Autonomic dysfunction and Sleepiness

[SadieSunflower]

Hi,

Thank you very much for participating in this forum! I may never have been diagnosed if it wasn't for MedHelp.

I am a 26 year old female of average weight. I have been diagnosed with autonomic neuropathy. I also have POTS (Postural Orthostatic Tachycardia Syndrome) which is caused by the autonomic neuropathy. I am working with some very good neurologists who have not been able to find find the cause of my neuropathy but we are still trying. I also have problems with muscle fatigue which no one can find a cause for. I do not have diabetes.

I take a low dose of Propranolol to help with the tachycardia. Sleepiness has been a problem before I started Propranolol. I have no problems falling asleep or staying asleep at night and I sleep alone.

Since I have been symptomatic with autonomic problems, I have gradually been getting more and more sleepy. I have sleep paralysis every time I fall asleep. Just the other day I was in starbucks drinking coffee and I started to fall asleep. I fell into sleep paralysis right there in the store and I couldn't move!

I have talked to my internist, and she has referred to a neurologist who is a sleep medicine specialist. My appointment is next week.

I am wondering if you know of any sleep problem that is common in people with autonomic dysfunction. If you can point me to any articles on the subject, that would be great. I am very concerned about what kind of sleep disorder I could have. I hope that I do not have some kind of central neurological problem. Can dysautonomia cause sleep apnea?

[SadieSunflower]

I take a beat blocker, and it does cause some fatigue, but shouldn't be making me THAT tired.

The sleep study found that I am swallowing excessively at night due to GERD reflux. GERD is very common if you have autonomic neuropathy. I do not have heart burn. I have treated the GERD, and feel much better but I am still very sleepy. I will follow up with my doctor soon.

Goodluck!

[Steven Y Park, MD]

One particular condition that comes to mind after reading your history is upper airway resistance syndrome (UARS). People with UARS are generally young thin women who have orthostatic hypotension, cold hands or feet, normal or low blood pressure, are chronically tired, and prefer to sleep on their sides or stomach. They never wake up refreshed, no matter how long they sleep. There's a lot of controversy over whether UARS is a distinct clinical entity or along a continuum with sleep apnea. Anatomically, I see small jaws with dental crowding and severe narrowing of the space behind the tongue when lying flat on their backs.

Your history of sleep paralysis has to be better defined by your sleep doctor to see if it's the classic sleep paralysis or dozing off due to fatigue. Sleep paralysis has other implications besides sleep-breathing issues, such as narcolepsy. The best way to get a full answer is to see your  sleep medicine specialist and undergo appropriate testing.

[netthetics]

I just joined the med help community and was interested in your post because I am having more and more of a problem with sleepiness and have been complaining about it to my doctor.  I noticed that the beta blocker I take for tachycardia seems to knock me right out.  But, I am not taking the beta blocker any more and I have recently noticed that I am very sleepy again.  I just learned about dysautonomia from my daughter this Christmas so am just now looking for answers.  Did you ever find a solution to your sleepiness?  I am cold all the time and it seems the only way I can get warm is to lay down under the covers.  I almost fell asleep over breakfast this morning.

[SadieSunflower]

Hi,

I had my sleep study, and it turns out that I swallow often during the night. My doctor says that you cannot swallow during sleep, so I must wake up to swallow. She also says that people do not salivate during sleep, so she thinks I have GERD, and the acid reflux is coming up to my throat at night and that is why I swallow during the night.

I also had about 6 RERAs per hour and 1 central sleep apnea event. I have periodic leg movements, hundreds per night, but they movements do not wake me up. She thinks that the real problem is the swallowing and I have started taking a proton pump inhibitor before I go to bed and to my surprise, it has helped tremendously. I am still sleepy but it is manageable.

Autonomic Neuropathy causes GERD problems. I did not think of that connection before. I do not have symptoms of heart burn, but I have had friends who have had problems with their vocal cords because of reflux problems with no heart burn symptoms.

[sleepykelly]

I had a sleep study done over a year ago and the doctor had mentioned this, I initially went in because I snore and I was constantly tired/fatigued and it progressively got at the end of my 20s.  The findings were that I had resistance and would often wake up or disturb myself during sleep with the snoring.  My oxygen level did not drop but it was thought that the constant waking up may be related to my tiredness during the day.

I was not tolerant of a CPAP machine (can't have stuff on my face) and I sleep on my side and back.  I am also of normal weight and was 'diagnosed' at age 30.  I looked in to LAUP surgery but the cost and the fact that there was a decent chance that the surgery would not stop my snoring was enough for me to nix that option.  My doctor put me on Provigil in the mean time and it has helped tremendously...I used to fall asleep at my desk...or just doze off at random places.  She also thought that I might just have idiopathic hypersomnia, based on my age and physical symptoms.

I started using a dental device at night when I'm sleeping with my fiance, although I'd rather sleep without it, it does prevent me from snoring and keeping him awake.  I need to try sleeping with it for an extended period to see if it affects my daytime sleepiness before I stop taking the Provigil...if it doesn't then I may need to stay on it indefinitely.