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Sleep Disorders

Sudden Waking

11/16/2009

Question:

I have a strange problem. I can only sleep on one side of my body. If I sleep on my back or my left side I begin to sleep and then in less than 5 minutes of sleep my body jolts me awake. I do not feel any gasping or breathing problem, it is more like a nervous condition or my brain saying no, you can`t sleep this way. I can tell I am starting to sleep and then my brain wakes me up. Until I turn over on my right side, I cannot sleep. This happened to me within the last ten years. I am 46. I used to be able to sleep on any side and any position. The only difference I can identify is that I have gained weight since then. The last five years it has worsened. I used to be able to sleep on my left side if my arm could stretch out. Now, I can`t sleep on that side at all. I am a little worried. What if my only side to sleep begins to develop the same symtons,

Answer:

Thank you for using NetWellness. Your sleep related problem may certainly reflect a sleep, neurologic, or a psychological disorder, though it may also just be normal sleep. A comprehensive history and physical examination is required in order to provide you with a correct diagnosis. You should start by seeing your primary care physician who can provide you with a referral to a Sleep Specialist if needed. It’s possible you may require at least one polysomnogram (sleep study) to investigate whether or not you have a sleep disorder.

There are a number of possible explanations for your symptoms, including normal sleep physiology, a primary sleep disorder (such as obstructive sleep apnea), a nerve disorder (such as pinched nerves), anxiety, or a conditioned sleep response.

Many types of movements that occur during sleep are normal. For example, large muscle contractions that occur during the transition from wakefulness to sleep are common, and are known as hypnic jerks or “sleep starts.” Why this would occur when you only sleep on one side and not the other is not clear to me.

It’s possible that this may be a sign of obstructive sleep apnea (OSA), which is defined by the presence of recurrent complete or partial closure of the airway during sleep. This may result in "jolting" and awakenings that you describe. As a result, individuals with OSA suffer from fragmented sleep and tend to feel unrefreshed upon awakening as well as sleepy and tired during the daytime. The main risk factors for the development of sleep apnea include being overweight and/or having specific anatomic abnormalities (such as large tonsils) that may narrow the airway. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness. It is important to diagnose and treat this condition as treatment can improve symptoms and reduce the risks of long term complications associated with OSA. The diagnosis typically requires a sleep study. OSA can be “positional,” meaning it is may be worse when sleeping in one position as opposed to another, though it is usually worse when sleeping in the supine position and not when sleeping on one’s side.

It’s possible that there could be a pinched nerve in your neck that is affected only when you lie on your left side. However, if this were the case, I’d expect you to have other symptoms such as arm weakness or numbness. And finally, this may represent a conditioned or learned response for you not to sleep on your left side. Sometimes this can occur as the result of something that happened in the past when sleeping on your left side and you now feel anxious or worried when on your left side. This is probably the least likely explanation, but worth considering none-the-less.

I suggest you discuss this with your doctor and consider whether you should undergo testing. Additional history and an examination will be helpful in determining if a sleep study is needed. Once again thank you for using NetWellness.

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Response by:

Steven  Kadiev, MBBCh Steven Kadiev, MBBCh
Formerly:
Assistant Professor
College of Medicine
The Ohio State University