Sleep-onset twitching, also called sleep-onset myoclonus, is when there are twitches of the body during falling asleep, sometimes in association with other abnormalities. Sleep onset twitches are usually harmless and can occur in the course of life and disappear again on their own. Only when falling asleep twitches make it difficult or impossible to fall asleep do we speak of a disease.
What are sleep onset twitches?
The term twitching to fall asleep includes various phenomena that can be observed during falling asleep or during the first phase of sleep. In addition to twitches of the body, visual, auditory, and sensory twitches of falling asleep may occur. Twitches of the body are manifested as sudden and brief twitches of the limbs or trunk called myoclonias. In visual twitches of falling asleep, the person falling asleep perceives flashes of light that do not exist. In auditory onset twitches, on the other hand, the person falling asleep hears loud noises, such as a bang, which, like the flashes of light, cannot be perceived by others. In sensory twitches, on the other hand, the person falling asleep feels a sensation of falling or stumbling. Visual, auditory, and sensory twitches to fall asleep may accompany twitches of the body. Only in rare cases – when the falling asleep twitches are severe – does the affected person awaken from the falling asleep twitches. In addition, there may be an accelerated heartbeat and irregular breathing.
Causes
To date, there are no known causes for either mild or severe twitches to fall asleep. They are classified as a natural phenomenon, since during the process of falling asleep, about seventy percent of the population will experience twitches at least intermittently during their lifetime. Especially in young children, twitching of the limbs can be observed, which is completely harmless. Although the causes are unknown, it has been observed that twitching to fall asleep occurs more frequently in response to external sounds and in people who are stressed. Scientists believe that when a person falls asleep, there are changes in the nerve cells in the brain or spinal cord, triggered by a structure of gray and white matter that resembles a net. This arrangement is called the formatio reticularis. It sends inhibitory signals to the nervous system during the process of falling asleep, causing the muscles to relax. Thus, twitches to fall asleep could possibly be related to the formatio reticularis.
Symptoms, complaints, and signs
As a rule, twitching to fall asleep is a harmless complaint that usually does not negatively affect or reduce the quality of life of the affected person. Only in rare and severe cases do the affected persons suffer from severe sleep disturbances due to the twitching to fall asleep and thus from psychological upsets or even depression and irritability. The affected persons twitch before falling asleep or even after falling asleep and wake up again due to these twitches. They can vary in severity and in some cases disturb sleep. In some cases, the twitches are so strong that they lead to an epileptic seizure, which causes severe pain in the muscles. Cramps can also occur. Furthermore, the regularity of these convulsions can usually not be determined, so that the convulsions to fall asleep occur spontaneously, but can then disappear on their own. The symptoms can be treated relatively well in most cases, so that there are no particular complications. The life expectancy of the affected person is also not reduced by the twitching to sleep. In many cases, stress can exacerbate the symptoms.
Diagnosis and course
Differential diagnoses must be ruled out as part of the diagnosis, since myoclonias can be an accompanying symptom of various diseases. Thus, fragmentary or propriospinal myoclonus, restless legs syndrome (RLS for short), muscle spasms, and epilepsy may also be considered in cases of twitching to sleep. Restless legs syndrome refers to a neurological disorder in which there is an increased urge to move and involuntary movements may occur. Twitches that fall asleep can be measured using electromyography or EMG for short.Here, either the electrical voltage in a muscle or the voltage in a muscle fiber is examined. Short, high voltage peaks then occur during sleep twitches. However, the twitches do not have to occur every night. They can appear suddenly after many years, accompany the daily falling asleep for a while and then disappear just as suddenly. However, they can also occur only irregularly.
Complications
Twitching to fall asleep is usually a common and, more importantly, harmless symptom that does not need to be treated by a doctor. The twitches to fall asleep occur in almost everyone and are not always clear to the affected person. Often they are only noticed by the partner. If the twitching to fall asleep is strong, it can disturb the partner and have a negative effect on the relationship. In some cases, the affected person wakes up by himself after the falling asleep twitches, in which case sleep problems and sleep deprivation may occur. In this case, stress, an aggressive basic attitude and other complaints occur in the course of sleep deprivation. Treatment is usually not carried out, so that there are no further complications. However, a doctor should be consulted if the twitching to fall asleep makes restful sleep impossible. This may be a psychological problem or the so-called restless leg syndrome. In most cases, treatment leads to a positive course of the disease without further complications. In most cases, however, no treatment takes place.
When should you go to the doctor?
Twitching to fall asleep is generally harmless and usually does not require a medical examination. However, if the twitches cause problems, this needs to be clarified. Anyone who, for example, can no longer fall asleep or sleep through the night in connection with the muscle contractions, or who develops anxiety, is best advised to speak to their family doctor. If the partner feels disturbed by the twitches, this should also be clarified. In most cases, twitching to fall asleep can be mitigated by self-help measures (e.g., yoga, exercise or calming teas) or gentle medication. Sometimes, however, psychological trauma underlies them. Anyone who has been through a bad experience or has had psychological problems in the past should take the twitches of falling asleep as an opportunity to talk to a psychologist. If the contractions were preceded by an accident, they may be caused by muscle or nerve problems. In order to rule out complications, a doctor should be consulted to clarify the cause and treat it if necessary. If complaints such as heart palpitations or shortness of breath are added, medical advice must always be sought with twitching to fall asleep.
Treatment and therapy
Even though the short, high voltage spikes in the muscles can be unpleasant, falling asleep twitches do not normally need to be treated. Any phenomena that occur are harmless. However, if sleep onset twitches permanently prevent restful sleep, a doctor should be consulted.
Outlook and prognosis
Twitches that fall asleep are said to be harmless in appearance, so no medical or drug treatment is usually required. This involves minor muscle twitches that occur during the falling asleep phase. If this appearance remains without any treatment, an aggravation is nevertheless not to be expected. Often, normal stress at work or in everyday life is responsible for a restless phase of falling asleep. Thus, the said twitching to fall asleep should disappear again without any treatment. However, if the stress in everyday life or at work increases, then the twitching to fall asleep can increase considerably. It becomes more and more difficult to fall asleep because the affected person is repeatedly awakened by the twitches. This can lead to increased sleep deprivation, making medical and drug treatment inevitable. In such a case, the cause of the twitching to fall asleep must be found out so that targeted treatment can be initiated. If the existing cause of the twitching to fall asleep is not found or treated, a prompt improvement is not to be expected. In more than 90 percent of cases, however, no treatment is necessary.
Prevention
Those who want to avoid twitching to fall asleep should avoid excessive consumption of caffeine, whether in coffee or other beverages. In addition to coffee, other stimulating substances should also be avoided. Nicotine is also associated with twitching to fall asleep. This applies not only to cigarettes, but also to nicotine-containing patches, for example. Since scientists have observed that people who are stressed tend to fall asleep more often, you should give your mind enough time to relax before falling asleep. It would be better to avoid stress. A stressed body also has a greater tendency to fall asleep twitching. Therefore, activities that put a lot of strain on the body should also be avoided.
Aftercare
In most cases, twitches to fall asleep do not require medical attention. They are considered harmless. Accordingly, no aftercare is necessary. The twitches do not interfere with life. They usually disappear on their own. Only in rare cases do the twitches make it difficult or impossible to sleep at night. In these cases, the signs are considered problematic. This leads to the fact that persons show themselves irritable and behaviorally conspicuous. The psyche and physique suffer. Successful treatment does not result in immunity. The symptoms can recur again and again. Aftercare consists in changing behavioral habits. The patient is responsible for this. As part of the initial treatment, he is informed by his attending physician about basic causes. For example, patients should avoid coffee and caffeinated beverages for several hours before going to bed. Nicotine can also cause twitching to fall asleep. Arduous physical exertion should not take place immediately before evening sleep. Relaxation exercises have been shown to be useful in preventing sleep onset twitching. Stress is considered to be the main cause of the complaints. It must be eliminated at all costs. If twitching to fall asleep occurs permanently, a medical consultation is urgently advisable. Only then can it be ruled out that there is no other underlying disease. The twitches can namely refer to epilepsy and RLS.
What you can do yourself
The often harmless twitching to fall asleep can be countered well with relaxation before going to bed. Those affected by hectic everyday stress can use relaxation techniques such as autogenic training, yoga or meditation to achieve inner calm, which makes it easier to fall asleep. Physical work also brings the body to full speed and does not let it find the desired recovery phase so quickly. Therefore, it is important to avoid major exertion and activities at this time of day. Patients who like to read before sleep should choose positive, relaxing reading and stay away from exciting titles. It is optimal to develop a set ritual for switching off in order to prepare body and soul. Keeping a daily journal can also be a useful tool for this. In addition to stress, caffeine can also promote the occurrence of the twitching to fall asleep. It is therefore advisable to refrain from consuming caffeinated beverages such as coffee, black tea or cola in the evening hours. Since nicotine can also have a negative effect on resting and falling asleep, smokers and patients using a nicotine patch should limit their use to a period before bedtime.