Just when you are about to fall asleep, you are awakened by grunts and groans coming from the other side of the bed. The act is repeated every night on account of your partner. Does it mean it is time to change rooms or maybe leave the relationship? Well, the situation might not be that desperate. So before you change your sleeping quarters, you might want to have a sneak peek into Catathrenia. It is a rare condition categorized under sleep disorders with the sub-category of sleep-related breathing disorder.
Catathrenia was considered parasomnia until 2013 when the latest International Classification of Sleep disorders manual, ICSD-3 highlighted it as a breathing infirmity rather than a sleep malady. Does Catathrenia reflect upon a serious underlying condition? Can it lead to complications in the long-run? Is there any cure available? Let’s find out.
What are the signs and symptoms of Catathrenia?
Very similar to Parasomnia, a condition characterized by abnormal behavior during sleep, Catathrenia is a breathing disorder that occurs while sleeping. It typically occurs during the REM phase of a sleep cycle.
We all breathe while sleeping but what happens in Catathrenia is the individual typically takes a deep breath, which is followed by a period of apnea (temporary interruption of breathing). The individual resumes breathing again. The expiration period is accompanied by a groaning, moaning, or sharp shrieking voice. The whole episode lasts about a few seconds to a minute. At the end of the episode, the patient might wake up or snort and continue sleeping. The process is repeated infinite times during a single sleep cycle.
The patient is not aware of the noise or the disturbance he/she causes to people around them. Of course, it disturbs the quality of their sleep. However, Catathrenia may alarm their partners. It causes a secondary sleep disturbance in people around them. Chronic cases may lead to sleep debt in the bed-partners of such patients. This leads to physical and social strain. If you are a caretaker of such a patient, your job becomes a bit more difficult. This is the main reason to get treatment for Catathrenia because it not only improves the quality of life of the patient but also delivers its upshots to friends and family.
Catathrenia is not synonyms with snoring. Snoring occurs during the inspiratory phase of breathing while Catathrenia occurs while expiration. As there is no drop of blood oxygen saturation levels in Catathrenia, like it happens with sleep apnea, the patient of the former wakes up refreshed and rested. That is why there is no excessive day-time sleeping in such patients as opposed to patients of sleep apnea who suffer from sleepiness and tiredness.
The etiology of Catathrenia
The medical community is researching the causes that lead to the development of Catathrenia. The debate is still on. Many theories are put forward in this regard. Some of the conspicuous ones are
- Catathrenia may be caused by restricted or obstructed upper airway
- The closure of vocal cords during REM phase causes a forceful expiratory act leading to disturbing noises
- Any disturbance of the cerebral center of the respiratory system
- Chronic stress may also contribute to the development of Catathrenia
- Some medications are declared culprits regarding the development of subject complaints but more evidence is required in this regard
- Family history
- Past history of Parasomnia as in childhood
- After any orthodontic procedure
- It may also develop after a tooth extraction
Whatever the cause is, Catathrenia cure or some kind of remedy is an obligation to improve the quality of life of the patient and others.
Differential diagnosis of Catathrenia
As already said, the patient of Catathrenia is not aware of their own situation. Such a case comes to light when their bed partner or a family member get disturbed and make them aware of it.
Consulting a medical expert helps. A detailed history and overnight sleep study, if required, support the diagnosis.
The condition should not be confused with
- Exhalatory snoring, there is no pause between breathing in and out
- Inhalatory snoring, where the noise is made while breathing in
- Stridor, the noise is quite high-pitched
- Sleep apnea, where the breathing pause occurs at exhalation
- Sleep talking
- Moaning in epilepsy
Since the patient is not much disturbed, Catathrenia cure tackles the problem via two ways
- Either the patient himself undergoes the treatment
- Or the individuals indirectly affected by the groans should find ways to block the unwanted noise
There are three options for the patient
- Use of an Oral device
- Use of CPAP machine
- Surgical intervention
For the partners of such patients
- Blocking the noise by using earplugs, using another sound machine in the room, creating white noise from a humidifier or a fan
- Changing the sleeping areas for both
CPAP is the most commonly recommended Catathrenia cure (a misnomer, because it aids the condition but not cures it 100%). CPAP is a system devised to deliver a steady stream of air under pressure through a mask that the patient wears and breathes through the night. The procedure thereby keeps the airway intact and decreases the frequency of episodes.
Though generally recommended, CPAP has the side effects that may make it less compliant for some. Some of these are
- Accidental removal of the mask during sleep
- Dry nasal passages
- Skin rash and irritation due to the mask
- Some patients are less tolerant of the pressurized air and become claustrophobic
The oral device is another alternative for CPAP in patients of Catathrenia. These are also used for sleep apnea and are called JAD (Jaw Advancing Devices) and MAD (Mandibular Advancing Devices). They help open the airways by moving the jaw forward.
However, the oral devices also exhibit side effects as jaw pain, sore teeth, and gums, increased production of saliva or dry mouth, jaw bite, permanent or temporary damage to jaws, and loosening of dental implants (braces, crowns, etc.).
Some cases of Catathrenia cure may require a surgical operation to remove the soft tissues in the upper airways and nasal passages. These are conducted by ENT specialists after careful case evaluation.