Thursday, April 10, 2008

Moans in the Night

An interesting article in a recent sleep medicine journal describes a rare condition where women moan intensely while sleeping. Contrary to what you may have been thinking, these women were not moaning due to either pain or erotic dreams. These seven women sought treatment at Stanford's sleep clinic due to a condition which has been coined catathrenia. They were all embarrassed by their condition, as well as having family members who were alarmed by the strange noises. Catathrenia has been classified in the parasomnia category, which are disturbances that occur during sleep-wake transitions, in contrast to sleep-breathing problems such as obstructive sleep apnea. This condition is typically seen in younger, premenopausal women, who are relatively thin.

When these women underwent an overnight sleep study, none were found to have obstructive sleep apnea. However, they all had in common the typical feature of multiple breathing pauses with arousals, leading to inefficient sleep. All these women also had in common smaller jaw sizes and a history of dental extractions for crowding or orthodontic problems. Many also complained of chronic fatigue symptoms as well.

This article caught my attention because of the nature of the cure for this condition. All the women were essentially cured with treatment that's normally given for people with obstructive sleep apnea. Yet, they didn't have obstructive sleep apnea. What they really had was upper airway resistance syndrome (UARS). As I've described at length in other articles, UARS is a variation/precursor to obstructive sleep apnea, where people have narrowed upper airway anatomy that causes brief obstructions and breathing pauses that are not severe enough to be called obstructive sleep apnea.

To receive a diagnosis of obstructive sleep apnea, you have to stop breathing completely or partially for 10 seconds or more, at least 5 times every hour while you sleep. But if you stop breathing 15 times every hour, but wake up after 2-3 seconds each, then your apnea score is 0 and you're told you don't have obstructive sleep apnea. These UARS patients are constantly tired and suffer from various other chronic conditions such as recurrent sinus pain or infections, low blood pressure, cold hands or feet, various gastrointestinal symptoms, anxiety/depression, and almost invariably, prefer not to sleep on their backs.

The lead author of this article (Dr. Guilleminault at Standford University) was the first to describe UARS as well. In his original UARS paper, he treated these constantly tired people with CPAP, or continuous positive airway pressure. This is a device that delivers gentle air pressure through the nose, thereby keeping their breathing passageways open. For the most part, they all did well, but in the long term, they could not continue sleeping with masks and hoses attached to their faces. Most UARS patients, due to heightened sensitivities, are unable to tolerate this device.

In this current study describing catathrenia, many of the patients tried CPAP as well, which worked, but they all refused to use it continuously. Most of the patients subsequently underwent various surgical procedures of the throat, and were reported as being "cured."

It's amazing how often I find studies that link common and uncommon medical conditions to sleep-breathing disorders. Knowing that sleep-breathing disorders (obstructive sleep apnea or upper airway resistance syndrome) may be linked to depression, anxiety, cold hands, migraines, irritable bowel syndrome, chronic fatigue syndrome, polycystic ovarian syndrome, obesity, ADHD, TMJ, diabetes, high blood pressure, high cholesterol, heart disease, heart attack and stroke, could a breathing problem during sleep be the common link? I've even seen multiple articles linking obstructive sleep apnea to epilepsy and cluster headaches. In my forthcoming book, Sleep, Interrupted, I propose that the this may be a possibility. It may be a bit of a stretch to say a definite yes, but I'm confident that in 10 to 15 years, the answer to the above question will be more clear. This just goes to show that what we generally take for granted my have an alternate explanation.

31 comments:

Anonymous said...

I'm a man and suffer from catathrenia... not just a young woman syndrome.

While rare, there are more and more people reporting the same symptoms of this "taking/holding breath and letting it out slowly with a high-pitched groaning sound" issue.

BratE1 said...

I find this all very interesting since I am a sleep moaner/groaner. Interestingly, it seems to have started a few years ago after I began suffering from allergies and recurring sinus infections, in my mid-20s. At that time it seemed to happen only during the times I was suffering from allergies of sinus problems. However it has not progressed into a nightly thing. And, in the last year it has become chronic such that it occurs even during the day if I take a shirt nap (say falling asleep on the train). Is the treatment mentioned purely experimental or would I be able to seek the same sort of treatment at any sleep clinic. Interestingly, I jus tthought I was a 'weird sleeper' I didnt think other people were moaning and groaning in their sleep, and never mentioned this to a doctor. However, when I got a sleep partner I realized that the issue was real, chronic and disturbing. But I still never thought it qualified as something I could be treated for....I just thought I was incredibly and irreversibly annoying!

Anonymous said...

Very interesting, thank you. I have been moaning in my sleep since I was a child. I am now 42 and was diagnosed with OSA. I have been on CPAP for ONE night and while on the machine, all the breathing problems ceased, as well as the moaning! First time in my life.

That is an interesting connection itself. But additionally, I am obese and have been since I was a child. I have also suffered from depression and anxiety, high blood pressure, IBS, and most other things you discussed.

Cause and effect? I guess it remains to be seen whether CPAP "changes everything." IF it does, I am certainly an interesting case study, I imagine.

L Mark said...

I have been aware of the holding of breath and subsequent noises I make during exhalation since 1984. It was only yesterday (9/9/09) before I was given the "catathrenia" term by a pulmonologist. Mine began shortly after starting rotating shift work. I was married in 1981 and my wife first noticed it within a year after the shift work began.

Anonymous said...

I am a man, age 34 and I have heard from others that I do this in my sleep. Haven't gone to any Dr about this.

anon moi at yahoo com said...

I am female in her early 30s, I have the same condition and have suffered from it since I was a teenager. I too have read Dr. Guilleminault's study. CPAP cures my condition, but like the other patients in his study, I am unable to tolerate it. I have had the surgery as well as an oral appliance. This combination supposedly cured his patients, but it is not working for me. Can you help me?

Steven Y. Park, MD said...

Anon Moi,

It depends on what type of surgery you had and where in the nose/throat you had it done. This is an anatomic problem. If CPAP worked for you, then it just means that you just have to find the right combination of procedures, anywhere from the tip of the nose to the tongue area.

Anon Moi said...

Dr. Park,

I've had:

- tonsils and adenoids removed
- tongue reduction
- modified UPPP (uvula intact)

I have also tried oral appliance. My situation has not changed.

CPAP does cure me but I cannot tolerate it.

I have 2 questions for you:

1) Do you personally know anyone who was cured of catathrenia using means other than CPAP?

2) Do you know a researcher in the bay area who is currently working on catathrenia or might be interested in testing some theories on a real patient?

Steven Y. Park, MD said...

Anon Moi,

Dr. Guilleminaut at Stanford is the only one I know of that studies this, but I'm sure there are others. Personally, I haven't seen any, since it's not a common condition.

Art is everything! said...

I just fell asleep in my lounge chair after 2 hrs raking leaves, dinner and a glass of wine. I woke up after a brief drift into sleep moaning. This has happened before during naps. I have no idea if I do it regularly as I live alone. I sure thought it was odd...I seemed ot have some consciousness while doing it as I was aware of it. I was also aware that I was trying to wake up because I had my hard contacts on my eyes.

I happen to be 60, obese and regularly wear CPAP, just not during naps. I'm glad to hear it isn't something psychological, which was my initial suspicion.

Anonymous said...

Very interesting article indeed! My wife's mother has been living with us for a few months and she experiences the exact symptoms described by all these people. My wife says she's always made the moans as long as she can remember. Her mother naps whenever there is an idle moment on the couch and these sounds are present each time. There is always very heavy snoring accompanying it. She suffers chronic sinus issues and is obese. I decided to give it a Google because my wife exhibits the same breathing patterns and has made the same moans a few times. My wife doesn't suffer the snoring, but very heavy breathing. I am curious about the connection to ictal headaches as my wife is seeing a neurologist and is prescribed Topomax. I am also curious about a correlation to very heavy sleepers as they both are. It takes considerable physical effort to wake either during an episode. Any thoughts?
wheels6294@yahoo.com

Steven Y. Park, M.D. said...

Wheels6294,

It sounds like both your mother and mother-in-law have sleep-breathing problems, but at different ends of the spectrum. Your wife may have upper airway resistance syndrome, and your mother-in-law, obstructive sleep apnea. Seizers, sinus problems (which are actually migraines) and headaches are common with sleep-breathing problem, since inefficient sleep lowers pain and seizure thresholds. Since your wife is her mother's daughter, it's not surprising since UARS progresses into obstructive sleep apnea as you gain weight.This also explains the fact that your wife normally can't sleep on her back, and probably has cold hands or feet. I suggest you read my book, Sleep, Interrupted. Then have your wife and mother get evaluated by a sleep medicine doctor.

You can also read more about these conditions at my website at http://www.doctorstevenpark.com.

Anonymous said...

MissingLinks said...

My son, now 18, has groaned in his sleep since he was a toddler. He never napped well as a child, and would wake up and cry for (and I'm not exaggerating) an hour afterward. He had his tonsils removed (chronic strep) when he was young. When we travel as a family, we have to get him a separate room just so we can get some sleep. As he prepares to head for college, we are having to request a single room for him at the dorm. His groaning is VERY loud, and we're afraid he would make life miserable for a roommate. He is tired all the time, and sleeps a LOT. He also has bouts with ABS. I fear the groaning will adversely affect any future marriage for him. I certainly hope more research is being done on this sleep disorder.

Kevin said...

I'm struggling with this. I finally found someone who makes me happy and vice-versa. But with this sleep moaning... I can tell it's taking its toll during the night. I'm afraid it's going to cause tension and for a lack of better words.. really screw things up for us. Over the past few months I have gotten MUCH louder with my moaning. I guess it started about 3 or so years ago, from what I know. She also says I sometimes choke in my sleep as well as snore. Not only am I tired of this.. im just TIRED. I want a normal life again... I'm desperate.

Kevin said...

I also want to add.. im turning 40 soon and (im not real sure if this applies) but I also had some very serious stomach issues before all this happened. The Dr's could never figure out what was wrong. My stomach was descended and it really looked like I had malnutrition swell belly. That has gone away for the most part now. Its manageable under my own care, seeing as the drs could do nothing for me. Im afraid this is going to be the same way. they wont be able to help me. Im only 150 lbs and even though im 40, I look as if im in my mid 20's. And the only other thing to add is that it feels like my adams apple is choking me at times. weird huh?

jo said...

I have just read your study. I have been moaning in my sleep now for about 3 years and its become chronic now, as i can drift off on couch, i find i wake myself up, then return to sleep and carry on. I use to do it when i was pregnant with my son, then it stopped afterwards. Unfortunately 8 years later it has returned, and no i am not pregnant. I am 40 and slim, suffer with stress, anxiety and my sleep pattern is all over show. I didn`t realise how bad it is getting till my friends stayed the night, and told me, its continuous, and they are now all taking the mickey out of me, but its getting past a joke. I am single lady and i won`t go to sleep till everyone else has, as i am embarrassed of the noise. I haven`t seeked advice, or mentioned it to doctor. I am aware now its a problem, as it a permanently happening, while i am sleeping or knapping and is extremely loud, moaning and grunting noises. Would you advice me to see my local GP? Many thanks.

Steven Y. Park, M.D. said...

Jo,

You should talk to your doctor about seeing a sleep medicine physician. As I mentioned in my post, you may have a treatable sleep-breathing problem.

mnairc489 said...

very informative article! glad i can finally put a medical explanation on my talking/moaning sleep problem. this article hits right on and is very applicable in my situation. im 21,female, and ive had a history of dental extractions for teeth crowding. aside from moaning, i also wake up tired and prefer not sleeping on my back.

julia said...

I have been going through this situation of the moaning and groaning since I was a teenager.It is very embarrassing. I suffer from kidney stones I even lost a kidney due to this. I have a 3 cm lump on my lower left side
that hurts especially when I'm on my period.I'm 31 years old and am always very tired and sleepy.I suffer from depression and am overweight.

julia said...

UpI have been going through this situation of the moaning and groaning since I was a teenager.It is very embarrassing. I suffer from kidney stones I even lost a kidney due to this. I have a 3 cm lump on my lower left side
that hurts especially when I'm on my period.I'm 31 years old and am always very tired and sleepy.I suffer from depression and am overweight.

Anonymous said...

thanks for this article. I am a 17 year old girl and have been moaning in my sleep for about 4 years now. I have a lot of similarities to these woman, such as being thin,having dental extractions, a small jaw, always tired, cold hands and feet, and I never sleep on my back. I didn't think that anyone else experienced these sleep moanings. I will definitely research the cures discussed.

Anonymous said...

I'm a mountaineer. My sleep is normal at sea level, but when I climb faster than my healthy acclimatization schedule, I get catathrenia at night. My climbing partners note (with laughter) that I moan in my sleep -- of course they don't realize that its only when we're at altitude. Also consistent with the ladies reported on in this article, I notice myself waking up to an inability to breathe whenever this happens. It would be nice, but impractical, to have some kind of positive pressure breathing device while climbing.

Melanie said...

My son is now 13. Years ago my husband noticed that he would stop breathing in his sleep and start again. It was never addressed with a doctor. I found this blog because I googled "moaning in my sleep." He has been diagnosed with juvenile diabetes and is overweight by 25 lbs. He has started this moaning at night and it is not related to any physical excercise or pain. Being diagnosed with ADHD (hugely subjective diagnosis)in first grade, he was observed by several teachers that later said we do not think he has ADHD or ADD. I think why ADHD is part of this is because those kids do not rest well due to disturbances in their energy cycle not UARS, nescessarily. If you don't rest well that is an extra point added to the score of whether or not you have ADHD. My 13 year old is 6'2 and doesn't nescessarily suffer from allergies all the time.

Anonymous said...

Thank you for this!
I just recently found out from one of my friends that I have been moaning in my sleep. When I questioned other people I have been around in my sleep, they agree that yes, I do make such noises. Why no one told me until now is a mystery to me. I will be sure to research more into this now!

Anonymous said...

Hey there about the catathrenia, I've personnaly tried the Catathrenia cure book on this site http://www.outbreathing.com/ and it was pointing me in really good directions to cure this for myself.

Anonymous said...

Some people call it moaning, but I have actually woken myself up with it, and it is more of a tuneless, monotone hum on the exhale. My boyfriend brought it to my attention, and now I am completely paranoid, and can't sleep well when he is around. Sometimes, when I am really tired, it becomes a snore (inhale)/hum (exhale). I have also been told I used to whimper or cry in my sleep as a kid. Is there ANYTHING I can do to lessen or eradicate this annoying and embarrasssing habit?

Jessica Brown said...

This past year I started moaning in my sleep. The first time it happened my boyfriend told me about it and I did not believe him. The next night, I woke myself up doing it. Now I notice this happens sometimes when I am nodding off. I found your blog and was struck by how closely I fit the profile. I am 110 pounds, 25 years old, and have had 13 teeth pulled in my life due to overcrowding. It was nice to find a possible explanation, but also a little disheartening to learn that catathrenia is a precursor to sleep apnea.

Brian said...

Great information! This article was the first page I came to when I searched for "nighttime moaning" and led me to discover the name for my condition. I hope with more discussion and combined knowledge, we can find the underlying causes of Catathrenia, and discover treatments and maybe even a cure!

Here's a yahoo group that has more information and further discussion: http://health.groups.yahoo.com/group/catathrenia .

Please join and contribute! Your personal experience is invaluable.

~Brian

Karina said...

I'm a woman, 36 years old, thin and suffering from catathrenia mostly when I have a cold or sinus problems. My feet and hands are always cold and I feel sleepy all day long.
For 2 years I'd been taking a low dose of atemperator to keep under control epilepsy and latanoprost for 2 years since I have glaucoma in my left eye (before latanoprost was timolol since I was 1 year old).
My mom does the same moaning and snoring too.
Since I don't want to follow into her footsteps I really want somebody to help me, and tell me if all this symptoms are related. Please!!!

Anonymous said...

I've had catathrenia or some type of breath holding condition for over 35 years.

I was diagnosed with OSA 12 years ago and I can attest, that at least for me, CPAP is NOT a cure for catathrenia.

I do feel better on CPAP but I still hold my breath while sleeping and my CPAP machine has calculated my AHI > 10 and most events are grouped together later in my sleep period (REM?).

Anonymous said...

Thank you for the article it has given me somewhat relief to know that I am not the only one experiencing this. I'm in my early 30's and I have only just recently started heavy groaning in my sleep. Seems to coincide with my first dental procedure - root canal that I had last year.