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Sleeping in a more upright position seems to lessen catathrenia (as well as sleep apnea). Performing regular aerobic exercise, where steady breathing is necessary (running, cycling etc.) may lessen catathrenia. Strength exercise, on the other hand, may worsen catathrenia because of the tendency to hold one's breath while exercising. Yoga and/or meditation focused on steady and regular breathing may lessen catathrenia.
Catathrenia is a rapid eye movement sleep parasomnia consisting of end-inspiratory apnea (breath holding) and expiratory groaning during sleep. Catathrenia is distinct from both somniloquy and obstructive sleep apnea. The sound is produced during exhalation as opposed to snoring which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners. Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound.
Catathrenia typically, sometimes even exclusively, occurs during REM sleep, although it may also occur to a lesser degree during NREM sleep. Catathrenia begins with a deep inspiration. The sufferer holds her or his breath against a closed glottis, similar to the Valsalva maneuver. After a period of time and some blood oxygen desaturation, there is an arousal, followed by expiration. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation with no sound.
There is debate about whether the cause is physical or neurological, a question that requires further study. While some speculate about a direct correlation to high anxiety and stress or the concept that catathrenia is purely psychological, there is only anecdotal evidence of either proposed cause.
Catathrenia has been defined as a parasomnia in the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2), but there is debate about its classification.
There are a few other similaritiesamongst catathrenia sufferers that have not yet been studied properly:
- Many catathrenia sufferers mention that they also suffer from some form of stress or anxiety in their lives.
- Sufferers themselves do not feel like they are experiencing a sleep apnea; the breath-holding appears to be controlled though the unconscious. Oxygen desaturation during a catathrenia episode is usually negligible.
- Many took part in sports activities during teens and twenties some which required breath-holding which included many types of sports such as swimming and even weight lifting. They find a certain level of comfort in breath-holding, and often do it while awake.
- Observations have been made of instances of breath holding during daily activities that require concentration.
- Some sufferers recalled suffering from lucid or stress dreams during their catathrenia episodes during their sleep.
- Some sufferers complain of having a painful chest upon waking from sleep.
Because catathrenia itself is not considered life-threatening, there has been very little research done in the medical community, and many experts assume that the way to treat catathrenia is to treat the underlying sleep apnea, though there is no conclusive evidence published that catathrenia results from sleep apnea, and sleep studies show that not all sufferers of catathrenia have been diagnosed with sleep apnea.
While doctors tend to dismiss it as an inconvenience, sufferers routinely describe the condition's highly negative effects on their daily lives including tiredness, low energy, dizziness and vertigo, work problems, relationship and social issues, and other physical and mental problems that could be associated with low sleep quality.
Treatments for sleep disorders generally can be grouped into four categories:
- Behavioral and psychotherapeutic treatment
- Rehabilitation and management
- Medication
- Other somatic treatment
None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.
Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Certain disorders like narcolepsy, are best treated with prescription drugs such as Modafinil. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results.
Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted.
Special equipment may be required for treatment of several disorders such as obstructive apnea, the circadian rhythm disorders and bruxism. In these cases, when severe, an acceptance of living with the disorder, however well managed, is often necessary.
Some sleep disorders have been found to compromise glucose metabolism.
Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM sleep in the 1950s and circadian rhythm disorders in the 70s and 80s, the medical importance of sleep was recognized. The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. By the 1970s in the USA, clinics and laboratories devoted to the study of sleep and sleep disorders had been founded, and a need for standards arose.
Specialists in Sleep Medicine were originally certified by the American Board of Sleep Medicine, which still recognizes specialists. Those passing the Sleep Medicine Specialty Exam received the designation "diplomate of the ABSM." Sleep Medicine is now a recognized subspecialty within internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the United States. Certification in Sleep Medicine shows that the specialist:"has demonstrated expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory."
Competence in sleep medicine requires an understanding of a myriad of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder", such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine–Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances. Another common complaint is insomnia, a set of symptoms which can have a great many different causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.
Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dental specialties, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is recognized by the American Academy of Sleep Medicine (AASM), and these dentists are organized in the Academy of Dental Sleep Medicine (USA). The qualified dentists collaborate with sleep physicians at accredited sleep centers and can provide oral appliance therapy and upper airway surgery to treat or manage sleep-related breathing disorders.
In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College Healthcare Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians." The Imperial College Healthcare site shows attention to obstructive sleep apnea syndrome (OSA) and very few other sleep disorders. Some NHS trusts have specialist clinics for respiratory and/or neurological sleep medicine.
Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and NREM sleep, or wakefulness and REM sleep.
REM sleep behavior disorder or RBD is the most common REM sleep parasomnia in which muscle atonia is absent. This allows the individual to act out their dreams and may result in repeated injury—bruises, lacerations, and fractures—to themselves or others. Patients may take self-protection measures by tethering themselves to bed, using pillow barricades, or sleeping in an empty room on a mattress.
Demographically, 90% of RBD patients are males, and most are older than 50 years of age.
Typical clinical features of REM sleep behavior disorder are:
- Male gender predilection
- Mean age of onset 50–65 years (range 20–80 years)
- Vocalisation, screaming, swearing that may be associated with dreams
- Motor activity, simple or complex, that may result in injury to patient or bed-partner
- Occurrence usually in latter half of sleep period (REM sleep)
- May be associated with neurodegenerative disease
Acute RBD, occurs mostly as a result of a side-effect in prescribed medication—usually antidepressants. But if not then 55% of the time the cause is unknown the other 45% the cause is associated with alcohol.
Chronic RBD is idiopathic, meaning of unknown origin, or associated with neurological disorders. There is a growing association of chronic RBD with neurodegenerative disorders—Parkinson's disease, multiple system atrophy (MSA), or dementia—as an early indicator of these conditions by as much as 10 years.
Patients with narcolepsy also are more likely to develop RBD.