The patient, a delightful woman in her mid-twenties, reported the acting out of terrifying vivid dreams involving spiders, intruders, dead people in her apartment, being physically attacked and the like. She would run in her sleep with risk of injury and had struck others with her fists. The attacks began in high school but had worsened to the point that at the time of referral to our Center, they were occurring every night.
She also described grogginess, fatigue and confusion on awakening, daytime sleepiness and dreaming in brief naps. Her father was said to snore loudly and had acted out his dreams.
She had been in perfect health otherwise. She was slender and took no medications. Her physical and neurological examinations were normal but her jaw seemed a bit small.
During her first overnight recording at our Center, although she demonstrated only mild snoring, she experienced nearly 35 episodes of upper airway obstruction per hour--with struggling to overcome increased upper airway resistance even at times of regular breathing.
Nasal CPAP normalized her breathing and she felt much better after sleeping with the device.
A multiple sleep latency test revealed severe sleepiness with REM sleep in all of four nap recordings, potentially consistent with narcolepsy. However, home treatment with nasal CPAP eliminated both her sleepiness and the violent behaviors during sleep.
COMMENTS: There are many causes of violent behaviors during sleep. Both a thorough history and skilled diagnostic testing are vital if the physician is to arrive at the underlying cause in an individual patient. In this instance, struggling to overcome upper airway collapse was triggering the abnormal behaviors.
Sleep apnea is a frequent cause of the violent acting out of dreams and it must always be looked for--particularly since many drugs used in an attempt to treat these abnormal events can make sleep apnea worse! And we now realize that sleep apnea can occur in young women and in patients of normal body build. It is not a disorder restricted to overweight, middle-aged men!
It is our opinion that simply attempting to attach a diagnostic label to each case--followed by immediate trials of medications--can be a serious mistake. Careful analysis of factors that improve or worsen the problem, followed by a healthy dose of common sense, can prove more effective and less dangerous than immediately resorting to drug trials.
If this patient's story reminds you of your own--or that of a loved one--please do not hesitate to contact us at flamenco@netexp.net with any questions that you may have. We are here to help.
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