Question:

Here is my situation: I have severe PTSD. I do take meds but for last month or so I have been having such bad nightmares that I awake out of a dead sleep and sit up. I don`t remember these things; my husband tells me. I have been crying and shaking in my sleep as well. Another thing is I also hit my husband while asleep. Should I call my doctor?

Answer:

Your complaint is interesting in that you may have more than one sleep issue going on at present. The nightmares you describe likely represent a night terror disorder. However, you describe sleep-related movements as well, and these may represent a second condition altogether. When dealing with sleep disorders there is often quite a bit of overlap, and people may have more than one disorder at the same time.

During an episode of night terror, a person will appear awake and scared, and may exhibit rhythmic movements or shakes, but will have no recollection of the episode. The episode is very upsetting to the person who is witnessing it because the affected person is not consolable and does not respond to any comforting efforts. Night terrors are not related to scary dreams in particular, but may coincide with those kinds of dreams in the same person. There is no particular treatment needed for night terrors. A psychiatric evaluation may be of help in persons with history of traumatic events as in your case. Treatment of PTSD may result in decreasing frequency of night terrors in some individuals.

The other issue pertains to erratic movements during sleep that result in hitting others or harming yourself. This is rarely a manifestation of night terror and it may represent a sign of another sleep movement disorder such as REM behavioral disorder (RBD). During normal rapid eye movement (REM) sleep, when most dreaming occurs, our voluntary muscles are paralyzed, which protects us from acting out our dreams. In people with RBD, this paralysis may not happen, and people may act out their dreams. These kinds of movements may also occur without any particular memory of associated dreams. REM behavior disorder needs to be evaluated by a specialized physician. This may include a careful review of the history of the problem and other medical problems, and may include performing a sleep study since many sleep disorders, certain medications (you may be taking some), and some sleep habits may cause REM behavior disorder to occur or to worsen.

Until you are able to see your doctor, and until you get a sleep evaluation, there are some things that you are able to do to help with your sleep problems:

• Assure a comfortable, quiet, cool, and dark sleep environment
• Minimize volitional sleep deprivation, and keep a regular sleep/wake schedule
• Minimize alcohol, caffeine, and tobacco use close to sleep time
• Avoid using sleep aids, even those available over the counter

If you are at risk of falling off the bed or wandering during sleep, sleep on a mattress close to/or on the floor, and lock your bedroom door and windows

Please visit the American Academy of Sleep Medicine for a list of sleep specialists in your area.

Best of luck and I wish you safe sleep.

For more information:

Go to the Sleep Disorders health topic.