Do you find yourself picking up the phone when your alarm clock goes off in the morning? Do you know someone who actually turns violent when they are suddenly awakened? A disorder called "sleep drunkenness," which affects about 15 percent of the population, could be to blame, according to a study published in the journal Neurology.
The disorder may in fact be as prevalent as affecting one in every seven people. Sleep drunkenness disorder involves confusion or inappropriate behavior during or following arousals from sleep, either during the first part of the night or in the morning. An episode, often triggered by a forced awakening, may even cause violent behavior during sleep or amnesia of the episode. "These episodes of waking up confused have received considerably less attention than sleepwalking even though the consequences can be just as serious," says study author Maurice M. Ohayon, MD, DSc, PhD, professor of psychology and behavioral science at Stanford University School of Medicine in Palo Alto, CA.
For the study, 19,136 people age 18 and older from the general U.S. population were interviewed about their sleep habits and whether they had experienced any symptoms of the disorder. Participants were also asked about mental illness diagnoses and any medications they took. The study found that 15 percent of the group had experienced an episode in the last year, with more than half reporting more than one episode per week. In the majority of cases—84 percent—people with sleep drunkenness also had a sleep disorder, had a mental health disorder, or were taking psychotropic drugs such as antidepressants.
People with depression, bipolar disorder, alcoholism, panic disorder, or post-traumatic stress disorder and anxiety were more likely to experience sleep drunkenness. But about 30 percent of people with the disorder reported taking psychotropic drugs like antidepressants. "The first question to ask is whether 'sleep drunkedness' is a symptom of a more serious underlying disorder," says Gary Kaplan, DO, author of Total Recovery: Breaking the Cycle of Chronic Pain and Depression. "The condition is highly associated with mental health disorders and sleep disorders, all of which are symptoms of an inflammatory condition in the brain."
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Dr. Kaplan says physicians (inappropriately) are oriented to treat these conditions as diseases and not look for an underlying cause. "In the case of sleep apnea, also highly associated with 'sleep drunkedness,' inadequately treated sleep apnea causes the brain to be deprived of oxygen and results in death of brain cell and chronic inflammation in the brain. Properly treating the sleep apnea should resolve the problem." (A recent study even linked depression to a higher risk of Alzheimer's disease.)
He says he's concerned that physicians are too quick to treat the symptom and don't take the time to properly identify the underlying cause. "The majority of people who suffer with this condition were taking antidepressants; there is a wide range of conditions for which antidepressants are prescribed, including for the treatment of sleep disorders, migraines, and other chronic pain conditions, as well as mental health issues," he says. "I have listened to many patients who take these medications frequently complain of 'feeling hung over in the morning,' completely consistent with the finding in this study."
For instance, Dr. Kaplan says one of his patients had depression and sleep disturbances consistent with sleep drunkenness, but he really had undiagnosed Lyme disease. "Treatment of the Lyme resulted in complete resolution of symptoms," he says.
In another case, Dr. Kaplan saw a teenager with a severe depressive disorder who was taking multiple antidepressants and complaining of being "hung over" on the medication. It turned out he had undiagnosed celiac disease. "Off gluten, the depression resolved and his sleep returned to normal," Dr. Kaplan explains. "It took around a year for him to get to fully recover because it takes time for the brain to heal.
"I treat depression and all sleep disturbances as a symptom of an underlying inflammation in the brain," Dr. Kaplan says. "You need to take a detailed history and do the appropriate testing to determine exactly what is the cause and more frequently are the causes of the symptom, in this case depression."
Dr. Kaplan's 3 Tips to Ease Inflammation in the Brain:
1. Eat a hypoallergenic diet: rice, fish, chicken, fresh fruits, and vegetables. This eliminates all milk and milk products, gluten, soy, and refined sugars. (Learn more about elimination dieting.) There may be other foods such as corn that you may be sensitive to, and you will have to pay attention to how you feel after eating. Stay on this diet for one month and see what's changed. Remember that while 1 percent of the population has celiac disease, around 6 percent of people are gluten intolerant. There are plenty of other foods that could be causing inflammation in you body and brain, so you need to eat mindfully. (Be sure to avoid mood-wrecking foods!)
2. Meditate 20 minutes a day. Meditation reduces inflammation in the brain and promotes the growth of new nerve tissue.
3. Get moving. Regular aerobic exercise reduces inflammation in the brain and promotes brain healing.
"Are too many people taking antidepressants? Yes. We are too quick to treat symptoms and not look for the underlying cause," Dr. Kaplan adds. "One of my first-line approaches to help people improve their sleep without medication is acupuncture and, if appropriate, herbs.
Published on: September 3, 2014