Catathrenia, widely known as nocturnal groaning, is an uncommon sleep-related breathing disorder that can significantly impact the sleep environment. This condition is defined by involuntary, often prolonged, groaning or moaning sounds produced during the exhalation phase of breathing. While the person groaning is unaware of the noise, the sound can be loud enough to cause considerable distress and sleep disruption for bed partners or household members. Understanding the medical processes and available treatment paths is the first step toward managing this disruptive nighttime issue.
Understanding the Medical Basis of Nocturnal Groaning
Catathrenia is distinct from common snoring, which occurs during inhalation when air causes tissues in the throat to vibrate. Nocturnal groaning happens during a prolonged exhalation, where the individual holds their breath and then slowly releases it with a characteristic, often monochromatic sound originating from the larynx, or voice box. Polysomnography, an overnight sleep study, is required to accurately diagnose the condition and differentiate it from other sleep disorders.
The groaning episodes most frequently occur during Rapid Eye Movement (REM) sleep, although they can happen in other sleep stages. The exact cause remains unknown, but current theories suggest it involves an abnormal respiratory control mechanism in the brain. It is categorized as a sleep-related breathing disorder, and some research points toward anatomical factors, such as smaller upper airways, contributing to the condition. Diagnosis relies on monitoring breathing patterns, brain activity, and audio recordings throughout the night.
Clinical Interventions for Stopping Catathrenia
The most common clinical intervention for catathrenia is Continuous Positive Airway Pressure (CPAP) therapy. A CPAP machine delivers a constant stream of pressurized air through a mask worn during sleep, stabilizing pressure within the upper airway. This consistent pressure prevents the airway from collapsing or narrowing, which is thought to cause the groaning sound during exhalation. CPAP is effective in reducing or eliminating groaning episodes, especially when catathrenia is associated with other sleep-disordered breathing.
Another therapeutic option involves custom-made oral appliances, such as Mandibular Advancement Devices (MADs). These devices are fitted by a dentist or sleep specialist and work by gently moving the lower jaw and tongue forward. Repositioning the jaw helps to enlarge the upper airway space, reducing the resistance that may trigger the abnormal breathing pattern. MADs can significantly decrease the groaning index, offering a non-CPAP option for symptom management.
Surgical procedures are generally not the first-line treatment for catathrenia, but they may be considered in rare instances where a clear anatomical obstruction is a contributing factor. Procedures such as tonsillectomy or adenoidectomy may be assessed if enlarged tissues are narrowing the airway and exacerbating the groaning. These interventions are typically reserved for patients who have not responded to less invasive treatments like CPAP or oral appliances.
Lifestyle Adjustments and Sleep Hygiene
While clinical treatments focus on airway mechanics, behavioral adjustments and optimizing the sleep environment can help mitigate the frequency of catathrenia episodes. Establishing a consistent sleep schedule helps regulate the body’s natural circadian rhythm, promoting stable sleep cycles and potentially reducing periods of sleep instability where groaning is likely to occur.
Positional therapy is another adjustment, as some individuals find their groaning is worse when they sleep on their back. Elevating the head or ensuring a side-sleeping position may reduce the gravitational effect on the airway tissues. Avoiding substances that disrupt sleep stages can also reduce episode frequency. Alcohol, caffeine, and heavy meals should be avoided in the hours leading up to bedtime, as they can fragment sleep and increase the likelihood of abnormal breathing events.