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Frightening Spells at Night
Address correspondence to: Alon Y. Avidan, MD, MPH, Director, UCLA Sleep Disorders Center, Professor of Neurology, Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Blvd., Room 1-145 RNRC, Los Angeles, CA 90095-1769, ude.alcu.tendem@nadiva
Received 2015 Dec; Revised 2016 Mar; Accepted 2016 Mar. Copyright © 2016 American Academy of Sleep MedicineA 36-year-old male presented for evaluation of bothersome nighttime awakenings since age 18. The patient describes episodes of “waking up suddenly with a concern of a noise in the house, or intruder,” associated with a “sense of choking.” Sometimes he feels that he is in a falling elevator, another treacherous environment, or threatening situation where he “loses control.” These events are temporally associated with episodes of racing heart rate, chest discomfort, and a sense of impending doom. He has full memory of these events and is generally able to fall asleep shortly after awakening. The frequency of the episodes is once per night when sleeping at home, occurring mostly during the second part of the night. The events will increase to as many as 3–4 times a night if he sleeps away from home. He also has had more recent issues with insomnia after he heard that symptoms similar to this can be related to a neurodegenerative disease.
A questionnaire completed by his bed partner noted nightly awakenings 45 minutes after falling asleep with intense anxiety/dread, often with voiced concerns that he is choking or that there is an intruder in the house. The patient has no significant past medical history.
The patient's medications include alprazolam for sleep, used as needed. The use of this medication seems to lessen the likelihood of his nocturnal events. Additional factors which reduce the severity/frequency of the episodes include the presence of his wife and family at home, incorporation of relaxation techniques, medication, and completing all work duties by 8 P.M. His mother had similar symptoms during adulthood, and has a concomitant diagnosis of anxiety.
His neurological exam is normal. He had a Mallampati class II airway and a neck circumference of 15.5 inches.
His Epworth Sleepiness Scale score was 14/24 and Patient Health Questionnaire (PHQ-9) score was 5 (indicative of mild depression). Generalized anxiety disorder 7-item scale (GAD-7) score was 11 (indicative of probable anxiety disorder). Polysomno graphy demonstrated an apnea-hypopneas index of was 2/h. Minimum SpO2 was 89%. His sleep efficiency was 90%. Baseline SpO2 was 95–97%. REM sleep latency was 146 minutes. Stages N1, N2, N3, and REM sleep comprised 7, 67, 0, and 26% of sleep, respectively. There was borderline augmentation of EMG tone during REM sleep. He did not have his typical spell during the night.
What is the most likely etiology of the spells?
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Reviews for "How Citrus Magic Multi-Functional Sanitizing Solution Can Help Prevent the Spread of Illnesses"
1. Rachel - 2 stars - I was really disappointed with the Citrus Magic Multi Functional Sanitizing Solution. I had high hopes for it based on the positive reviews I read, but it just didn't work for me. The scent was overpowering and gave me a headache every time I used it. Additionally, I found that it left a residue on surfaces, which was frustrating. I will not be repurchasing this product.
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