Catathrenia
Encyclopedia
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, although once aware of it, sufferers tend to be woken up by their own groaning as well. 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 occurs during REM sleep, although it may also occur to a lesser degree during NREM
sleep. Often the groaning occurs toward the end of the sleep cycle, within a couple hours of waking. In many cases it occurs exclusively during REM sleep. Catathrenia begins with a deep inspiration. The sufferer holds 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 a debate about whether the cause is physical or neurological, a question that requires further study. While some speculate about a direct correlation to high stress or the concept that this purely psychological, there is only anecdotal evidence of either 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.
A study in the SLEEP Journal by Guilleminault C; Hagen CC; Khaja AM. Catathrenia: "para-somnia or uncommon feature of sleep disordered breathing?". SLEEP 2008;31(1):132–139 concluded:
While a CPAP machine successfully treats catathrenia as defined by Dr. Guilleminault, there is debate whether he has confused catathrenia with expiratory snoring
. Expiratory snoring can be cured by CPAP. It does not, however, include catathrenia's characteristic breath holding spells. Furthermore, there are catathrenia sufferers who have not seen improvement with CPAP, upper airway surgery, or oral appliance.
There are a few other similarities amongst catathrenia sufferers that have not yet been studied properly:
Because catathrenia 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 relationships, social lives and sleep quality.
Rapid eye movement
Rapid eye movement sleep is a normal stage of sleep characterized by the random movement of the eyes. REM sleep is classified into two categories: tonic and phasic. It was identified and defined by Nathaniel Kleitman, Eugene Aserinsky, and Jon Birtwell in the early 1950s...
sleep parasomnia
Parasomnia
For the 2008 horror film, see Parasomnia Parasomnias are a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep...
consisting of end-inspiratory apnea (breath holding) and expiratory groaning during sleep
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...
. Catathrenia is distinct from both somniloquy
Somniloquy
Somniloquy or sleep-talking is a parasomnia that refers to talking aloud while sleep. It can be quite loud, ranging from simple sounds to long speeches, and can occur many times during sleep...
and obstructive sleep apnea
Obstructive sleep apnea
Obstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...
. The sound is produced during exhalation as opposed to snoring
Snoring
Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant...
which occurs during inhalation. It is usually not noticed by the person producing the sound but can be extremely disturbing to sleep partners, although once aware of it, sufferers tend to be woken up by their own groaning as well. 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 occurs during REM sleep, although it may also occur to a lesser degree during NREM
NREM
Non-rapid eye movement, or NREM is, collectively, sleep stages 1 – 3, previously known as stages 1 – 4. Rapid eye movement sleep is not included. There are distinct electroencephalographic and other characteristics seen in each stage. Unlike REM sleep, there is usually little or no eye movement...
sleep. Often the groaning occurs toward the end of the sleep cycle, within a couple hours of waking. In many cases it occurs exclusively during REM sleep. Catathrenia begins with a deep inspiration. The sufferer holds his breath against a closed glottis
Glottis
The glottis is defined as the combination of the vocal folds and the space in between the folds .-Function:...
, similar to the valsalva maneuver
Valsalva maneuver
The Valsalva maneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut...
. 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 a debate about whether the cause is physical or neurological, a question that requires further study. While some speculate about a direct correlation to high stress or the concept that this purely psychological, there is only anecdotal evidence of either 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.
A study in the SLEEP Journal by Guilleminault C; Hagen CC; Khaja AM. Catathrenia: "para-somnia or uncommon feature of sleep disordered breathing?". SLEEP 2008;31(1):132–139 concluded:
"Catathrenia may have subtypes related to sleep stage specificity or presence of sleep disordered breathing." and
"CPAP and select soft tissue surgeries of the upper airway (often augmented with an oral appliance) successfully treated nocturnal groaning."
While a CPAP machine successfully treats catathrenia as defined by Dr. Guilleminault, there is debate whether he has confused catathrenia with expiratory snoring
Snoring
Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant...
. Expiratory snoring can be cured by CPAP. It does not, however, include catathrenia's characteristic breath holding spells. Furthermore, there are catathrenia sufferers who have not seen improvement with CPAP, upper airway surgery, or oral appliance.
There are a few other similarities amongst catathrenia sufferers that have not yet been studied properly:
Many took part in sports activities during teens and twenties which required breath-holding. They find a certain level of comfort in breath-holding, and often do it while awake.
Sufferers themselves do not feel like they are experiencing a sleep apnea; the breath-holding appears controlled though unconscious. Oxygen desaturation during a catathrenia episode is usually negligible.
Because catathrenia 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 relationships, social lives and sleep quality.
External links
- http://www.sleepeducation.com/Disorder.aspx?id=40
- http://www.sleepassociation.org/index.php?p=catathrenia
- http://www.neurology.org/cgi/content/abstract/56/5/681
- http://www.journalsleep.org/ViewAbstract.aspx?citationid=3456
- http://groups.yahoo.com/group/catathrenia
- A message board dedicated to Catathrenia