When I first saw exhaustion described as the “leaky emotion of chronic illness“, it reminded me of something else. (This happens to me a lot, by the way, a fizzy stream of consciousness that bubbles ideas around my cranium like pinballs until one finally settles in with a *plink*). The plink this time was that, along with the chest pain, exhaustion and the damned relentlessness that can so often accompany episodes of my refractory angina (or many other symptoms of chronic illness for others), there’s another response I’ve only recently begun to learn about.
And that’s the sound of soft little moaning, groaning, or sighing noises.
Remember that, for many of us who’ve already survived a heart attack, every twinge afterwards between neck and navel feels like the grim threat of another one, any minute now.
For those living with a cardiac arrhythmia like atrial fibrillation, every fleeting palpitation looms large as a possible warning of more to come.
For those diagnosed with heart failure (still waiting for cardiologists, by the way, to come up with a far less horrible name), every bout of shortness of breath is frightening.
Any one of these episodes may call for moaning, groaning and sighing.
I assumed that my own moaning may have started with a kind of reflexive whisper: “Oh, no, no, no…. This can’t be another heart attack…. I don’t want this to be happening. Not now. Not today. Oh, pleeease. No. No. No-o-o-o-o-o-oooo….”
But soon it became so “normal” for me to be moaning, groaning and sighing all over the place during these episodes that I now often forget to notice I’m even making any sounds at all – unless my family or friends who happen to be nearby ask me: “What’s wrong?” (Wrong? Nothing’s wrong! Can’t a person moan and groan around here?!)
It turns out that some of these audible yet unbidden sounds may actually have some beneficial health purpose.
Take sighing, for example. A study on sighing published in the journal Nature was co-authored by UCLA’s Dr. Jack Feldman, who explained Sighing 101 like this:
“Sighing starts out as a normal breath, but before you exhale, you take a second breath on top of it. Whether you realize it or not, you do this about 12 times an hour, and even more than that when you’re stressed or anxious.”
No wonder I tend to make this sighing sound more often when I’m in the middle of feeling stressed or anxious during a flare-up of scary cardiac symptoms. But although some components of sighing do relate to an emotional state, Dr. Feldman says that the mechanism behind the emotional roots of conscious sighing “remains a mystery”.
The physiological purpose of sighing, he explains, is to inflate the alveoli, the half-billion tiny, delicate, balloon-like sacs in the lungs where oxygen enters and carbon dioxide leaves the bloodstream. But sometimes, individual sacs can collapse. According to Dr. Feldman:
“If you don’t sigh every five minutes or so, these alveoli will slowly collapse, causing lung failure. When alveoli collapse, they compromise the ability of the lung to exchange oxygen and carbon dioxide. The only way to pop them open again is to sigh, which brings in twice the volume of a normal breath.
“If you don’t sigh, your lungs will fail over time. That’s why patients in early iron lungs had such problems, because they never sighed. The machines had not been programmed to give patients regular deep, lung-filling breaths. Current ventilators regularly deliver a large inflation of air that mimics a sigh.”
From this, I learned that sighing is good, so I plan to do lots more of it from now on.
Go ahead and join me. Let’s try a nice deep lung-filling *s-i-g-h* right now . . .
Next, let’s consider the audible moaning and groaning I’ve started adding to my sighing repertoire.
If I were engaging in this kind of unconscious moaning in my sleep, doctors might know it as something called catathrenia or nocturnal groaning that typically occurs during our sleep-wake transitions.(1)
It’s often only apparent to those unfortunates whose sleep is disturbed by all the racket caused by their moaning companion. The phenomenon usually starts during one’s late teens or early 20s. It sounds like a low, sustained, mournful sound, often repeated in clusters ranging from two minutes to one hour, many times per night. Not surprisingly, it may seem like these sounds indicate sorrow or pain, but facial expressions are typically calm and do not reflect discomfort or anguish. Despite the sleepy moaning sounds of catathrenia, the groans don’t seem to be related to any particular emotional feelings, according to the American Academy of Sleep Medicine.
New York City sleep specialist Dr. Steven Park has spent decades treating sleep disorders, including catathrenia. He explains that this diagnosis is usually associated with something known as upper airway resistance syndrome (UARS), often a precursor or variation of obstructive sleep apnea. Here’s how he describes the average UARS patient:
“These UARS patients are constantly tired and suffer from various other chronic conditions such as recurrent sinus pain or infections, low blood pressure, cold hands or feet, various gastrointestinal symptoms, anxiety/depression, and almost invariably, prefer not to sleep on their backs.”
By the way, Dr. Park has reported for years on studies suggesting that sleep-breathing disorders are linked to far bigger problems than just having trouble getting a good night’s sleep. He has long advocated that sleep disorders are actually linked to many medical conditions, both common and uncommon, including heart disease. For example, here’s his comprehensive response to my article on KevinMD about women and heart attacks. This theory makes sense when you consider how chronically impaired sleep patterns can impact the entire body’s ability to function.
But what about moaning/groaning when we’re wide awake and conscious? This might be a different animal compared to sleep moaning. For examples:
- Tired babies moan during self-soothing.
- Adults moan during sex, except social scientists give it a fancy name: “copulatory vocalization”.
- People living with fibromyalgia or other forms of chronic pain report that they’ll often moan and grimace during painful episodes.
- Researchers suggest that surgical patients recovering from general anaesthesia will “grimace, frown, exhibit muscle tension, and make sounds (e.g. sighs, moans, and groans) in proportion to their pain intensity.”(2)
- Some people make a harsh, shrill, creaking sound when they breathe, most often heard when inhaling. This is called stridor. It may occur during sleep, except that stridor happens with almost every breath. Unlike groaning, it doesn’t appear in blocks of time during the night. Stridor can sound something like this.
- Some people do make a moaning type of sound while snoring. But the primary sound of snoring occurs when you inhale. Groaning, on the other hand, occurs when you exhale. Try it out right now and you’ll see.
Resources: Dr. Jack Feldman, Dr. Steven Park, American Academy of Sleep Science, Mayo Clinic
(1) Christian Guilleminault. “Catathrenia: Parasomnia or Uncommon Feature of Sleep Disordered Breathing?” Sleep. 2008 Jan 1; 31(1): 132–139.
(2) Kathleen A. Puntillo et al. “Pain behaviors observed during six common procedures: Results from Thunder Project II.” Critical Care Medicine. 03/2004; 32(2):421-7.
Q: Have you noticed your own sighing or moaning lately?
NOTE FROM CAROLYN: I wrote much more about becoming a patient in my book, A Woman’s Guide to Living with Heart Disease . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 30% off the list price).