Just when you thought you were dropping off to sleep, your partner irritably shakes you awake. A conversation along these lines takes place:
“You’re making that weird noise again!”
“You know, with that horrible groaning sound that goes on for ages. I can’t sleep with you doing that…”
If this sounds familiar, it could be that you’re suffering from catathrenia.
What is Catathrenia?
Sometimes known as nocturnal groaning, catathrenia is a sleep disorder which falls under the category of sleep-related breathing disorders.
People who have catathrenia will typically breathe in deeply while sleeping. They then hold their breath for a short while. When they breathe out if may sound like a long groaning, moaning or shrieking noise.
The noise can last from a few seconds up to a minute. And at the end of the groan, they might make a secondary noise like a snorting, or they might also wake up.
The noise made can be very loud, and for some people can even sound like a sexual noise. This can be quite disturbing or annoying for other people in the household who hear it, not to mention embarrassing for the person making the noise.
Catathrenia usually occurs during the Rapid Eye Movement (REM) stage of sleep, though can occur in other sleep stages.
People who have catathrenia will usually experience it for many years, and during this time will in many cases experience it most nights. And unless their partner can sleep through the noise, it can become a source of frustration for both people.
Some researchers further suggest there could be sub-types of catathrenia, for example depending on whether the noise made on each out-breath is short or long.
What Catathrenia isn’t
As it’s not a very common sleep disorder, catathrenia is sometimes confused with other sleep disorders or health issues. So it’s important to understand that it isn’t any of the following:
- Snoring. The easy way to tell the difference is that snoring usually takes place on the in-breath, whereas catathrenia takes place during the out-breath.
- Related to exhalatory snoring (which seems like it contradicts the first point). The noise in this kind of snoring is also made on the out-breath. However, people with catathrenia pause after breathing in.
- Sleep apnea. Even though both disorders involve a pause in breathing, there’s a key difference. With apnea the pause happens after breathing out; with catathrenia the pause happens after breathing in.
- Stridor, which is a potentially dangerous condition where a person lets out a high pitch sound due to a constriction of the airways.
- Sleep talking. Despite the fact that sometimes people can make a very strange sound, it isn’t the same as sleep talking.
- Moaning which occurs during epileptic seizures.
- Related to any other breathing disorder.
When forming a diagnosis, a medical professional would want to rule out the above possibilities, particularly the more serious conditions like apnea, epilepsy, and stridor.
What causes catathrenia?
As with many sleep disorders, the exact cause is still in debate among the medical and scientific community. There have been various theories put forward, including:
- Obstruction or restriction of the upper airway.
- During REM sleep, the vocal cords may partially close off. A forced out-breath then takes place to push through this closure and unblock the vocal cords.
- Damage to brain structures that control breathing.
- There have also been suggestions it’s connected to high stress levels.
Unfortunately, there hasn’t been as much research done into the physiopathology of catathrenia as other sleep disorders which are thought to have more serious consequences if unmanaged.
Despite the lack of consensus as to the cause, it seems many researchers believe an obstruction or restriction of the airways is involved; what causes that restriction in the first place isn’t clear though.
Many people don’t even realize they make the noise until a partner or someone sleeping in their house tells them.
Talking with a medical professional or having a sleep study conducted is the best way to make sure catathrenia is identified correctly.
You may be diagnosed purely from your history and reported symptoms. But you might be asked to have an overnight sleep study in a sleep center.
Following this there are 2 ways of looking at treatment:
- Should the sufferer look at ways to address the problem?
- Should the person who is being disturbed find ways to block out the noise?
Interestingly, researchers in 2017 who looked into catathrenia made some recommendations for possible future treatment research avenues.
Direction for further research could involve consideration of deep breathing exercises, yoga, meditation, or myofunctional therapy to help abate symptoms.
In the surveys they investigated for their study, the most common comorbid medical conditions were anxiety and depression, which perhaps explain why those techniques could be helpful. So if this applies to you, perhaps it’s worth trying self-help, or reaching out for professional help if you haven’t already.
The data also suggests that alcohol use, smoking and recreational drug use could be factors to consider. This is an area where some experimentation at home (with reduction!) could prove fruitful.
And interestingly, the survey results also appears to suggest swimming could be a factor. So if you’re a swimmer, perhaps keep an eye on whether it’s worse on days you’ve been in the water.
Successful treatment with a CPAP machine
Researchers at Stanford University found in a study of seven patients that a Continuous Positive Airways Pressure (CPAP) machine helped resolve the nocturnal groaning for all of them.
A CPAP machine delivers air gently through the nose to keep the airways open and is regularly used by people who have apnea.
In that study, five people also chose to have surgery later on. And of the four people that reported back later to the researchers, three needed an oral device as well.
It might sound like it was quite an ordeal for those in the study, but the good news is that all four were eventually cured.
And in 2012, researchers in Spain gave four people from their group of 10 sufferers a CPAP machine, finding that all of them has significantly less moaning events.
More recently, in 2020 researchers published a case study of a patient with catathrenia who was successfully treated with the lowest CPAP pressure settings.
They explain that CPAP machines are known to be problematic for some people as they don’t like wearing them. They suggest that perhaps only needing the lowest setting might make it easier for people to continue using.
They say in their study:
…catathrenia is an uncommon disorder characterized by a distinct breathing pattern in which CPAP treatment seems to be effective but its utility is limited by poor patients acceptability. Setting CPAP pressures to control cathatrenia events (leaving aside flow limitation) could be related to better CPAP compliance.
Blocking the sound
It seems then that using a CPAP machine is currently the most successful treatment offered. However, not everyone finds them comfortable enough to wear in the long-term.
One alternative is for people who are being disturbed by the noise to try and block out the sound as much as possible. Wearing earplugs could help in some circumstances, though possibly not reduce the sound completely if it’s very loud.
It might help if you’re hearing it from another bedroom in the same house, but perhaps not if you’re right next to the person making the groaning noises.
Another option is to use headphones and listen to music or white noise if you like that. Good noise-cancelling headphones might add an extra boost to the sound masking too.
So if you’re unable to find ways for you and anyone else living with you to cope, or are concerned that you might have a different sleep disorder, you may find seeking medical advice a good first step.
Several readers have commented to say that they found raising their pillows helped stop the groaning sounds. I haven’t seen this published as a recommended treatment, but it’s great that readers think it helps.
Some have also offered the suggestion of avoiding sleeping on your back. Again, this doesn’t have research to back it up, but it’s worth trying out.
There have also been suggestions that it’s worse with stress and sleep deprivation. So try to stay on top of both your daily stress levels and make sure you get enough sleep.
I’d be very grateful if you could leave a comment to say if these ideas work for you, if you decide to try them or already have done. That way I can write in more detail about how often it helps people.
And if you have any other suggestions for coping mechanisms that might benefit other readers, please feel free to leave a comment below.