Uncontrollable Body Shaking and Sleep Disturbances: A Neurological Concern

Q: Uncontrollable Body Shaking and Sleep Disturbances: A Neurological Concern

Hello, Ruo Xue： Based on the above information, the results of the thyroid function and carotid artery examinations are normal. <br>Autonomic nervous system dysfunction is the most likely diagnosis. <br>It is recommended to cooperate with the physician for medication treatment an

Involuntary body shaking and inability to sleep?

Hello Doctor, I apologize for the lengthy question.
After being diagnosed with chronic gastritis in May, my doctor prescribed me Sucralfate for a month.
However, three days after stopping the medication, I began to hear my heartbeat when I was still or lying down (feeling of palpitations?), which caused me to wake up suddenly.
I later visited a psychiatrist, who confirmed that there was no autonomic nervous system disorder and prescribed me 0.5 mg of Clonazepam and 0.5 mg of Quetiapine to take before bed.
While taking these, I was able to sleep intermittently.
At the beginning of July, I tried Sertraline (an SSRI) for a week, but the side effects were severe, so my doctor advised me to stop the medication.

Currently, I feel extremely tired, and my eyelids tend to close involuntarily, but I keep waking up due to the sound of my own pulse.
My heart rate is within the range of 60-100 bpm without significant abnormalities, yet I cannot fall asleep whether sitting or lying down.
I also experience involuntary nodding and hand tremors, and I need to keep working or exercising to distract myself from these issues.
However, during exercise, I experience dizziness and photophobia.
I would like to confirm whether this is a side effect of the medication or if further examination is needed.
Thank you.

So far, I have undergone tests: no abnormalities in endocrine function (no hyperthyroidism), normal carotid artery flow velocity, and blood tests during an emergency visit showed no abnormalities.
Currently, I am taking: antacids before meals, Quetiapine, and Clonazepam 0.5 mg before bed.
I do not smoke or drink alcohol, and I have avoided sugar, iced drinks, and fried foods for several months due to gastritis.
I cannot identify any sources of stress.

Ruo Xue, 30~39 year old female. Ask Date: 2024/07/21

Dr. Cai Zongzhang reply Neurology

Hello, Ruo Xue: Based on the above information, the results of the thyroid function and carotid artery examinations are normal.
Autonomic nervous system dysfunction is the most likely diagnosis.
It is recommended to cooperate with the physician for medication treatment and to avoid excessive stress.
If symptoms persist without improvement, please visit a neurology outpatient clinic.

Reply Date: 2024/07/21

More Info

Your symptoms of uncontrollable body shaking, sleep disturbances, and the sensation of hearing your heartbeat while lying down can indeed be concerning and warrant further investigation. Given your medical history and the medications you have been prescribed, it is essential to consider both the potential side effects of these medications and the possibility of underlying neurological issues.

Firstly, the medications you mentioned, such as Seroxat (paroxetine) and other sedatives, can have various side effects, including sleep disturbances, tremors, and changes in heart rate. While you have reported that your symptoms existed before starting these medications, it is still possible that they could exacerbate underlying issues. For instance, paroxetine is known to affect serotonin levels, which can influence mood and sleep patterns. If you experienced significant side effects from this medication, it may be worth discussing alternative treatments with your physician.

The sensation of hearing your heartbeat and the accompanying anxiety can be indicative of heightened sympathetic nervous system activity, which can occur due to stress, anxiety, or even certain medications. The fact that you have been experiencing these symptoms after stopping medication suggests that your body may still be adjusting to the changes in your treatment regimen.

The involuntary head nodding and hand tremors you described could be related to several factors. One possibility is a condition known as essential tremor, which can cause rhythmic shaking, particularly when the muscles are in use. Another consideration is the potential for a movement disorder, especially if these symptoms are persistent and worsening. Given that you have already ruled out autonomic nervous system disorders and endocrine abnormalities, it may be beneficial to consult a neurologist for a thorough evaluation.

In addition to neurological concerns, it is also essential to consider the impact of lifestyle factors on your symptoms. You mentioned that you have made significant dietary changes and are avoiding stimulants, which is a positive step. However, stress management techniques, such as mindfulness, meditation, or cognitive-behavioral therapy, may also help alleviate some of your anxiety and improve your sleep quality.

Since you have already undergone several tests, including blood work and carotid ultrasound, and found no abnormalities, it may be helpful to keep a detailed sleep diary. This diary should include information about your sleep patterns, any disturbances, and how you feel upon waking. This information can be invaluable for your healthcare provider in determining the best course of action.

In summary, your symptoms are complex and multifaceted, and while they may be related to medication side effects, they could also indicate an underlying neurological condition. It is crucial to follow up with a neurologist who can perform a comprehensive assessment, including possibly an EEG or MRI, to rule out any neurological disorders. Additionally, continue to communicate openly with your healthcare providers about your symptoms and any changes you experience. This collaborative approach will be vital in finding an effective treatment plan that addresses both your physical and mental health needs.

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