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Neurology help please
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Neurology help please

I have cervical mild spinal cord stenosis, bulging discs c3-7 and compression C5-7, bilateral radiculopathy confirmed by MRI.  Apart from associated pain and nerve issues, I'm also having sleep onset myoclonus and brain zaps (not connected to SSRI as never taken) my neurologist has discharged me following confirmation scan and says my neck is normal for age and just being hypervigilant.  My GP has suggested psychiatric review to check whether psychogenic as I now have the "hypervigilant" label, despite me having assured that genuine and never suffering from any mental disorders or depression.  I reluctantly attended and confirmed not depressed and normal attitude to illness/  Other sites suggest Spinal myoclonus and I have pushed for a sleep clinic, but no current appointments this year. I am currently getting 3 hrs average sleep as zaps and twitches preventing sleep and affecting decision making at work/  Help what can I do, I feel no one is listening?
Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.
Without the ability to examine and obtain a history, I cannot tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
I am sorry to hear that you are suffering from so much sleep deprivation.
Small herniations/protrusions/bulging discs  are quite common. They are very often present without causing any significant symptoms. However, if the MRI shows the herniations are pressing on the spinal cord or it shows that the neural foramina (the spaces/bony canal through which nerves exit the spinal cord to get to all the muscles/body) are narrowed, then one can get symptoms of muscle weakness and tingling in the region supplied by those affected nerves. I am unsure if these are the symptoms you are feeling but it appears your neurologist reviewed the scan and didn’t think that the disc bulges were causing significant pathology
Coming to the sleep onset myoclonus and brain zaps, I am not sure what the nature of those are, you have not provided more description of those symptoms.
Myoclonus is basically a brief, involuntary, fast contraction of muscles. Not all myoclonus is associated with pathology. There is a kind of myoclonus called hypnagogic myoclonus which occurs just as a person is beginning to fall asleep, often causing them to awaken suddenly for a moment. Most experts agree that this is a natural part of the sleeping process, much like slower breathing and a reduced heartbeat. The occurrence is well known and has been well documented.
For someone with very irregular sleep the occurrence of these hypnagogic jerks would increase, so perhaps this is what is going on in your case.
It might be useful to see a sleep physician.
General sleep hygiene tips are as follows:
Maintain a regular sleep routine
• Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same (+/- 20 minutes) every night of the week.
Avoid naps if possible
• Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset.
• Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
• When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and diffulty initiating sleep, and may lead to insomnia.  
Don’t stay in bed awake for more than 5-10 minutes.
• If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.
• If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.
Don’t watch TV or read in bed.
• When you watch TV or read in bed, you associate the bed with wakefulness.
• The bed is reserved for two things – sleep and hanky panky.
Do not drink caffeine inappropriately
• The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon.
• Remember that soda and tea contain caffeine as well.
Avoid inappropriate substances that interfere with sleep
• Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.
Exercise regularly
• Exercise before 2 pm every day. Exercise promotes continuous sleep.
• Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.
Have a quiet, comfortable bedroom
• Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
• Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK.
• If your pets awaken you, keep them outside the bedroom.
• Your bedroom should be dark. Turn off bright lights.
If you are a ‘clock watcher’ at night, hide the clock.
Have a comfortable pre-bedtime routine
• A warm bath, shower
• Meditation, or quiet time
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
2 Comments
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Avatar_f_tn
Many thanks for your very comprehensive reply which has been very helpful. Although it is hard to maintain, I do mainly practice most of the sleep hygiene you have recommended, but will be worth reviewing, so thanks again.  The neurosurgeon is reluctant to operate at the moment as my radiculopathy is not restricting movement and the pain is bearable.  Similarly the compression of my spinal cord, although causing some neuropathy, is not enough at the moment to risk surgery and I fully agree with this decision.

I appear to go to sleep very quickly as the onset of the brain zaps and jerks starts very soon after retiring.  The zaps occur every night and feel like a very sudden and brief electric shock in my head, associated with a burst of light and loud fizzing sound, like an electric shock.  This startles me awake and is repeated over and over until I am exhausted and eventually manage to sleep.  On the very rare occasions I try to nap, this also occurs and is not restricted to night. The "zaps" on a bad night may occur 20-40 times over a period of a few hours.  The jerks feel like an involuntary muscle spasm in isolated areas, for example can be my shoulder, neck, biceps, legs etc.  It sometimes repeatedly affects the same muscles other times random (I think.) This also occurs for long periods and recurs when I awake in the middle of the night (or might be when I go back to sleep.)  The muscles affected move to related sites at random.  I also have restless legs which I are considerably relieved with ropinorole.  The myoclonus feels very different to the generalised sleep starts that feel like a "falling sensation" and appear to involve more central muscles and I would agree these are normal,  

Can anyone shed any light on this as I feel these are not hypngogic in origin?  Is there such a thing as Spinal or Propriospinal myoclonus?  The exhaustion is now affecting my ability to make professional decision and quality of life.  Many thanks in anticipation.
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