Sleep Suddenly Sucks
June 28, 2014 12:35 AM   Subscribe

I used to be good at sleep. Now I suddenly suck at it.

I've been having sleeping problems that started suddenly about a week ago. The most annoying symptom is something like a hypnic jerk that happens right before falling asleep or soon after. The result is I can only usually sleep for an hour or so at a time, if at all, and when I wake up I'm quite agitated.

I have also once woken up gasping for air (I did have some nasal congestion at the time), woken up and saw "stars" upon standing up, and woken up with my teeth biting my tongue. This isn't very normal for me; I'm usually a viking when it comes to sleeping.

I've even been to the ER a couple of times because I woke up feeling my head was going to explode and that I might faint if I walked around too much. EKG, blood tests, chest X-rays looked great -- they gave me a prescription for Ativan and told me to chill out.

During the day, assuming I got a little bit of sleep, I'm fine. In a good mood, can hike and bike with no problem, etc. It's when I start to fall asleep that the bad juju starts and I am annoyed by the sound of my own heart beating.

Difficulty: We're traveling by car and 20 hours from home. I'm kind of worried about just taking the antidepressant and hoping for the best while we drive back. I have the option to stay put a few days and figure this out, but wondering what I can do in the next few days besides go back to the ER and get the same diagnosis.
posted by RobotVoodooPower to Health & Fitness (17 answers total) 4 users marked this as a favorite
You could get an overnight sleep study done to see if you have apnea or some other condition. With any luck, you're closer to a facility that does sleep studies, or to one that does them in comfortable hotel-like surroundings rather than spartan clinical surroundings, than you are at home.

One of the things that's done during a sleep study is that they have you wear a pulse oximeter all night to see if your blood oxygenation goes down, which may indicate that you've stopped breathing due to apnea. I think you can buy a non-recording pulse oximeter in a pharmacy for $25 or so these days, so a recording one that could track what happens over a few hours might be less than $100. You'd still want to be evaluated by a doctor as soon as possible, though, of course.
posted by XMLicious at 12:50 AM on June 28, 2014 [1 favorite]

What you're describing sounds a lot like sleep apnea to me, but you won't know what's really going on unless you get a sleep study.

Have your loved ones heard you gasp in your sleep? Are you snoring more? Are you overweight?

I would strongly suggest getting an OTC night guard from the drug store. It may not solve all your problems, but it won't hurt anything and it MIGHT help you in various ways.
posted by Ursula Hitler at 1:34 AM on June 28, 2014 [3 favorites]

If this *just* started, then high-intensity (like sprinting on an elliptical) interval training a couple times per week, forever, might make it go away. I am not a doctor. YMMV. Talk to your doctor. Etc.

(Carbon dioxide regulation, smooth muscle tone, etc.)
posted by zeek321 at 3:47 AM on June 28, 2014

I think you'll find this really useful.

Previously, you had asked this about your vision.

Go to a doctor and tell them all your symptoms at once. Its probably not neurological, but maybe just maybe you can be referred to rule out other serious stuff.

Travel safe.
posted by hal_c_on at 3:49 AM on June 28, 2014 [3 favorites]

This is a really long shot, but are you suddenly at high altitude?
posted by Cygnet at 6:12 AM on June 28, 2014 [1 favorite]

FYI, Ativan isn't an antidepressant; it's a benzodiazepine which is an anti-anxiety agent. People take them for all sorts of reasons and also as a sleep agent.

And you should definitely go for a full-scale medical checkup when you can. What you describe could be so many things that it's impossible for us to figure out.
posted by kinetic at 6:40 AM on June 28, 2014 [1 favorite]

This all started while you are away? Are you staying in the same place every night, or moving to a new place every night?

If it's the same place, my first thought is something environmental, some sort of allergy. Perhaps just to the pillow or the laundry detergent, but perhaps to something more, like mold.

The question about altitude is a good one too.

In general, at our house sleep issues are all about anxiety and stress. Are you traveling to (or under) stressful conditions?
posted by vignettist at 6:55 AM on June 28, 2014

You've been to the ER a couple of times in a week and you're still considering driving at least 20 hours? If this were happening to me, I'd find a non-ER doctor immediately and follow that doctor's advice.
posted by Etrigan at 6:57 AM on June 28, 2014

If I were you, I would do some research on Ativan (generic name lorazepam). There are some serious down-sides to taking it for more than a week or two. See, for example, this Wikipedia article about the rebound anxiety and rebound insomnia that can happen when you discontinue the drug. See also this article from the British Medical Journal.
posted by alex1965 at 7:14 AM on June 28, 2014

You describe

- waking up gasping for air
- waking up and seeing stars upon standing
- waking up with teeth biting your tongue (ouch!)

It sounds to me like some kind of parasomnia. Parasomnias are sleep disorders such as sleepwalking, tooth grinding and limb jerking. They are believed to be caused by dysfunction of the basal ganglia, organelles at the base of the brain. Cygnet asked if you were suddenly at high altitude. This isn't such a long shot. Parasomnias can be caused by insufficient tissue oxygen saturation. You don't need to be at altitude to have problems with oxygen saturation. That can be caused by apnea, or by low iron in blood and tissue.

The seeing stars upon standing suggests orthostatic hypotension: this is when the blood pressure does not rise enough when you stand up, so your brain is undersupplied with oxygen. This is difficult to diagnose because it is situational. People with orthostatic hypotension usually have normal blood pressure when it is measured in a typical doctor's office. It can also come and go.

Anyway, I have had very similar symptoms and I have a few suggestions for you.

Have you been spending a lot of time in the sun lately?
Are you having early-morning awakenings?
Do you eat a lot of dairy?
Are you vegetarian?
Are you physically active?
Have you made any significant changes in your diet recently?

When you were in the ER, did they do an iron panel (ferritin, serum iron, total iron binding capacity (TIBC), calculated iron saturation)? The routine blood test is a complete blood count, electrolytes, and liver enzymes and wouldn't include those extra iron parameters. You can have normal hemoglobin and blood count and still have iron insufficiency. Most doctors will miss this, because they're only trained to pay attention to really obvious deficiency. If you are male, they'll be even less likely to think of this as a possibility. In the ER, they are just going to make sure that there is nothing seriously wrong with you and send you on your way.

I had symptoms very like the ones you described and had an iron deficiency that was missed by maaaany doctors. Iron replacement ultimately fixed the problem for me. Even today, though I have iron levels that are "within the normal range", the symptoms will sometimes return, and they always go away again with renewed iron replacement.

The other thing I would investigate is sun exposure. My natural tendency towards disturbed sleep gets aggravated when I have been in the sun a lot, perhaps because vitamin D can crank up the metabolism. At first, sleep improves, but if I get enough sun, it goes over into excessive activation. I get the limb jerks, waking up with a start in the middle of the night, waking up in the early morning, and tooth grinding.

When you get home, it would also be worth looking into a sleep study and checking for sleep apnea.

If you are having dizzy spells, you shouldn't be at the wheel, though it's perfectly okay to travel and let somebody else drive :) If you take the Ativan, you shouldn't be driving either. Me, I would avoid it. It doesn't solve the real problem, it's habit-forming, and it loses its efficacy pretty quickly.
posted by rhombus at 7:21 AM on June 28, 2014 [7 favorites]

I've been having sleeping problems that started suddenly about a week ago.
Difficulty: We're traveling by car and 20 hours from home.

This is all happening in the context of a long car trip?

If so, I think you are probably suffering from low level CO poisoning due to exhaust exposure.
Hypoxic insomnia: effects of carbon monoxide and acclimatization.

Hypoxia causes severe disruption of both rapid-eye-movement (REM) and non-REM (NREM) sleep.
Have your car checked for leaks in the exhaust system, and if your car has a tailgate, make absolutely sure it seals completely.
posted by jamjam at 8:31 AM on June 28, 2014 [4 favorites]

By the way, since Ativan relaxes your muscles, I don't think it would be a great idea to take if you might have sleep apnea, since it would make it more likely for your throat to relax and close off.
posted by three_red_balloons at 8:58 AM on June 28, 2014

Note before I say anything else: IANAD. I have no comment about any of the more severe possibilities people have mentioned. I'm commenting only about things I have experience with.

I've had two sleep studies and both took months to schedule. Getting one done on short notice seems both impractical and expensive. If you can communicate with your doctor back home and get the wheels in motion for a sleep study, do that now. Get a foam wedge and try sleeping upright; it might take you a while to get to sleep, but it may help with breathing.
posted by wintersweet at 9:19 AM on June 28, 2014

It sounds like you're having anxiety attacks as you go to sleep. Ativan is not an antidepressant, it's the same family as Xanax - it's a tranquilizer, to use the old-fashioned term. It's to make the anxiety go away so you can sleep. If they're tablets and there's no warning on the label not to split them, take half of one when you go to bed tonight.

It would not ever occur to me to go to the ER multiple times over congested sleep, so it really does sound like you are having some very intense anxiety and maybe hypochondria? Your phrasing smacks of "I've always slept fine and now I've had a couple of nights of bad sleep I AM RUINED FOREVER" which is not a reasonable assumption*. Right now, wherever in the world you are, the days are at their longest/shortest, and that can throw your pituitary gland into a temporary befuddlement that often manifests in a sort of jet lag and systemic off-feeling-ness. Plus you're away from home, and that's a bitch - and even if you've always been okay before, as we get older we just get less flexible. But you'll be okay.

*It is, however, exactly where I go when I'm sleep deprived myself: my life will always be like this, for I am doomed. Last night was the first good sleep I've had in about 6 nights and I spent most of yesterday just crying at things and eating cookies and feeling nostalgic for the good old days back when the sleep came. Sleep dep makes you miserable.

Do go for that sleep study if you feel like this is an ongoing issue, but I'm not sure your doctor's going to order one based on sleeping badly a few nights while far away from home at the solstice.
posted by Lyn Never at 10:41 AM on June 28, 2014

I am wondering if this started while traveling, if traveling is an oddity somehow -- if the traveling itself might somehow be a source of the issue, either exposing you to things you are not normally exposed to or removing you from what works?

(If so, the short answer might be: Go home. A return to your normal schedule might fix this right up.)
posted by Michele in California at 12:07 PM on June 28, 2014

Thanks, everyone. Doc gave me a SARI and that seemed to lift me out of the hole enough that I could sleep 8+ hours the last few nights. I still get the sudden jerk a few times during the night, but at least I'm able to get back to sleep.

Walgreens carries a basic recording pulse oximeter and it looks like my O2 level was usually 95-96 dipping down to 91 at times (+/- 2%) but dunno whether that's atypical for me.
posted by RobotVoodooPower at 2:56 PM on July 7, 2014

I don't remember what the numbers were like during my own sleep studies before I started treatments for apnea, but if you actually suspect that you have sleep apnea you really want to get that checked out. The oxygen deprivation and other effects do cumulative damage over time that can cause or exacerbate very serious health problems.
posted by XMLicious at 3:35 PM on July 7, 2014 [1 favorite]

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