Dr. Blaivas Answers Your Questions About Sleep Problems

Allen Blaivas, M.D. Health Pro
  • Question:
    I am 25 years old and have had problems sleeping as long as I can remember. I no longer have problems falling asleep, however when I sleep I have very vivid dreams, sometimes nightmares and even worse, sometimes bloody/gory nightmares. I try to watch what I eat/drink/watch/read before bed, and it makes no difference. I always remember my dreams when I wake up. I need a minimum 10 hours of sleep, and I am always tired, sleepy and fatigued throughout the day. It is a struggle to stay up past 9:30 pm. I never feel rested and am easily agitated due to feeling like I am not sleeping. I also wake up often when I roll over, but never to a state where I am up and about and I immediately fall back asleep. I feel as though I am only sleeping for a couple hours when it's actually about 10. There aren't any life factors (stress, etc.) to explain this problem. What is wrong with me and what can I do?
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    Answer:
    The possible symptoms described could be a form of narcolepsy, which is a neurological disorder characterized by excessive daytime sleepiness. In order to have a final diagnosis please refer to a certified physician. Other possible symptoms of narcolepsy could be disrupted sleep, sleep paralysis (waking up feeling paralyzed), sudden loss of muscle tone during emotional events (called cataplexy) and vivid dream-like hallucinations that occur when an individual is falling asleep.

    Normal sleep is divided into segments, called stages. These stages vary in terms of how deep one is asleep, and cycle through the night. Sleep can be subdivided between non-REM and REM sleep. (REM stands for the rapid eye movement that occurs during this stage). The REM cycle occurs approximately every 90 minutes during the night in normal patients. Two important things to know about REM are 1) most dreams occur during this stage and 2) the body is normally paralyzed so we don’t act out our dreams.

    For unknown reasons, the brain is unable to regulate this normal cycle in narcoleptics and therefore elements of REM sleep intrude into wakefulness and wakefulness intrudes into sleep. Instead of occurring 90 minutes after sleep begins, REM can occur almost at sleep onset, and can even occur during the day when awake. This helps explain many of the symptoms noted above. Since REM is a dream state narcoleptic often experience vivid dreams, even while awake. The paralysis or weakness also can occur during periods of wakefulness. Sleep is often disrupted due to wakefulness intruding into sleep. No matter how much a person may sleep, they may feel tired. A useful analogy is to think of the body as a bucket and sleep as water. If the bucket has a “hole” then an individual can keep filling it up, but all the water will leak out.

    Recent research has demonstrated that patients with narcolepsy, especially those who also have cataplexy, have a deficiency of a protein named orexin in their brain.

    Narcolepsy symptoms usually start during the teen years, and not everyone will have every symptom. Also, not all symptoms start at the same time.

  • A possible diagnosis could be made with an overnight sleep study, followed by a daytime nap test to prove severe sleepiness despite enough nighttime sleep.
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    The final diagnosis can only be established by an experienced sleep physician who specializes in narcoleptic patients, as there are medications and behavioral modifications that could be helpful.

    “Important: We hope you find this general medical and health information useful, but this Q&A is meant to support not replace the professional medical advice you receive from your doctor.

    For all personal medical and health matters, including decisions about diagnoses, medications and other treatment options, you should always consult your doctor. See full Disclaimer

Published On: September 08, 2006