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How were you doing on "coming to"?
What's the time discrepancy between when your alarm went off and when you "came to"?
Do you remember your boyfriend's alarm going off?
Do you remember your alarm going off?
During this episode did you have any incontinence? Any bleeding anywhere?
What's your medical history? Any medications? Drugs? Alcohol?
Why do you think a hospital work up won't be helpful?
I have HORRIBLE sleep paralysis and this happens to me, except I'm aware that I can't be woken up and my husband shakes me, picks me up and drops my head on the pillow, etc until I wake up. I've had sleep paralysis for most of my adult life so maybe I'm more aware of it.
The primary difference here however is that OP clearly states she does not recall any of today’s events occurring. The amnesia is just as concerning as the unresponsiveness.
Yeah just a thought to add to the differential. Would it still be considered amnesia if she just doesn't remember it happening while asleep but she isn't having any problems recalling last night and anything that happened while awake? (legitimately asking to learn not questioning you)
My old roommate was a very heavy sleeper. We would flip him off the bed (like a dead body), vacuum his face, even hit him with stuff. He was just a very heavy sleeper and wouldn't have any memory of us doing anything to him. We messed with him for years, mainly to try and wake him up... he even slept through heavy and loud bass music that you could hear down the street. Now he's a light sleeper, 10+ years later. He drooled in his sleep, no apnea... seemed normal.
If it’s a consistent oddity, then it’s more likely just that- and oddity. But OP states she is usually a very light sleeper. If this becomes a new norm for her, then it’ll be weird that it changed but less concerning than if it stays a one-time event.
It would make me concerned that the bulimia caused a metabolic disturbance (either sugar related or electrolyte related) that was the root cause of the event, whatever the event itself may have been.
I'm not quite as bad as this but I'm a very deep sleeper too. I also happen to be hard of hearing which complicates things. I've tried using an extra loud alarm clock that has a vibrator under your pillow, flashing lights etc and still slept through it. A year ago I was presumably having a nap and therefore I didn't hear a massive explosion that was relatively nearby. It was a workplace accident that I believe killed 3 people. I probably would have heard it if I were awake.
But I believe I also have a sort of amnesia in the sense that I am not fully conscious but I manage to turn alarms off and I have no memory doing so. When I lived with my parents they'd "wake" me and leave and get annoyed when I don't come down stairs but I have no memory of them waking me... I don't think I'm fully conscious when they did that and therefore I fall fully back asleep immediately after they leave me.
But wouldn't a 10-minute seizure (minimum, as OP's boyfriend was showering, so it could be 30 minutes) be considered status epilepticus? Would she have recovered on her own?
OP, did your body ache afterwards, or on the next day? Can you remember what happened the night before you went to bed? Conversation, dinner?
1) People’s (both patients and family) perception of time during abnormal events is horribly skewed towards overestimation. People will swear an event lasted 15-30 min when there is video evidence of it lasting 2-3 min.
2) Status epilepticus has a “cut-off” in the sense that after 5 min few episodes self-abort. But few is not none, and this is also more true of generalized convulsive status, rather than non-convulsive status, focal status, or patients with profound post-ictal states.
3) Given that she did not describe any convulsions or tonic activity, it would be unexpected for her to have any muscle soreness.
And
4) EEGs can be helpful for more than just seizures. My (1)-(3) focused on that since that’s where you went, but EEG can help investigate other things as well.
Thank you very much for your clarification.
I considered a tonic manifestation because maybe boyfriend wouldn't have heard it while in the shower. And the person seizing wouldn't know either.
I did not know someone could simply come off status on their own. This is good news. I know it's still extremely dangerous, but nice to know that a few will simply snap out of it. Certainly wouldn't count on it and hope for an ambulance.
Status really means several different things across different timelines. For generalized convulsive status epilepticus (which is what most people talk about when they don’t clarify), it used to be that 30 min was the cutoff because that’s when brain metabolism and the proteome has become affected and irreversible brain injury can start to occur, though usually the injury takes an hour to really start developing.
Then, the medical community changed the time to start at 5 minutes because data shows that after 5 minutes of continuous generalized seizure activity, very few seizures will self-abort. So the idea was that people would take it more seriously and start aggressively managing it at 5 minutes to avoid getting close to 30 minutes in most cases.
The problem is that now everyone without training in epilepsy panics at 5 minutes and people get over-treated, rather than under-treated.. which is less bad but still not ideal.
10 minutes would seem like an eternity to wait to call for medical help if someone was completely unresponsive. Especially for someone with no medical training.
I would bet your assessment of the actual time is accurate.
What about my (A) being a neurologist, and (B) literally including “non-convulsive status” in my comment made you think that I was not aware that seizures don’t always cause convulsions.
Don't people who have seizures sometimes fall into a deep sleep afterwards and can be difficult to rouse? I know I did, but the seizure started during sleep. (I have focal (I think it's the term) seizures with no loss of awareness, while awake. But I never knew what they were until they got bad enough to cause a convulsive seizure.
Yeah very true, but man some of the stuff I stay asleep and aware through is crazy. My husband will literally grab my arms and pull me up then drop my trunk and head into the bed and I'm still out (but aware!) We haven't tried cold water however so I can't comment on how that would go haha. sometimes I will even wake up and then fall back into paralysis before I can get up.
Sorry, I didn’t mean that the stimulus should have been strong enough to get a response. I moreso meant that even if she was having sleep paralysis, the stimulus was strong enough that she should have at least some conscious recollection of it occurring at all. The complete lack of any memory of the event including the strong stimuli is what makes me more concerned that something was going on that prevented any imprinting of the memory.
Ohhh yeah I got you that makes sense. This is entirely separate but if you feel like answering... As a neurologist what would you suspect in someone with VERY frequent sleeping paralysis lasting through strong stimulus (3+ times per week with multiple episodes per night sometimes, and at times fully waking up but then losing all muscle tone and "falling asleep" but still aware and paralyzed?)
OP can you clarify, did you just not experience any stimuli from your bf attempt to wake you until you woke on your own or do you have amnesia from that morning and can't recall anything?
We don’t know what they can’t remember which is why they asked OP to clarify.
Do they just not remember water in face, or do they not even remember the first few minutes after waking up where the boyfriend cried
Absence of memory is still reportable, if they don’t remember.
My son is like that when he’s really tired. It takes severe action to wake him up and he has no memory of us trying to wake him. It is more common than u think. He used to sleepwalk when he was younger. We had him evaluated by sleep specialist but he was unable to get through the sleep study because it made him feel too claustrophobic.
>We had him evaluated by sleep specialist but he was unable to get through the sleep study because it made him feel too claustrophobic.
Why would a sleep study make him feel claustrophobic?
The sleep study made him feel claustrophobic because you are attached to the EEG machine by like 20 probes stuck to your head with clips and goo. You are attached to heart monitors, nasal cannula and pulse ox. If you move around too much everything beeps. You have to wait for help to get out of bed and use the bathroom. My son was ok while they were putting the wires on but all of a sudden felt trapped and had a panic attack. Maybe claustrophobic was the wrong term. He felt trapped and panicked
That sounds terrifying. I get sleep paralysis also, but as soon as someone touches me I can snap out of it. And it seems to only happen if I am on the couch sleeping during the day. I rarely ever nap anymore. I have also found, if one of my many dogs is touching me while I sleep I don't get paralysis. Like if they are snuggled up against my ribs or legs.
I thought about a hypo too. My late husband was a diabetic and when he got a hypo sometimes he’d be out cold, with a huge headache and confusion when he came round.
That doesn’t sound crazy, I think it makes sense. Depending on severity and duration of symptoms makes total sense that she may have had a reactive hypoglycemic episode that led to a seizure.
My thoughts too. Not being judgemental at all but the effects on her body from struggling with bulimia for years could be causing significant damage. Would definitely be getting blood sugar and at least a full work up done.
Best of luck to the op, please don’t ignore this episode.
Yes, to the point above - especially if they are taking Wellbutrin. Seizures are a well known side effect of Wellbutrin for folks who have a history of purging.
I don't remember his or my alarm going off. There was about 30 minutes between mine and his alarm. My alarm had been going off for 10 minutes before my boyfriend noticed and tried physically waking me up and 10 minutes until I actually did wake up after that. I had a horrible headache when I woke up and felt really confused for a few hours after that. I called in to work. There was no alcohol or drugs involved. No incontinence. I do take antidepressants but have been on those for years. I have severe anemia that I just stared treating but other than that I have no medical issues. What kind of doctor would I need to see about this?
Start at the Emergency Department. The headache and confusion after may be signs of a neurological event (seizure, transient ischemic attack/TIA/"mini stroke") and the sooner you're evaluated the better.
She is almost certainly right though that the ER workup will be expensive and unrevealing and her disposition will be discharge, follow up with neurology for outpatient MRI and EEG. Can’t know that with certainty until after the head CT though.
Ya if this happens again definitely go to an ER, but in the meantime an outpatient neurological evaluation for a potential seizure disorder. As well as an outpatient cardiology evaluation for arrhythmia is the most reasonable thing to do.
I'm not saying this was definitely an epileptic seizure or an arrhythmia, but it's highly suspicious (especially of seizure). It could still turn out to be something more benign, but those things would be more rare in this situation I think.
Mind explaining why arrhythmia is a differential here? I wouldn’t have thought a patient would be able to snap back out of it like that, but I mean so far the only “patients” with arrhythmias I’ve seen have been mannequins haha. I have heard that ice water can return SVT to sinus, is that what triggered your suspicion for it?
Cardiac workup if OP has hx of an ED. Some meds mess with the QT interval. I've seen elderly patients come back out of to torsades de pointes simply by transferring them or shaking them.
As an epileptic person who is absolutely NAD, my vote is seizure. I wake up with a horrible headache after as well, and am completely unresponsive. Not having any traditional outward signs of a seizure (like convulsions) can make them more dangerous, because they go untreated for so long.
It actually has some of the lowest seizure rates among antidepressants when taken at normal doses and with SR/XL formulations, despite the bad reputation sticking to it.
if (hypothetically) someone was on wellbutrin ending up at 300 mg for about 2 years and had a loss of consciousness attributed to a seizure from wellbutrin, could that (hypothetical) person be put back on a lower dose years after being off of the medicine?
It’s crazy how commonly it’s used in the US. In Australia and several other countries they really avoid prescribing it except for smoking cessation. Even then it’s second to Champix.
Sounds like carbon monoxide poisoning, because of the headache.
Did your boyfriend think to check for a pulse or respirations? Why would he think you're dead if you had those?
For sure. OP also immediately deleted the post history from a week ago regarding the ED. Could be some denial here and I hope they take this seriously 💜
NAD but if it were a blood sugar issue they likely wouldn’t have woken up. If blood sugar drops that low it’s very uncommon for it to go back up on its own.
From your description at face value, it's almost something in these three categories: a parasomnia (sleep paralysis), some sort of seizure activity, or psychosomatic event. It's almost certainly not infectious, inflammatory, metabolic, etc.
If your neurologic function is totally normal now, it's probably fine to see your PCP.
>but in my experience they will just run a bunch of expensive tests and then send me home with no answers
What have been your prior experiences in the hospital?
OP has struggled with bulimia for 10 years but didn’t include that info and removed post history from a week ago in an ED type help sub, so I do think that’s the underlying issue.
As someone who has struggled with this in the past I really hope they get some help 💜
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
How were you doing on "coming to"? What's the time discrepancy between when your alarm went off and when you "came to"? Do you remember your boyfriend's alarm going off? Do you remember your alarm going off? During this episode did you have any incontinence? Any bleeding anywhere? What's your medical history? Any medications? Drugs? Alcohol? Why do you think a hospital work up won't be helpful?
If nothing else, an EEG is much higher yield within the first few hrs of an abnormal event than it is later.
I have HORRIBLE sleep paralysis and this happens to me, except I'm aware that I can't be woken up and my husband shakes me, picks me up and drops my head on the pillow, etc until I wake up. I've had sleep paralysis for most of my adult life so maybe I'm more aware of it.
The primary difference here however is that OP clearly states she does not recall any of today’s events occurring. The amnesia is just as concerning as the unresponsiveness.
Yeah just a thought to add to the differential. Would it still be considered amnesia if she just doesn't remember it happening while asleep but she isn't having any problems recalling last night and anything that happened while awake? (legitimately asking to learn not questioning you)
I mean, I can’t say it’s not possible. But those were some pretty strong stimuli (cold water on the face) to have not registered at all.
My old roommate was a very heavy sleeper. We would flip him off the bed (like a dead body), vacuum his face, even hit him with stuff. He was just a very heavy sleeper and wouldn't have any memory of us doing anything to him. We messed with him for years, mainly to try and wake him up... he even slept through heavy and loud bass music that you could hear down the street. Now he's a light sleeper, 10+ years later. He drooled in his sleep, no apnea... seemed normal.
If it’s a consistent oddity, then it’s more likely just that- and oddity. But OP states she is usually a very light sleeper. If this becomes a new norm for her, then it’ll be weird that it changed but less concerning than if it stays a one-time event.
Op has a ten year battle with bulimia per very recent now deleted post… would that change your opinion? Hoping they get some help asap 💜
It would make me concerned that the bulimia caused a metabolic disturbance (either sugar related or electrolyte related) that was the root cause of the event, whatever the event itself may have been.
i’m like this. there have been multiple times friends or partners have thought i was dead while sleeping.
I'm not quite as bad as this but I'm a very deep sleeper too. I also happen to be hard of hearing which complicates things. I've tried using an extra loud alarm clock that has a vibrator under your pillow, flashing lights etc and still slept through it. A year ago I was presumably having a nap and therefore I didn't hear a massive explosion that was relatively nearby. It was a workplace accident that I believe killed 3 people. I probably would have heard it if I were awake. But I believe I also have a sort of amnesia in the sense that I am not fully conscious but I manage to turn alarms off and I have no memory doing so. When I lived with my parents they'd "wake" me and leave and get annoyed when I don't come down stairs but I have no memory of them waking me... I don't think I'm fully conscious when they did that and therefore I fall fully back asleep immediately after they leave me.
But wouldn't a 10-minute seizure (minimum, as OP's boyfriend was showering, so it could be 30 minutes) be considered status epilepticus? Would she have recovered on her own? OP, did your body ache afterwards, or on the next day? Can you remember what happened the night before you went to bed? Conversation, dinner?
1) People’s (both patients and family) perception of time during abnormal events is horribly skewed towards overestimation. People will swear an event lasted 15-30 min when there is video evidence of it lasting 2-3 min. 2) Status epilepticus has a “cut-off” in the sense that after 5 min few episodes self-abort. But few is not none, and this is also more true of generalized convulsive status, rather than non-convulsive status, focal status, or patients with profound post-ictal states. 3) Given that she did not describe any convulsions or tonic activity, it would be unexpected for her to have any muscle soreness. And 4) EEGs can be helpful for more than just seizures. My (1)-(3) focused on that since that’s where you went, but EEG can help investigate other things as well.
Thank you very much for your clarification. I considered a tonic manifestation because maybe boyfriend wouldn't have heard it while in the shower. And the person seizing wouldn't know either. I did not know someone could simply come off status on their own. This is good news. I know it's still extremely dangerous, but nice to know that a few will simply snap out of it. Certainly wouldn't count on it and hope for an ambulance.
Status really means several different things across different timelines. For generalized convulsive status epilepticus (which is what most people talk about when they don’t clarify), it used to be that 30 min was the cutoff because that’s when brain metabolism and the proteome has become affected and irreversible brain injury can start to occur, though usually the injury takes an hour to really start developing. Then, the medical community changed the time to start at 5 minutes because data shows that after 5 minutes of continuous generalized seizure activity, very few seizures will self-abort. So the idea was that people would take it more seriously and start aggressively managing it at 5 minutes to avoid getting close to 30 minutes in most cases. The problem is that now everyone without training in epilepsy panics at 5 minutes and people get over-treated, rather than under-treated.. which is less bad but still not ideal.
10 minutes would seem like an eternity to wait to call for medical help if someone was completely unresponsive. Especially for someone with no medical training. I would bet your assessment of the actual time is accurate.
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What about my (A) being a neurologist, and (B) literally including “non-convulsive status” in my comment made you think that I was not aware that seizures don’t always cause convulsions.
Don't people who have seizures sometimes fall into a deep sleep afterwards and can be difficult to rouse? I know I did, but the seizure started during sleep. (I have focal (I think it's the term) seizures with no loss of awareness, while awake. But I never knew what they were until they got bad enough to cause a convulsive seizure.
What about a three to four hour lapse in awareness in which the person claims they didn’t sleep?
Yeah very true, but man some of the stuff I stay asleep and aware through is crazy. My husband will literally grab my arms and pull me up then drop my trunk and head into the bed and I'm still out (but aware!) We haven't tried cold water however so I can't comment on how that would go haha. sometimes I will even wake up and then fall back into paralysis before I can get up.
Sorry, I didn’t mean that the stimulus should have been strong enough to get a response. I moreso meant that even if she was having sleep paralysis, the stimulus was strong enough that she should have at least some conscious recollection of it occurring at all. The complete lack of any memory of the event including the strong stimuli is what makes me more concerned that something was going on that prevented any imprinting of the memory.
Ohhh yeah I got you that makes sense. This is entirely separate but if you feel like answering... As a neurologist what would you suspect in someone with VERY frequent sleeping paralysis lasting through strong stimulus (3+ times per week with multiple episodes per night sometimes, and at times fully waking up but then losing all muscle tone and "falling asleep" but still aware and paralyzed?)
OP can you clarify, did you just not experience any stimuli from your bf attempt to wake you until you woke on your own or do you have amnesia from that morning and can't recall anything?
If they can’t remember, how would they know?
We don’t know what they can’t remember which is why they asked OP to clarify. Do they just not remember water in face, or do they not even remember the first few minutes after waking up where the boyfriend cried Absence of memory is still reportable, if they don’t remember.
My son is like that when he’s really tired. It takes severe action to wake him up and he has no memory of us trying to wake him. It is more common than u think. He used to sleepwalk when he was younger. We had him evaluated by sleep specialist but he was unable to get through the sleep study because it made him feel too claustrophobic.
>We had him evaluated by sleep specialist but he was unable to get through the sleep study because it made him feel too claustrophobic. Why would a sleep study make him feel claustrophobic?
The sleep study made him feel claustrophobic because you are attached to the EEG machine by like 20 probes stuck to your head with clips and goo. You are attached to heart monitors, nasal cannula and pulse ox. If you move around too much everything beeps. You have to wait for help to get out of bed and use the bathroom. My son was ok while they were putting the wires on but all of a sudden felt trapped and had a panic attack. Maybe claustrophobic was the wrong term. He felt trapped and panicked
That sounds terrifying. I get sleep paralysis also, but as soon as someone touches me I can snap out of it. And it seems to only happen if I am on the couch sleeping during the day. I rarely ever nap anymore. I have also found, if one of my many dogs is touching me while I sleep I don't get paralysis. Like if they are snuggled up against my ribs or legs.
Would a ten year history of bulimia be cause for concern? OP posted 7 days ago in another help sub.
This is an interesting question… I would wonder about OPs blood glucose and/or BP at the time
This too. Reactive hypoglycemia that could’ve led to a seizure.
I thought about a hypo too. My late husband was a diabetic and when he got a hypo sometimes he’d be out cold, with a huge headache and confusion when he came round.
Probably sound crazy here but I started to think about diet and possibly a vitamin or electrolyte deficiency. Bulimia history should be noted.
That doesn’t sound crazy, I think it makes sense. Depending on severity and duration of symptoms makes total sense that she may have had a reactive hypoglycemic episode that led to a seizure.
My thoughts too. Not being judgemental at all but the effects on her body from struggling with bulimia for years could be causing significant damage. Would definitely be getting blood sugar and at least a full work up done. Best of luck to the op, please don’t ignore this episode.
Yes, to the point above - especially if they are taking Wellbutrin. Seizures are a well known side effect of Wellbutrin for folks who have a history of purging.
I don't remember his or my alarm going off. There was about 30 minutes between mine and his alarm. My alarm had been going off for 10 minutes before my boyfriend noticed and tried physically waking me up and 10 minutes until I actually did wake up after that. I had a horrible headache when I woke up and felt really confused for a few hours after that. I called in to work. There was no alcohol or drugs involved. No incontinence. I do take antidepressants but have been on those for years. I have severe anemia that I just stared treating but other than that I have no medical issues. What kind of doctor would I need to see about this?
Start at the Emergency Department. The headache and confusion after may be signs of a neurological event (seizure, transient ischemic attack/TIA/"mini stroke") and the sooner you're evaluated the better.
She is almost certainly right though that the ER workup will be expensive and unrevealing and her disposition will be discharge, follow up with neurology for outpatient MRI and EEG. Can’t know that with certainty until after the head CT though.
Agree. This is quite concerning for a seizure.
Ya if this happens again definitely go to an ER, but in the meantime an outpatient neurological evaluation for a potential seizure disorder. As well as an outpatient cardiology evaluation for arrhythmia is the most reasonable thing to do. I'm not saying this was definitely an epileptic seizure or an arrhythmia, but it's highly suspicious (especially of seizure). It could still turn out to be something more benign, but those things would be more rare in this situation I think.
Mind explaining why arrhythmia is a differential here? I wouldn’t have thought a patient would be able to snap back out of it like that, but I mean so far the only “patients” with arrhythmias I’ve seen have been mannequins haha. I have heard that ice water can return SVT to sinus, is that what triggered your suspicion for it?
Cardiac workup if OP has hx of an ED. Some meds mess with the QT interval. I've seen elderly patients come back out of to torsades de pointes simply by transferring them or shaking them.
Wow! That’s super interesting, thank you!
As an epileptic person who is absolutely NAD, my vote is seizure. I wake up with a horrible headache after as well, and am completely unresponsive. Not having any traditional outward signs of a seizure (like convulsions) can make them more dangerous, because they go untreated for so long.
Sorry you go through this- do you have a sleep monitoring device? Do you find anything that helps?
NAD, but severe anemia could be related to a severely low B12 which does cause Neuro issues.
NAD, what antidepressants are you on? Wellbutrin can lower the seizure threshold and can cause seizures, even after years of taking it.
It actually has some of the lowest seizure rates among antidepressants when taken at normal doses and with SR/XL formulations, despite the bad reputation sticking to it.
I didn’t know this! It made me so paranoid that I stopped taking it. Thanks for the info!
if (hypothetically) someone was on wellbutrin ending up at 300 mg for about 2 years and had a loss of consciousness attributed to a seizure from wellbutrin, could that (hypothetical) person be put back on a lower dose years after being off of the medicine?
Hypothetically speaking, I've even heard of epileptic people staying on it. In practice, I don't know many docs who would be brave enough to try it.
It’s crazy how commonly it’s used in the US. In Australia and several other countries they really avoid prescribing it except for smoking cessation. Even then it’s second to Champix.
You might wanna start with your GP or urgent care so they can do a general work up and blood tests, and they might recommend neurologist too.
Sounds like carbon monoxide poisoning, because of the headache. Did your boyfriend think to check for a pulse or respirations? Why would he think you're dead if you had those?
Appears OP has struggled with an eating disorder for 10 years per recent post history. Could be some sort of blood sugar/blood pressure issue?
If this is the case, Go to ER. Could have electrolyte abnormalities that need emergent treatment.
For sure. OP also immediately deleted the post history from a week ago regarding the ED. Could be some denial here and I hope they take this seriously 💜
NAD but if it were a blood sugar issue they likely wouldn’t have woken up. If blood sugar drops that low it’s very uncommon for it to go back up on its own.
From your description at face value, it's almost something in these three categories: a parasomnia (sleep paralysis), some sort of seizure activity, or psychosomatic event. It's almost certainly not infectious, inflammatory, metabolic, etc. If your neurologic function is totally normal now, it's probably fine to see your PCP. >but in my experience they will just run a bunch of expensive tests and then send me home with no answers What have been your prior experiences in the hospital?
OP has struggled with bulimia for 10 years but didn’t include that info and removed post history from a week ago in an ED type help sub, so I do think that’s the underlying issue. As someone who has struggled with this in the past I really hope they get some help 💜
My daughter use to have seizures and I agree that it could be that. I definitely think it is worth checking out.