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Thursday, August 28, 2014
Falling Out of Bed
My 62 year old husband has sleep apnea and uses a CPAP machine at night to sleep. He has started to have incedents with falling out of bed violently. Also, if he falls asleep on the couch or chair he has been finding himself on the floor with a violent fall on his knees and is not able to catch his breath and feels faint. He takes blood pressure medicine for high blood pressure. Thank you for your time.
While it’s hard to know for sure why your husband is having these problems, it certainly seems concerning and you are right to seek help. If I understand you correctly, he has violent “falling” spells out of sleep that seem to occur whether or not he is using his CPAP and they maybe associated with shortness of breath and feeling faint. There are a number of possibilities to consider for your husband symptoms, including inadequately treated obstructive sleep apnea (OSA), a secondary sleep disorder, a neurologic disorder (such as seizures) and even a primary heart problem. He will require a thorough evaluation by his doctor to determine the exact cause of his current problems. I will briefly discuss how it’s possible that some of his symptoms may be related to a sleep disorder, but again, he will need to see his physician.
OSA is a common condition, affecting roughly 5% of middle aged adults in America. Most individuals with this condition are still not diagnosed and, of those that are diagnosed, many have had it for many years prior to undergoing appropriate testing.
OSA is a condition where the airway partially or completely collapses during sleep. This results in fragmentation of sleep and, in some individuals, low oxygen level during sleep. The consequences of this condition can be serious and range from a poor quality of life (morning headaches, disabling sleepiness, poor concentration, irritability, etc) to increasing problems with blood pressure control, heart disease and strokes. Symptoms may include waking up choking or gasping at night, very loud snoring, poor and unrefreshing sleep, morning headaches and daytime sleepiness. Sometimes, while attempting to breath in sleep, individuals with OSA may have rather violent appearing body jerks as part of the brains arousal phenomena. This could be occurring with your husband, especially if his CPAP machine is set to a pressure setting that is too low. Therefore, he may need a reassessment of his CPAP pressure setting by a sleep study.
It also possible that your husband could be suffering from another sleep-related disorder, such as a parasomnia or narcolepsy. Parasomnias are a group of disorders characterized by undesirable physical events or experiences that occur during entry into sleep, within sleep or during 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 causes of these parasomnias are not entirely known. Many cases of these conditions are idiopathic, meaning we don’t know for sure what causes these behaviors. Evaluation for this type of problem requires a thorough history and repeat sleep testing.
If you husband's falling episodes were occurring during wakefulness, then it’s possible that they could represent cataplexy associated with narcolepsy. Narcolepsy is characterized by excessive sleepiness and abnormal intrusions of rapid eye movement (REM) sleep phenomena into awake time. Typically, during REM sleep, our muscles are inactive (except for our breathing muscles and eye muscles) and unable to move. In individuals with narcolepsy, this "paralysis" of muscles may occur during wakefulness (known as cataplexy, usually brought on by strong emotions) or during transitions between sleep and wakefulness (sleep paralysis). During cataplexy attacks, individuals often fall down. Dreams may intrude upon these times as well (known as hypnagogic or hypnopompic hallucinations).
Other symptoms of narcolepsy may include poor nighttime sleep and automatic behaviors (performing tasks without being aware of what you are doing or having recall of having done it). While true cataplexy is considered very strong evidence of narcolepsy, the other symptoms listed may be seen in individuals without narcolepsy.
It would probably be a good idea for your husband to discuss his case with his primary doctor as well as his sleep doctor to help determine how best to proceed.
To learn more about sleep apnea 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. Good luck and here's to good sleep!
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University