Fear of a neurodegenerative disease; I act out my dreams. Female, 29 years old.
Since my early 20s (as far as I can remember), I’ve occasionally screamed in my sleep, but over the last 3 months it has become much more frequent — sometimes every 3–4 days. I’m 29 now, i am woman.
I grew up with a narcissistic family and an alcoholic, abusive, manipulative father, and from ages 26–28 I went through the most stressful years of my life. I suspect I may have PTSD.
After finally moving out about a year ago, I started developing several symptoms: silent reflux, tachycardia, chronic insomnia, and now violent dreams where I scream, fight, or physically act things out in my sleep. The dreams are usually about fighting a man or someone breaking into my home. Sometimes I remember them, sometimes I don’t. Usually someone wakes me up because I’m screaming.
I had a sleep study done in March. The diagnosis was possible Generalized Anxiety Disorder and chronic insomnia. I barely slept during the study due to anxiety (around 4 hours total), and only 8% of that was REM sleep.
I’m terrified of developing a neurodegenerative disease. I finally escaped my toxic environment and want to start living my life, but this fear is consuming me. Has anyone experienced something similar related to trauma/anxiety/PTSD?
The most relevant sleep study findings were the following:
Regarding sleep onset and sleep continuity indices, there was a prolonged sleep latency of 51 minutes and a low sleep efficiency of 48% (Normal >90%), along with a prolonged REM sleep latency of 121 minutes (Normal 90–120 minutes). WASO (wake after sleep onset) was 199 minutes.
An INCREASE was observed in the percentage of N2 sleep stage, as well as wakefulness. A high number of awakenings was recorded (10 total awakenings and 2 micro-awakenings throughout the study). In addition, there was a low percentage of REM sleep stages. These values indicate that the patient has fragmented sleep, which is indicative of light, non-restorative sleep.
Regarding respiratory data, 0 apnea/hypopnea events were recorded, with an index of 0 events per hour of sleep, which is considered Normal.
Average oxygen saturation while awake was 93%, while during sleep it was 92%, with a minimum of 86%, which is considered hypoxemia. The number of snoring events was 7, with an index of 1.8, which is considered Normal.
The average heart rate during sleep was 80 beats per minute, while the minimum heart rate was 62 bpm and the maximum was 112 bpm.
A total of 7 lower limb movements were recorded, none of which had periodic characteristics, with an index of 0 per hour of sleep, which is considered Normal.
Note: Central hyperarousal disorder with sleep dissociation causing chronic insomnia exacerbated by anxiety. Patient with a complex non-respiratory sleep disorder requiring multidisciplinary management. Pharmacological and non-pharmacological specialized treatment is justified. Not a candidate for CPAP therapy.
Values Obtained:
Vigil: 52%
Sleep stages N1: 5%
Sleep stages N2: 57%
Sleep stages N3: 30%
Rapid Eye Movement (REM) Sleep: 8%
Diagnosis:
- F51.0 Sleep initiation and maintenance disorder (chronic insomnia)
- F41.1 Generalized Anxiety Disorder (clinical evaluation suggested)
Recommendations:
- Cardiorespiratory activity is considered abnormal due to the presence of snoring.
- Consider positional sleep therapy and myofunctional therapy.
- Neuropsychological testing to evaluate the emotional-behavioral component.
- Cognitive behavioral therapy (first-line treatment): stimulus control, sleep restriction, cognitive restructuring.
- Evaluate the low percentage of REM and N3 stages; use melatonin for correction.
- Consider pharmacological treatment.
- Avoid sleep deprivation and sleep restriction.
- Maintain good sleep hygiene.
- Autonomic nervous system re-regulation techniques: diaphragmatic breathing, mindfulness.