Dear Dream Doctor,

My husband has had difficulty sleeping for his entire life, but this condition has worsened significantly in the past 9 months. He has been seen by two sleep disorder specialists, one diagnosed him with either narcolepsy or sleep apnea, while the other thought he had REM behavior disorder or sleep apnea (both diagnoses were pending overnight observation). He has been scheduled to be monitored overnight later this week. I was interested in your opinion based on his symptoms as follows.

During sleeping he snores, grinds his teeth, and talks in short bursts throughout the entire night. He has occasionally arisen during his sleep (twice a year). He normally cooks food for himself during these sleep walking sessions, however once he urinated in the corner of the bedroom because he was dreaming he was in the woods hunting and needed to use the bathroom. He also is very restless, constantly repositioning himself during sleep. When he awakens, he feels like he has not slept and is constantly tired during the day, taking frequent naps if he does not distract himself by doing some type of activity. He is very difficult to wake up. When I attempt to do so he incorporates me into his dreams—it is like he is stuck between sleep and wake states. For example he will think I am working with him and ask me to read blueprints, hand him tools etc, all the while appearing to have a normal conversation while sleeping. There are times when I think he is awake and he will tell me something i.e. once he told me not to use the washing machine because it was not draining properly. When I questioned him later he had no recollection of the incident. I have hundreds of examples of these types of situations.

His disorder is now to the point that he cannot work because he cannot awaken in the morning or falls asleep on the job. His sleep schedule is a complete mess. He sometimes will not sleep for days (insomnia) and then will sleep continuously for days, but feel completely unrested upon awakening.

I believe that this is caused by his anxiety over not being able to wake up and the general stress that this sleeping problem has caused. This stress has also led to depression, for which my husband is currently taking Paxil (10mg)

I am aware of the treatments for sleep apnea and narcolepsy, but cannot find any information on REM behavior disorders. I am also very interested in your opinion on this as while I feel the doctors that my husband is seeing are interested in his well being and helping his life return to normal, they appear completely fascinated by the complexity/severity of his disorder. Being suspicious by nature, I do not want my husband to become a case study or research paper topic at the expense of his health and happiness.

Any information, suggestions, or other venues for my further research on this topic would be greatly appreciated.

—Laurel, Age 29, Rocky Point, NY, USA

Hi Laurel—

Your husband almost definitely has a severe case of sleep apnea, and the sooner he is treated for it—by use of a Nasal CPAP machine—the sooner all these symptoms are going to go away. He is completely exhausted—but the apnea keeps awakening him during sleep—which is what causes his “confusional arousals.” He actually, to me, doesn’t sound as if he has REM Behavior disorder—as he only is awakening from sleep and leaving the bed, as you note, 1-2 times per year.

Step #1 is to get that sleep apnea treated—and pursue therapy for at least a month or so. If he keeps on having strange behaviors during sleep, then you can begin to think about other disorders. But I suspect most if not all of his symptoms are going to resolve with treatment of the apnea. For more information on sleep apnea, please visit the Sleep Disorders section and look under category heading Sleep Apnea.

Please write back if you or your husband have further questions about the use of CPAP for treatment of sleep apnea, or if your husband experiences any difficulties in adapting to the mask and air pressure level. I am excited for your husband to receive treatment for his sleep apnea. It is going to make an enormous difference in the quality of his—and your—life! Don’t delay!