Nocturnal vocalizations, such as moaning, groaning, or shouting, are a common concern for caregivers of older adults. These sounds range from soft, repetitive noises to loud, distressed cries. Understanding the source requires differentiating between benign sleep phenomena and serious underlying medical conditions. Age-related changes in sleep architecture, health conditions, and medications all contribute to these vocalizations.
Defining Sleep Moaning and Catathrenia
The term for repetitive, monotonous moaning or groaning during sleep is Catathrenia, classified as a rare sleep-related breathing disorder. This phenomenon is distinct from snoring because the sound is generated during a prolonged exhalation rather than an inhalation. The person takes a deep breath, holds it against a closed glottis, and then releases the air slowly, generating a low-pitched groan.
Catathrenia is often described as a monotone noise, sometimes reaching 75 decibels. Unlike sleep talking, it is a simple, drawn-out vocalization the sleeper is usually unaware of making. While generally harmless to the sleeper, it can be disruptive to a bed partner’s sleep.
Primary Sleep Disorders Leading to Vocalization
Obstructive Sleep Apnea (OSA) is a common cause of distressed nocturnal sounds in the elderly. In OSA, throat muscles relax and block the airway. The vocalizations are gasping, snorting, or choking sounds as the individual struggles to breathe or the brain briefly wakes them to restore airflow. OSA is more prevalent in adults over 65 because upper airway muscle tone naturally decreases with age, making the airway prone to collapse. These loud noises disrupt the sleep cycle and lead to excessive daytime fatigue.
Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is another significant source of vocalization. RBD is a parasomnia where the normal muscle paralysis during dreaming is absent. The person physically acts out vivid dreams, often involving shouting, yelling, talking, or crying that aligns with the dream narrative. This behavior can involve purposeful movements like punching or grabbing, sometimes resulting in injury to themselves or a bed partner.
RBD is common in older adults and is strongly associated with the later development of neurodegenerative conditions, such as Parkinson’s disease and Lewy Body Dementia. Non-REM parasomnias, like night terrors or confusional arousals, are less common but can also cause moaning or shouting. These episodes occur during the deepest stages of sleep and are characterized by agitation and confusion upon waking.
Medications and Neurological Factors in the Elderly
Medications and medical management frequently contribute to nighttime vocalizations. Older adults often manage multiple chronic conditions, known as polypharmacy, which can introduce drug interactions that disrupt sleep. Certain medications, including common antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs), can alter sleep architecture and increase the risk of developing RBD. Benzodiazepines, often prescribed for anxiety or sleep, can lead to confusion and disorientation upon waking, sometimes resulting in agitated vocalizations.
Neurodegenerative diseases profoundly impact the sleep-wake cycle and can cause agitated moaning or groaning. Patients with dementia, particularly Alzheimer’s Disease, may experience “sundowning,” a marked increase in confusion and agitation that begins in the late afternoon and continues into the night. This heightened confusion manifests as restlessness, pacing, and distressed vocalizations like moaning or screaming. This is thought to be caused by the deterioration of the brain’s internal clock, which disrupts the natural sleep rhythm.
Chronic physical discomfort is a straightforward cause for subtle nocturnal groaning. Joint pain, arthritis, or back pain can become more noticeable when the body is at rest or as daytime pain medication wears off. The individual may moan softly as they shift positions or briefly enter a lighter stage of sleep. This vocalization is a reaction to momentary physical discomfort. Treating the underlying pain is the most effective way to eliminate these reflexive sounds.
Indicators for Medical Evaluation
Professional evaluation is warranted when nocturnal vocalizations are witnessed, especially if they are new or have worsened suddenly. A medical assessment is needed if the moaning is accompanied by signs of respiratory distress, such as choking, gasping, or visible pauses in breathing, which indicate Obstructive Sleep Apnea. Vocalization that includes shouting, aggressive talking, or violent movements suggests REM Sleep Behavior Disorder. Consulting a physician is also advised if the moaning leads to persistent daytime sleepiness, unrefreshing sleep, or a decline in cognitive function, as these symptoms indicate a lack of restorative sleep.