Groaning During Sleep May Represent Catathrenia

Groaning or making other vocal sounds during sleep is a phenomenon that can disturb both the individual who experiences it and their bed partner. While occasional groaning is common, persistent or intense groaning during sleep could be indicative of a sleep disorder known as catathrenia. This condition is characterized by abnormal vocalizations during sleep, often in the form of groaning or moaning. Though it is less widely known than other sleep disorders like sleep apnea or snoring, catathrenia is a real condition that can have a significant impact on sleep quality and health. In this article, we will explore what catathrenia is, its potential causes, how it affects sleep, and possible treatment options.

What is Catathrenia?

Catathrenia, derived from the Greek words kata meaning "down" and threnia meaning "lament," is a sleep disorder characterized by groaning, moaning, or other vocalizations that occur primarily during exhalation while the individual is asleep. Unlike the sounds associated with snoring, which are typically produced by vibrations in the throat, the vocalizations in catathrenia are produced by the vocal cords, and are often described as loud, prolonged, or even guttural groaning sounds.

These sounds are most commonly made during non-REM (rapid eye movement) sleep, but vocalizations may also occur in REM, which is the stage of sleep where most dreaming occurs. Catathrenia episodes can last anywhere from a few seconds to several minutes, and they may occur several times throughout the night. The groans can be faint or so loud that they wake up the person making the sound or their partner.

Symptoms of Catathrenia

The primary symptom of catathrenia is the occurrence of groaning or moaning sounds during sleep, which may be louder than typical snoring. These sounds may be brief or prolonged, with some individuals experiencing a continuous groaning sound for the duration of their exhalation. The groaning usually occurs during the exhalation phase of the breathing cycle. In many cases, the individual is often not aware that they are making these sounds, as they are happening during sleep.

Some individuals with catathrenia may also experience other sleep-related disturbances, such as disrupted sleep or daytime sleepiness. Groaning during sleep can disrupt the overall sleep quality of both the individual and their bed partner, potentially leading to feelings of fatigue or sleep deprivation upon waking. Sleep fragmentation caused by catathrenia may result in difficulty concentrating at school or work, and this could lead to irritability and other behavioral issues.

In many cases, individuals with catathrenia may experience these sounds due to other sleep disorders, like sleep apnea or restless leg syndrome, which may complicate diagnosis and treatment.

Potential Causes of Catathrenia

The exact cause of catathrenia is not fully understood, but several theories have been proposed to explain the condition. It is often thought to be related to issues with the breathing mechanism or sleep cycle. Some of the most commonly proposed causes include breathing obstructions, disruption in REM sleep, underlying sleep disorders, and psychological factors.

One widely considered cause of catathrenia is the presence of upper airway obstruction or partial airway blockages during sleep. Similar to other sleep disorders like snoring and sleep apnea, catathrenia may arise due to disruptions in airflow during sleep. The vocal cords may vibrate in response to the partially blocked airway, producing the groaning or moaning sounds associated with catathrenia.

Catathrenia episodes may predominate during REM sleep. REM sleep is a critical stage of the sleep cycle associated with vivid dreaming and intense brain activity. During this phase, muscle tone is typically reduced, which can cause disruptions in the breathing cycle. Some researchers suggest that catathrenia may result from abnormal patterns of diaphragm movement or muscle relaxation that occur during REM sleep, which could lead to the characteristic groaning sounds.

Some sleep disorders, such as sleep apnea, narcolepsy, and restless leg syndrome, may increase the likelihood of developing catathrenia. In particular, individuals with sleep apnea, a condition characterized by repeated pauses in breathing during sleep, may also experience vocalizations like groaning. The groans in catathrenia may be linked to the body’s attempts to overcome breathing obstructions during sleep.

Stress and anxiety have been found to influence many sleep disorders, and catathrenia may also be related to mental health. Individuals who experience high levels of stress may be more prone to sleep disturbances, including groaning. However, while psychological factors might contribute, they are unlikely to be the sole cause of the condition.

How Catathrenia Affects Sleep

Catathrenia can have a significant impact on the quality of sleep for both the affected individual and their bed partner. While the individual may be unaware of their vocalizations during sleep, the noise can disrupt the natural sleep environment and lead to increased arousals throughout the night. For the individual, the sleep disruption caused by catathrenia can lead to reduced sleep quality, as they may not experience a full, uninterrupted sleep cycle. This can lead to sleep fragmentation, where the individual spends more time in lighter stages of sleep, rather than in deeper, restorative stages.

Chronic sleep disruption due to catathrenia can result in daytime fatigue and tiredness. Individuals with catathrenia may have difficulty staying awake during the day, and this can negatively affect their cognitive function, mood, and overall energy levels. Daytime drowsiness can make it difficult to concentrate on tasks or engage in activities that require mental clarity.

For the bed partner, the constant groaning sounds associated with catathrenia can also lead to sleep disturbances. The noise from catathrenia can disturb the bed partner’s sleep, causing them to wake up during the night or experience fragmented sleep. Over time, the repetitive groaning sounds may lead to frustration, anxiety, or resentment towards the person experiencing the condition, which can affect the relationship.

Diagnosis and Treatment of Catathrenia

If you suspect that catathrenia may be affecting your sleep or the sleep of a loved one, it is important to consult a healthcare provider for a proper diagnosis. A thorough evaluation of sleep patterns and an assessment of symptoms can help identify the presence of catathrenia.

The most reliable method for diagnosing catathrenia is a sleep study, or polysomnography, which involves monitoring the individual overnight in a sleep center. The sleep specialist will observe brain activity, breathing patterns, and muscle movements to determine if catathrenia is present, as well as whether any other sleep disorders, such as sleep apnea, may be contributing to the vocalizations.

Treatment for catathrenia generally focuses on improving sleep quality and addressing any underlying conditions contributing to the disorder. While there is no specific medication for catathrenia itself, several approaches can help manage symptoms. If catathrenia is associated with sleep apnea, a CPAP machine may be prescribed to help maintain airflow and prevent airway obstruction during sleep. Dental devices that reposition the jaw or open the airway may also be used to alleviate breathing obstructions during sleep, which could reduce groaning.

Relaxation techniques, such as mindfulness, meditation, and deep breathing exercises, may help reduce anxiety and promote more restful sleep. Encouraging consistent sleep routines, a comfortable sleep environment, and good sleep habits can improve sleep quality and reduce disruptions from catathrenia.

In some cases, the use of a medication called clonazepam may be tried to reduce the condition.

Conclusion

Catathrenia is a sleep disorder characterized by groaning or moaning during sleep, typically caused by airflow disruptions or muscle relaxation during REM sleep. Though it is relatively rare, catathrenia can have a significant impact on both the affected individual and their bed partner. The condition is often associated with other sleep disorders, and it can lead to fragmented sleep, daytime fatigue, and relationship issues. Early diagnosis and treatment, including sleep studies, CPAP therapy, and relaxation techniques, can help alleviate the symptoms and improve sleep quality for individuals affected by this condition.

This article was created using OpenAI’s ChatGPT on February 23, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

What Are Confusional Arousals?

Confusional arousals are a type of parasomnia—unusual behaviors that occur during sleep. They are characterized by episodes of confusion and disorientation upon awakening from sleep, typically occurring in the first half of the night. These episodes can be perplexing and concerning for both the individuals experiencing them and their family members. Understanding what confusional arousals are, their causes, and potential treatments can help manage and mitigate these episodes effectively.

What Are Confusional Arousals?

Confusional arousals are characterized by partial awakenings from deep, non-REM (Rapid Eye Movement) sleep, often resulting in confusion, disorientation, and sometimes inappropriate behavior. Unlike other parasomnias such as sleepwalking or night terrors, confusional arousals usually involve a degree of mental fogginess and difficulty in responding to external stimuli.

During these episodes, individuals may appear to be awake, but they often have impaired cognitive function and memory. They might struggle to understand their surroundings or may exhibit behaviors that seem odd or out of character. The episodes can last from a few seconds to several minutes, and upon full awakening, individuals may have little or no recollection of the event.

Causes and Risk Factors

Confusional arousals occur during slow-wave sleep (SWS), which is the deepest phase of non-REM sleep. The exact causes are not always clear, but several factors may contribute to the likelihood of experiencing these episodes:

1. Sleep Deprivation: Lack of adequate sleep can increase the likelihood of confusional arousals. Sleep deprivation can lead to more frequent transitions between sleep stages, increasing the chances of arousal from deep sleep.

2. Stress and Anxiety: High levels of stress and anxiety can disrupt normal sleep patterns and increase the frequency of confusional arousals. Stress can exacerbate the tendency to experience these episodes by impacting overall sleep quality.

3. Sleep Disorders: Certain sleep disorders, such as sleep apnea or insomnia, can contribute to confusional arousals. Fragmented sleep caused by these disorders can increase the likelihood of arousals from deep sleep stages.

4. Alcohol and Medications: Consumption of alcohol or certain medications can interfere with sleep architecture, potentially increasing the risk of confusional arousals. Alcohol, in particular, can disrupt the normal progression of sleep stages and contribute to sleep disturbances.

5. Sleep Environment: An uncomfortable or disruptive sleep environment can increase the chances of experiencing confusional arousals. Factors such as noise, light, or an irregular sleep schedule can impact sleep quality and contribute to these episodes.

6. Genetics: There may be a genetic predisposition to confusional arousals, as they can sometimes run in families. Individuals with a family history of parasomnias may be more likely to experience these episodes.

Symptoms and Characteristics

Confusional arousals typically occur during the transition from deep sleep to a lighter sleep stage or to wakefulness. The symptoms can vary in intensity and duration, but common characteristics include:

• Confusion: Individuals may appear disoriented and confused, struggling to understand their surroundings or make sense of their situation.

• Inappropriate Behavior: During an episode, individuals might exhibit behaviors that seem unusual or out of character, such as wandering around the house, talking incoherently, or performing routine tasks in a disorganized manner.

• Difficulty Recalling the Episode: Upon waking fully, individuals may have little or no memory of the episode, which can make it challenging to recognize and address the issue.

• Partial Awakening: The episodes often occur during partial awakenings from deep sleep, and individuals may not fully transition to wakefulness during the episode.

Diagnosis

Diagnosing confusional arousals involves evaluating the individual’s sleep patterns and behaviors. A healthcare provider may consider the following steps for diagnosis:

1. Sleep History: A detailed sleep history is crucial for identifying potential triggers and understanding the frequency and nature of the episodes. This history typically includes information about sleep patterns, sleep environment, and any contributing factors such as stress or medication use.

2. Polysomnography: In some cases, a sleep study or polysomnography may be recommended. This involves monitoring various physiological parameters during sleep, including brain activity, eye movements, and muscle tone. Polysomnography can help determine whether confusional arousals are occurring and rule out other sleep disorders.

3. Medical Evaluation: A comprehensive medical evaluation may be necessary to identify any underlying health conditions that could contribute to confusional arousals. This evaluation may include a review of the individual’s medical history, medication use, and lifestyle factors.

Treatment and Management

Managing confusional arousals often involves addressing contributing factors and implementing strategies to improve sleep quality. Some effective approaches include:

1. Improving Sleep Hygiene: Practicing good sleep hygiene can help improve overall sleep quality and reduce the frequency of confusional arousals. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants such as caffeine and nicotine before bedtime.

2. Managing Stress and Anxiety: Addressing stress and anxiety through relaxation techniques, counseling, or therapy can help improve sleep quality and reduce the likelihood of confusional arousals. Techniques such as deep breathing, meditation, and progressive muscle relaxation can be beneficial.

3. Addressing Sleep Disorders: Treating any underlying sleep disorders, such as sleep apnea or insomnia, can help improve overall sleep quality and reduce the occurrence of confusional arousals. This may involve using CPAP (Continuous Positive Airway Pressure) therapy for sleep apnea or other appropriate treatments for different sleep disorders.

4. Adjusting Medication Use: If medications or substances such as alcohol are contributing to confusional arousals, adjusting their use or finding alternative treatments may be necessary. It’s important to discuss any concerns with a healthcare provider to determine the best approach.

5. Creating a Relaxing Sleep Environment: Enhancing the sleep environment by minimizing noise, controlling light levels, and ensuring a comfortable mattress and bedding can contribute to better sleep quality and reduce the risk of confusional arousals.

6. Behavioral Interventions: In some cases, cognitive-behavioral therapy (CBT) or other behavioral interventions may be recommended to address sleep-related issues and improve sleep patterns.

There can be additional options, including the use of a prescription medication called clonazepam, that can be considered if the condition persists.

Prognosis

The prognosis for individuals with confusional arousals varies depending on the underlying causes and contributing factors. In many cases, improving sleep hygiene, managing stress, and addressing any contributing sleep disorders can lead to a significant reduction in the frequency and severity of episodes. For some individuals, confusional arousals may diminish over time, while others may require ongoing management to control the episodes.

Conclusion

Confusional arousals are a type of parasomnia that can disrupt sleep and cause confusion and disorientation upon awakening. They are characterized by partial awakenings from deep sleep and can be influenced by factors such as sleep deprivation, stress, sleep disorders, and certain medications. Diagnosing confusional arousals involves evaluating sleep patterns and may include polysomnography and medical evaluations. Treatment typically focuses on improving sleep hygiene, managing stress, addressing underlying sleep disorders, and adjusting medication use. By implementing these strategies, individuals can often reduce the frequency and impact of confusional arousals and improve overall sleep quality.

This article was created using OpenAI’s ChatGPT on September 13, 2024 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.