Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
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MISSIONARY MEDICAL MOMENT
Sleep Disorders - Part Two
"...Amid disquieting thoughts from the visions of the night,
when deep sleep falls upon men, dread came upon me, and trembling,
and made all my bones shake..."
Job 4:13-14
In Part One we examined the primary sleep disorders (insomnia, dysomnias,
sleep apneas). Less common than these disturbances of sleep are the Parasomnias - unusual,
unwanted physical events occurring during sleep. The parasomnias can also be divided into
primary (sleepwalking, night terrors, REM behavioral disorder) and secondary (sleep-related
panic attacks, eating disorders) types. Often aggravated or triggered by stressful
circumstances, the unusual presentation often leads to a diagnosis of psychiatric disorder.
In sleepwalking, the person has episodes of motor behavior which appear to have a purpose,
including arising from bed and walking about; they seem to be unresponsive to communication
from others who may try to awaken them. Episodes may vary from simply sitting up in bed to
complex behaviors such as opening doors, going down stairs, eating and carrying on limited
conversation. Usually when the person awakens, they have limited or no memory for any of
the event. Sleepwalking occurs primarily in children, peaking in early adolescence; it
usually disappears spontaneously by age 16. When it continues into adulthood, it tends
to wax and wane, with episodes occurring over a period of several years.
Night terrors, or "sleep terrors", known in Latin as pavor nocturnus, are episodes in
which a person awakens suddenly with a panicky scream or cry, then appears terror
stricken and agitated for up to 10 minutes. If they are awakened, they usually cannot
recall a specific dream or cause for their panic, and often appear somewhat confused
and disoriented (as opposed to Nightmare Disorder, where the person awakens clear-minded,
with detailed recall of a complex frightening dream). Upon awakening the next morning,
the person with night terrors usually has no memory of the event at all. This parasomnia
is also primarily a disorder of childhood, usually starting about age four and disappearing
spontaneously during adolescence. An adult form, beginning in the third decade, may be more
chronic. Often, victims of sleep terror disorder have other family members who have suffered
the same type of problem.
As we have discussed in Part I, brain electrical activity changes throughout sleep, with
different electrical patterns or stages being seen. In one particular stage, the blood
pressure may fluctuate, muscle twitching may occur, and there is a rapid darting movement
of the eyes. This Rapid Eye Movement stage is known as the REM stage, and is the stage of
sleep during which most of dreaming occurs. Occasionally, people may arise from sleep while
dreaming, and exhibit defensive and even assaultive behavior in response to a disturbing
dream. Hitting, striking out, and breaking objects may occur during REM Behavioral Disorder
(RBD). These attacks can be triggered by stress, or may follow abrupt changes in medication
or alcohol intake.
The secondary parasomnias are even more likely to be triggered by stressful circumstances,
medication effect, or other illnesses. Sleep-related panic disorder is similar to sleep
terrors; most people with this condition already experience panic attacks [see prior MMM:
Panic Disorder]. They may awaken abruptly, with full awareness but no particular memory of
dreaming, and experiencing an overwhelming physical sense of dread and impending danger.
Sleep-related eating disorder is a particularly curious sleep disorder in which a person
will arise during sleep, prepare and voraciously consume large amounts of heavy, thick,
high carbohydrate foods.They may or may not have any memory of the event the next morning.
All of the sleep disorders discussed require evaluation using special recording equipment
to verify the diagnosis and to exclude other possible causes. If someone experiences any
of these unusual sleep disturbances, it is important to not draw premature conclusions;
one can imagine how frightening such conditions might seem, particularly if they occur
for the first time in a strange culture and different land, such as one might experience
on the mission field. Getting proper information will help dispel fear. Above all, trust
God to supply the protection, the rest, and the information needed to continue in His
service
"...In peace I will both lie down and sleep, for Thou alone,
O Lord, dost make me to dwell in safety..."
Psalms 4:8 NASB
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