Question:

Hello I am hoping you can help me..for years off and on my entire body will shake uncontrollaby just as I am falling asleep or just upon waking. I attended a sleep clinic for 2 days and the shaking did not occur, and no cause was found. I have also not slept past 5-6 hours a night for years and again the sleep clinic found no answer. I am more concerned now more than ever as I have noted it is occuring just days before vertigo attacks…which get quite severe and last weeks. I have had MRI scans done of the brain due to the vertigo…and that, too, is inconlusive.cHowever an area that shows some change in the brain is consistant with MS or Lyme diease and my symptoms are not fitting perfectly with either 3 of my doctors have said.cGenerally I need to ask if it could be tied to any sleep disorder,cor if there is an avenue my doctors may not have thought of.cAny help would be so appreciated
Thanks!

Answer:

It sounds like you have had a relatively thorough evaluation for your problems with no clear answers found yet. As this is clearly a complicated issue, a complete history and physical examination, as well as a review of your past testing will be required before a diagnosis can be made. It may be worthwhile to seek the opinion of a Sleep Specialist at an academic or university setting, who might have more experience with complicated cases such as yours. Having said that, I will provide you with some information that hopefully you can find useful.

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.” There are also a wide variety of movement disorders that are related to sleep or to the transition between sleep and wakefulness. These include:

• Wakefulness related movements include Parkinson’s disease and Essential Tremor. These get better during sleep.
• Simple sleep-related disorders like periodic limb movement disorder and hypnagogic foot tremor that mainly affects the legs.
• Complex movements that occur during sleep may be due to a disorder of partial arousal if the person is conscious or epilepsy if the person is not conscious during that time.

The shakes that you write about seem to be quite violent in that they cause your whole body to move. This can still represent hypnic jerks, especially if associated with a feeling of falling. In hypnic jerks it is important to ensure your sleep environment is safe. Otherwise, no treatment is necessary for the jerks themselves. The relationship between hypnic jerks and vertigo is not clear to me. There is probably some recall bias, where you are more likely to remember the events that happen immediately before the start of vertigo but where a cause-and-effect relationship may not exist. Despite this possibility, finding out the cause of your vertigo may help manage your sleep problems.

As for your sleeplessness, you are not alone. About one third of the population in the US sleep less than the recommended 7-8 hours per night. This can be due to multiple reasons, including personal preference, certain medical disorders, painful conditions, certain neurological/psychiatric disorders, the use of drugs and alcohol, or having a primary sleep problem such as an irregular sleep/wake cycle, restless legs, or sleep apnea.

Some suggestions that may help you get more restful sleep are:

• Avoid caffeinated beverages, alcohol, and tobacco in the evening
• Avoid intense mental activities and vigorous exercise up to 3 hours of bedtime
• Adhere to a regular sleep-wake schedule even on weekends and non-working days
• Avoid naps, and resist the urge to catch up on sleep during the day
• Avoid excessive time spent in bed (if not asleep in 20 minutes, get out of bed until sleepy)

Additional information regarding sleep can be obtained on the American Academy of Sleep Medicine website. This website contains a list of Sleep Centers across the country so you can find one if you need it.

For more information:

Go to the Sleep Disorders health topic.