep I often (at least a few times per week) am getting what I think are mini seizures. It starts with an "odd" feeling and rapidly spreads into my whole body as tingling, numbness, and mental confusion. Recently I have had a few episodes while I have been up and out in public. I think no-one else notices any change, but myself, I feel like I might fall, can`t talk properly and need to sit down. What could be causing this? I am on alot of medication for scleroderma, fibromyalgia, pulmonary hypertension. Could it be from the drugs, or is it a mini stroke, or is it a chemical imbalance? How serious is it?
It’s difficult to determine for sure why you are experiencing these problems without having additional information. There are a number of possibilities, some of which could be related to your sleep or a sleep disorder and others that are not at all related to sleep. I’ll try to address the primary sleep-related problems that could be contributing to the symptoms you are having.
The symptoms you describe as an “odd” sensation at sleep onset could represent a form of sleep paralysis, though this would be an unusual presentation. 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 typically 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.
Another possibility is that it could represent sleep-onset hallucinations. Sleep-related hallucinations are usually visual (seeing things), though they can be auditory (hearing things), tactile (sensation of feeling something) or kinetic (feeling of motion or movement). They more commonly occur with sleep onset (known as hypnagogic hallucinations) but can happen with morning awakenings (hypnopompic hallucinations) as well. Sleep-related hallucinations can be frightening and may, at times, be associated with other sleep behaviors such as sleep walking or sleep talking.
Both sleep paralysis and sleep-related hallucinations can occur in normal individuals when under situations of stress. They may also be brought on by lack of sleep or drug or alcohol use. They could also be signs of narcolepsy, though they are not specific for this condition.
The daytime symptoms you describe of feeling like you might fall could represent cataplexy. Cataplexy, the brief, sudden, bilateral loss of muscle tone brought on by strong emotions, is considered very strong evidence of narcolepsy. Other symptoms of narcolepsy may include excessive sleepiness (which is always present), poor nighttime sleep and automatic behaviors (performing tasks without being aware of what you are doing or having recall of having done it).
So it’s possible that narcolepsy could be underlying your symptoms if, with additional history, the symptoms you describe are consistent with sleep paralysis, sleep-related hallucinations and/or cataplexy and you have daytime sleepiness. If this is the case, then you would need to see a Sleep Specialist and obtain further testing. As mentioned earlier, a lack of adequate sleep (chronic partial sleep deprivation) could lead to some of the symptoms you are describing as well.
It’s also possible that your symptoms are not at all related to your sleep and not related to a primary sleep disorder, but could be the result of medications or your underlying medical conditions.
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. Good Luck!
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University