“My husband tells me that I have been making really strange, scary sounds during the night. It doesn’t sound like snoring, but more like a groan or moan that wakes him up and then keeps him up. He says it goes on for some time and then just stops. If he wakes me up, I have no memory of anything unusual. It’s not due to nightmares, and he says it really doesn’t sound like snoring. He hasn’t noticed breathing pauses, and I never wake up gasping for air. Is there something really wrong? Can something bad happen if this continues?”

   John Cline Ph.D.
    John Cline Ph.D. is a licensed psychologist, fellow of the American Academy of Sleep Medicine, and diplomate of the American Board of Sleep Medicine. He is on the professional staffs of the Sleep Disorders Centers of Connecticut; the Waterbury Hospital Regional Sleep Center; Behavioral Health Consultants, LLC; and Metta Consulting, LLC.

Editor:  Saad Shaheed

     Her husband reported that the first time he heard it, it was really scary, and for a moment, he considered the possibility that their new house was haunted, or that he was having a really bad dream. “I’m a rational kind of guy and usually don’t believe in spirits, but this was really strange.” No, the eerie sounds continued, and they were emanating from his wife. Because of their very busy schedules, they had not often slept together before getting married and moving into their new house, and they were really worried.

This is a common presentation for an uncommon sleep disorder known as catathrenia, or sleep-related groaning. Due to privacy and copyright considerations, I am not able to share with you a professional sleep laboratory recording of this unnerving sound—but it can be quite dramatic and unsettling. If you search for catathrenia on YouTube, you will find some clips that people have recorded themselves and shared. None that I could locate were as chilling as those I have heard recorded in the sleep lab. If you or a loved one has this disorder, it can be upsetting and anxiety provoking. It has been described as a “mournful moaning or groaning” sound. The condition is chronic, often starts between age 5 and 36, can occur nightly, often occurs in clusters of groans during the night, is generally considered benign with patients reporting no associated daytime symptoms, and mainly disturbs bed partners, potentially to the degree of damaging a relationship (Berry & Wagner, 2015). It typically starts in childhood and only comes to the attention of the person when he or she goes to college or to other settings, such as the military, where he or she has to sleep in a dormitory setting (Mahowald, 2011).

Catathrenia is a relatively rare disorder that, like snoring, usually causes more difficulty for other members of the household than the person who has it. The person with catathrenia is usually unaware of it, unless it is brought to their attention by concerned bed partners, or if a member of the household has recorded them making sounds during the night. The person with catathrenia is usually surprised to hear it. For bed partners and others in the house, it can be very unnerving to hear this really odd groaning sound coming at unpredictable times of the night.

Catathrenia has usually been considered a parasomnia, or an undesirable physical or behavioral phenomenon that happens primarily in sleep, such as sleep walking or frequent nightmares. In the most recent diagnostic classification of sleep disorders (American Academy of Sleep Medicine, 2014), catathrenia is listed as an “isolated symptom or normal variant” within the category of sleep-related breathing disorders, along with snoring. This is because it seems to be related to prolonged expiration, or breathing out, and most often, but not exclusively, occurs in REM sleep, as it has also been observed during NREM sleep. The person takes a deep breath followed by a long out-breath with a “monotonous vocalization resembling groaning” (American Academy of Sleep Medicine, 2014). This leads to complaints by bed partners, family members, or roommates. These complaints can, and should, lead to a sleep evaluation.

This kind of breath pattern has been referred to as bradypnea, or low respiratory rate. It is somewhat similar to a central apnea, in which the brain does not trigger a breath for a prolonged period of time, and there is no obstruction preventing the person from breathing as occurs in an obstructive apnea. A significant difference between central apnea and bradypnea is that typically no sound is produced during a central apnea.

Catathrenia is thought to be a rare disorder and is most often seen in men. It can occur several times a night and often happens in clusters of events. Any long-term consequences of the disorder are unknown, and it is primarily a social problem for the person in relation to those whose sleep is disturbed by it. To date, catathrenia has not been linked to other parasomnias or any psychiatric or psychological disorder. Some patients being treated for narcolepsy with the medication sodium oxybate have been reported to develop catathrenia after starting treatment, for unknown reasons (American Academy of Sleep Medicine, 2014).

No specific tests are indicated beyond clinical interview, although a full-night sleep study may be warranted to rule out other sleep disorders. A diagnosis of epilepsy must be ruled out, as similar sounds may be produced during nocturnal seizures. Clinically, epileptic seizure-related sounds would not occur as frequently as the groaning sounds in catathrenia. Snoring could produce similar sounds, but snoring mostly occurs during inhalation, rather than during exhalation as in catathrenia.

Continuous positive airway pressure therapy (CPAP) has been tried with some success in treating catathrenia (Guilleminault, Hagen, & Khaj, 2008). ENT surgery and oral appliances may also be considered (Guilleminault, Hagen, & Khaj, 2008). It is important to emphasize that at this time the only known problem caused by catathrenia is the social stress that may occur with those whose sleep is disturbed by it. In that case, ear plugs and a white noise sound machine may help diminish the impact of catathrenia’s creepy sounds.

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