We think our bodies shut down for the night when we fall asleep. But sometimes they’re still going – kicking, gasping, even making us wet the bed. These abnormal behaviors are called parasomnias, disorders involving involuntary physical activity that happens during sleep. Should you be worried about them?
“Sleep reflects our state of health, but it also affects our health – in ways we never knew until the last 20 years of sleep research,” says Kathy Gromer, M.D., a sleep specialist at the Minnesota Sleep Institute. We asked sleep experts what these bodily behaviors mean, what to do about them and when you should see a doctor.
1. Sleep Apnea
You might be spending the entire night gasping for breath – waking up and falling back asleep immediately, up to 20-60 times per hour. And you might not even know it. This potentially serious condition, called obstructive sleep apnea, occurs in people with a narrowed airway, either since birth or after gaining weight around their neck. Normally, muscles in the face and neck relax during sleep, including the tongue, cheek muscles soft palate and uvula (the soft tissue that hangs in the back of your mouth). If you have sleep apnea, this already narrow airway closes completely, making you stop breathing for at least 10 seconds. That’s when the body’s built-in survival mechanism kicks in, Gromer says. ”Your brain says, ‘Oh my gosh, I’ve got to save you,’ and wakes you up,” she says.”You’ll always wake up tired,” Gromer says. “Sleep becomes very unrestful. The most common thing I hear [from my sleep apnea patients] is ‘I sleep, but I have no energy.'”
Because sufferers fall asleep immediately after each episode, many don’t know they have sleep apnea until someone informs them. Bed partners unusually notice loud snoring, choking or gasping sounds.
What you can do about it: See a sleep specialist.
Sleep apnea gets worse as you age, and fatigue can be as dangerous as cardiovascular stress. It slows your reaction time, impairs judgment, and may even make you fall asleep at the wheel of your car.
The most common treatment is continuous positive airway pressure (CPAP), a mask the sleeper wears to assist with breathing. Other options include surgery to remove or reduce the uvula, soft palate and surrounding tissues, or to stiffen them with deliberate scarring. However, it doesn’t reliably cure sleep apnea, and some scarring may aggravate symptoms, cautions sleep expert Max Hirshkowitz, Ph.D., author of Sleep Disorders for Dummies.
Oral appliances that support the tongue, soft palate or jaw to open airways are also available. But they reduce apnea only by 50%, Hirshkowitz says.
2. Grinding Teeth
Bruxism – clenching or grinding teeth while you sleep – can wear molars down to nubs.
“Bruxing can occur in all stages of sleep, but it’s particularly disruptive in REM [rapid eye movement, the sleep state when dreaming occurs],” Hirshkowitz says. In that state, he explains, normal pain responses are gone, and people grind such force that it can be heard in another room.
If left untreated, bruxing can crack, loosen or break teeth. Nighttime jaw clenching can also lead to inflammation of the temporomandibular joint (TMJ), which results in pain, headache, earache, trouble biting, popping when opening your mouth, and even neck and shoulder pain. Bruxism can also be a sign of sleep apnea.
“Sometimes it’s part of the alarm system to wake you up. Lots of muscle activity comes into play, including your jaw muscles,” Gromer says.
Why do some people grind their teeth at night while others don’t? Researchers aren’t sure. They used to think misaligned teeth was the cause, but that has been disproven, Hirshkowitz says. However, many people with bruxism have tense, type-A personalities, or chronic stress in their lives, he adds.
What you can do about it:
If you think you’re grinding due to stress, relax before sleep. Try deep breathing, meditation, a warm bath, or listening to calming sounds or music as you drift off. Also, if, you’re clenching your teeth during the day, breaking that habit sometimes minimizes or eliminates night grinding. But if teeth are already showing signs of wear and tear, see your dentist.
Oral appliances are available, including mouth guards and nocturnal bite plates (also called bite splints). Some splints are designed to train your jaw into a more relaxed position, which can break the habit altogether. If grinding is a symptom of sleep apnea, treating that disorder can help you sleep better and typically stops the grinding too.
3. Restless Limbs
This bodily behavior, called periodic limb movement disorder (PLMD), mostly affects legs but sometimes arms too. It’s often confused with restless leg syndrome (RLS) – that irritating, tingling feeling that starts in the legs as you’re trying to fall asleep and makes you need to move around. Many people have both conditions. ”There’s a common overlap,” Gromer says. “Patients don’t often come in to be treated for PLMD, since it usually doesn’t disturb them, but they’ll want treatment for RLS.” PLMD differs from RLS because it occurs only when you’re asleep, and movements – ranging from twitches to kicks – are involuntary.
Most people with PLMD don’t know they have it. The biggest sign is that they wake up with the sheets strewn about, says Hirshkowitz. While these movements won’t necessarily harm you, “they tend to disturb a bed partner,” Gromer says. What you can do about it: If PLMD is disrupting your sleep, or you regularly wake up tired, talk to your doctor.
Treatment is the same as for RLS: It includes taking iron supplements, since the disorder is linked with having a low amount of ferritin, a protein that helps store iron. Regular exercise, such as walking and nightly stretching, and limiting caffeine and alcohol also seem to help, Hirshkowitz says.
4. Night Sweats
If you routinely wake up with your PJs, pillowcase and sheets drenched, you’re having night sweats. There are several possible causes: a temporary hormonal issue (such as menopause), fever due to flu or infection, the side effect of a medication (antidepressants are one culprit), sensitivity to alcohol or an overactive thyroid. It could also indicate another sleep disorder, such as sleep apnea, or a serious health issue, including lymphoma, HIV or tuberculosis.
What you can do about it:
See your doctor if night sweats continue consistently for more than a week or intermittently for more than a month, says Jill Grimes, M.D., a family physician. Because of the range of potential triggers, your doctor may ask about your medications and alcohol intake. ”Women in their 40s can develop an alcohol sensitivity that may manifest as night sweats after a glass or two of wine,” Grimes says.
Your doctor may order a number of tests, including:
• Checking hormones to see if you’re in menopause
• Tuberculosis skin test
• Blood work, to rule out overactive thyroid and low blood sugar
• HIV test
• Chest X-ray to look for enlarged lymph nodes, which can signal lymphoma
• A sleep study, if your doctor suspects sleep apnea is behind your sweats.
If your doctor rules out any serious issues, you may be able to minimize night sweats by cutting back on caffeine and alcohol. Regular exercise can also help, Grimes says. ”It seems to help reset the body’s internal thermostat and may decrease the frequency or intensity of night sweats.”
5. Wetting the bed
When adults soak the sheets, it’s called secondary incontinence. And it’s unnerving. ”A sudden nighttime accident can freak people out,” says Elizabeth Kavaler, M.D., clinical assistant professor of urology at Weill Cornell Medical College in New York City and author of A Seat on the Aisle, Please! (Springer). But it’s usually not as isolated as it appears. Typically, it’s part of a larger condition known as overactive bladder (OAB). That’s when the bladder becomes irritable and reactive – usually as part of aging – resulting in a greater and more frequent urge to urinate, Kavaler says.
“When people look back, they realize they’re going to the bathroom more than they used to. Or they’ve been having trouble getting to the restroom on time.”
Some adult bedwetting stems from a urinary tract infection (UTI), but OAB is the more common cause, Kavaler says.
What you can do about it:
Make a doctor’s appointment. If you have a UTI, you’ll be prescribed antibiotics. If OAB is the cause, there are three approaches to treatment, Kavaler says. The first course of treatment, behavior modification, involves reducing the amount of liquid you drink, especially bladder irritants such as caffeine and alcohol, and moving consumption to earlier in the day. You’ll also be asked to use the restroom more frequently and on a schedule. ”For bedtime, we might have a patient try to get up one more time in the middle of the night to void,” Kavaler says.
If that doesn’t work, there are nine different anticholinergic medications (such as Detrol), which treat OAB by relaxing bladder muscles. Medication comes in gels, patches and pills. And about 80% of the people who try them get some degree of relief, she adds. If you fall into the other 20%, your doctor may suggest invasive surgery to regulate urinary urges.