Why do some people scream in their sleep?

FOR ten years, my husband, 61, has screamed in his sleep. It happens up to eight times most nights. Sometimes he gets agitated and occasionally hurts me by flailing around, but is unaware of any of it. We saw our GP some years ago, but he just laughed.

My family and I can’t go on with my husband like this, but I don’t think he appreciates the stress it puts us under. Can you help? Pauline Stallard, Macclesfield, Cheshire.

YouR distress is entirely understandable — so, too, is that of others who stay overnight in your house (you tell me in your longer letter that your daughter broke down in tears during one visit).

Your husband appears to be suffering from night terrors, a form of parasomnia, which is characterised by abnormal movements or behaviours during sleep.

Parasomnias are not uncommon, with around 4 per cent of adults experiencing them. They are divided into two types: simple behaviours (typically a repetitive or rhythmic movement, such as hypnagogic foot tremor, a rapid rocking of one foot) and complex behaviours, such as sleepwalking, sleep-related eating disorder and sleep terrors (when people scream out and are terrified during sleep, as in your husband’s case).

Apart from his symptoms, we have only two clues about your husband’s situation: the problems began when he was about 50 and he has no recollection or awareness of what happens in his sleep.

Parasomnia may be due to a neurological condition, such as epilepsy, or a sleep disorder. Your husband’s story suggests he might have REM sleep disorder. REM refers to the rapid eye movement phase of sleep — when you dream.

UsuAllY in this state there is a ‘biological switch’ that disconnects the brain from the body so we don’t act out our dreams. But in people with this disorder, it’s thought the switch malfunctions — though we don’t know if they are acting out dreams, as they are unaware of what’s happened.

But they can perform complex, sometimes violent, movements, such as leaping out of bed or punching. There may also be vocalisations, such as screaming.

This condition is typically seen in older men, but it’s not clear why.

It’s important your husband’s symptoms are evaluated by an expert, which means persuading him to consult your new GP and asking to be referred to a sleep clinic. Ten years ago when your husband’s symptoms started, sleep clinics were few and far between, but there are more these days and your GP will be able to find the nearest to you.

A neurological examination that checks everything from reflexes to co-ordination, overnight video recording and even neuroimaging (such as MRI scans) may be needed for the specialists to reach the correct diagnosis. MY MOTHER has just had two operations to remove five large gallstones blocking her small bowel. The surgeons didn’t remove the whole gallbladder because there were ‘adhesions’, making surgery too risky.

You have previously been firm in your opinion that if gallstones are removed, the whole gallbladder should be taken out as well.

Are there any exceptions? How can she stop the gallstones coming back?

Philip Lishman, Llanelli, Dyfed. I AM still of the view that ideally the gallbladder should be removed once gallstones causing symptoms are detected, but the situation the specialist faced in your mother’s case was unusual, as I shall explain.

First, a quick biology lesson on gallstones for those who need it.

Gallstones are small balls of cholesterol, bile pigment or a combination of both. They develop when the gallbladder, the organ that releases bile into the intestine to digest food, becomes diseased or no longer works properly.

If it is not removed, more stones will inevitably form in the future.

Gallstones often cause no symptoms and smaller stones may pass without a problem via the bile duct (though some may become stuck there, causing pain).

sometimes, as in your mother’s case, a stone is too large (for example, more than 2.5 cm in diameter) to exit this way. This can lead to the gallbladder becoming infected and, in some circumstances, widespread inflammation.

The stone can erode through the gallbladder wall, passing directly into the small bowel, blocking it and causing symptoms such as severe abdominal pain, vomiting and bloating.

I imagine your mother’s first operation was an emergency procedure after a scan confirmed there was an obstruction in the bowel. Because of the urgency, it was not possible to remove the obstructing stone and then go on to remove the gallbladder containing yet more stones.

The whole area will have become inflamed and matted into a mass of adhesions, where scar tissue effectively glues the organs together into one solid lump (which is what allowed the gallstone to pass from the gallbladder into the small intestine).

so getting it all apart to reach the gallbladder would be, if not impossible, fraught with the danger of making holes in the small intestine and causing damage.

unfortunately, the remaining stones moved into the bowel and, as you explain in your longer letter, caused a further obstruction only one month later, which had to be surgically removed.

OncE every bit of infection and inflammation has cleared, it might be possible slowly to separate the adhesions and then remove the diseased gallbladder to prevent more stones forming in the future.

But this is likely to be done as an open operation rather than the standard keyhole procedure.

If your mother was older — 82 or 92 rather than just 72 — I suspect her specialist would adopt a watchand-see policy, preferring to leave the gallbladder well alone rather than operating again to remove it, trusting that further stones wouldn’t have time to re-form.

However, your mother could still develop more stones in the next ten or 20 years. This means that in the next year or so, once all the inflammation has quietened, her specialist will need to weigh up the risks and benefits of surgery against keeping her under observation (with a yearly scan to check if stones have formed).

In the meantime, there are no clear guidelines about how to stop stones forming, though some believe a virtually fat-free diet might be helpful.