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Sleep Disorders

Strange Wakings

11/12/2008

Question:

I often wake up within the first 45 minutes to an hour after going to sleep, sometimes in a panic but always confused and urgently needing to take my medicine. Sometimes, I`m in a different room searching for my medicine when I realize it`s one of my strange wakings and I go back to bed. Other times, I`m searching my bedside stand but always looking for my medicine that I forgot to take and urgently need. I don`t take any medications. Can you explain what these are about? They have been happening for about 10 years now.

Thank you.

Answer:

While I can’t make a diagnosis based on just your history, it sounds likely that this behavior may represent a parasomnia, or abnormal behavior in sleep. This most likely represent a combination of sleep-related hallucinations and sleep walking, though another parasomnia (such as a disorder of arousal) and a seizure disorder could also be considered (though seems less likely).

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 (sleep-onset) hallucinations) but can happen with morning awakenings (hypnapompic 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.

The underlying cause of sleep related hallucinations is not always clear. Factors known to bring these about or increase the frequency of occurrences include younger age, current drug use, past alcohol use, anxiety, mood disorders, insomnia and lack of sleep. Certain medications may also cause this as a side effect. In addition, these hallucinations may be a sign or symptom of another sleep disorder, such narcolepsy, a primary nightmare disorder or, rarely, they could be part of sleep-related seizures (epilepsy). Psychiatric disease (such as schizophrenia) should also be included as a possibility, though this would be less likely. Depending on the underlying cause or factors associated with the hallucinations, the hallucinations may decrease or resolve with age.

Sleepwalking, also known as somnambulism, occurs in somewhere around 1-15% of the general population with a peak incidence between the ages of 4 and 8. It tends to resolve with aging. If sleep walking starts in adulthood, it may suggest an underlying psychiatric or psychological disorder, excessive stress or substance abuse. In most cases, sleep walking is not serious and resolves over time. However, some sleep-related conditions can present with sleep walking as their primary symptom, and thus in some cases, additional evaluation and treatment is needed. Obstructive sleep apnea, a seizure disorder and REM behavior disorder all may have sleep walking as part of their presentation. Typically, in benign sleep walking, the individual does not act out violently in their sleep, though aggressive behavior may occur if the sleep walker is confronted with strong stimuli

While confusional arousals tend to occur early in the night as they arise out of slow wave sleep (mostly seen in the first ½ half of the night), these are usually accompanied by no recall of the events and tend to be uncommon in adults. As mentioned above, a seizure disorder can mimic a number of sleep problems, though the long duration of your symptoms seems to make this diagnosis less likely.

It certainly sounds as though your symptoms are troubling to you. It would be a good idea to discuss your problems with your Primary Care Doctor. Referral to a Sleep Specialist may be needed, depending on specifics in your history and examination. Additional testing may be required to help sort out the cause of these problems.

To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website Sleep Education.com also provides plenty of good consumer friendly information. Good luck and here's to better sleep!

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Response by:

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