The patient, a woman in her early 40's reported violent behaviors in sleep, beginning at age 10 but worsening rapidly over the past years to the point that she would experience up to five episodes per night on a nearly nightly basis.
The attacks involved screaming, biting her husband or herself and sometimes, leaving the bed. She noted hazy recall of unpleasant dreaming that she had failed to complete some imaginary task. The episodes would begin early in the night when much REM sleep (the stage in which we experience our most vividly recalled dreaming) would not be anticipated.
The attacks occurred most frequently in relation to stress and were uncommon when she would be afraid of disturbing others (for example, when staying away from home).
She also reported excessive sleepiness. Her teen-aged son had experienced classic sleep terrors up through age 6 and would sometimes walk in his sleep.
She slept very soundly at our Center (better than at home by her estimate) without any attacks. She demonstrated only rare episodes of upper airway obstruction that were eliminated by elevating her head and back. A multiple sleep latency test showed no evidence of narcolepsy.
The fact that the attacks seemed to be suppressed under conditions in which they might prove embarrassing or frightening to others suggested to us that they might be controlled with self-hypnosis training, which is both harmless and demonstrably effective in such other sleep disorders as common sleepwalking. Hence, rather than jumping to drug trials, we referred her to a hypnotherapy consultant.
This approach worked beautifully. When last seen, she reported only rare attacks and also stated that she felt more relaxed and calm in a general sense: without any need for medications.
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.
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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