Catathrenia is a parasomnia – abnormal behavior of the nervous system during sleep – and characterized by groaning on exhalation during sleep. The person will usually take a very deep inhalation, hold their breath for a moment, and then release with a long, sustained, usually high-pitched groan.
It is believed that catathrenia occurs most often during the rapid eye movement (REM) stage of sleep; however, there are studies that have found it to be present during all stages of sleep. It is not the same as sleep apnea or regular snoring, as the person often wakes up feeling fully rested, even though their bed partner will probably not say the same.
Catathrenia is a condition that is more bothersome to a spouse or bed partner than it is to the individual; however, there are some cases where the person will awaken with expiration due to oxygen desaturation; therefore, many studies have suggested this condition may be a feature of sleep-disordered breathing.
What the Research Shows
With its inclusion as a parasomnia into the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2) about a decade ago, catathrenia has made its way into the sleep medicine nomenclature, but with much debate about its causes, treatments, and background.
One study, done in 2008, which was published in the journal, SLEEP, was performed to try to determine if catathrenia was a symptom of sleep-disordered breathing or a condition all on its own. Researchers also wanted to determine if previous literature was correct in reporting that CPAP (continuous positive airway pressure) was a viable treatment option for someone with catathrenia.
CPAP is the primary form of treatment for someone with sleep apnea or sleep-disordered breathing.
In this particular study, which was performed at the Stanford Sleep Disorders Clinic, seven women between the ages of 20 and 34 years with an average BMI of less than 25 were studied over a period of five years. Each of the women (or their partners) had reported ongoing, long-term sleep groaning.
All participants in the study underwent clinical evaluation, sleep questionnaires, physical examination, an overnight sleep study, a log provided by their sleep partner for 10 days noting when and how long the groaning occurred, and craniofacial evaluation (looking for septal deviation, structure deformity, turbinate enlargement, etc., which can all affect breathing).
CPAP was administered to all seven women, but if they could not tolerate the CPAP machine, which is noisy and can be uncomfortable, then they were offered the option of undergoing a special soft tissue/upper airway surgery.
Groaning was present in all stages of sleep, which was relieved in all participants who used CPAP.
Five of the women elected to undergo surgery, only three of which followed up after the procedure and were given additional oral appliance treatment. All three women experienced ultimate resolution of catathrenia more than three years later.
Causes and Background of Catathrenia
It is still unclear what causes the nighttime groaning or who is more likely to suffer the condition. Some studies found that there was a similarity in cases concerning the size of their jaw (all patients have a small jaw). Furthermore, about 14% of patients reported a positive family history of catathrenia.
In this study at Stanford, it was noted that 43% of participants had a past history of some sort of parasomnia (such as sleep talking) in childhood, 86% had orthodontic procedures, and 71% had tooth extractions in adolescence.
Tips for Living with Catathrenia
Since catathrenia is not a particularly dangerous condition and is not associated with the development of more concerning health problems, there has been very little research in the way of determining origin and treatment options. It is notable that the studies mentioned in this article are very small scale, with a group of people who were otherwise healthy. Further research will be needed to determine best courses of treatment.
On the other hand, Dr. Roxanne Valentino of St. Thomas Center for Sleep recommends some ways to help bed partners deal with catathrenia. These include:
© 2020 American Sleep Association.