Excessive yawning in ALS/MND

Posted July 7th, 2007 by

The first thing we experience about yawning is an urge to do so, one that can be so hard to suppress that we end up gulping down an extra serving of air when we’re trying to appear interested, or polite, or awake. But what if you yawned even if you weren’t tired, or bored? What if you got attacks of yawning six, seven, eight times in a row that you couldn’t stop? This can be a problem for some patients with ALS, and it’s made worse by the fact that due to weak jaw muscles they could dislocate their jaw.

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That’s why I was particularly interested when a news report on PatientsLikeMe listed “increased yawning” as a symptom of ALS. It occurred to me then that we had in front of us the perfect way to investigate excessive yawning in more detail. The first step was to set up “excessive yawning” as a primary symptom in ALS, meaning that all new members would be rating whether they felt it was mild, moderate, or severe. Coincidentally, a paper had just come out which reported two patients (not with ALS) with excessive yawning after being prescibred an SSRI antidepressant drug. We now had a couple of different hypotheses we could test out; first that yawning in ALS was associated with respiratory funciton, second that it was associated with SSRI use, and third that it might be something to do with emotional lability. I took the new publication as an opportunity to write a letter to the editor on the subject. I wrote:

254 patients (47%) completed the survey on excessive yawning. Excessive yawning was reported to be absent in 75 patients (30%) mild in 75 (30%), moderate in 81 (32%), and severe in 22 (9%). Using Spearman’s Rho there was no correlation between severity of yawning and age (r = −0.63, P = 0.329, n = 244) months since diagnosis (r = −0.032, P = 0.619, n = 250), or the last recorded measurement of forced vital capacity (r = −0.136, P = 0.99, n = 148). There was no association between yawning severity and anti-depressant usage (χ2 = 3.269, P = 0.352). However, there was an association between yawning severity and site of onset (χ2 = 18.705, P = 0.028). Patients with a bulbar onset of disease were more likely (57%) to have moderate or severe yawning than patients with an arm onset (42%) or leg onset (31%).

So, from this data it looks like we can reject hypothesis one (breathing) and hypothesis two (SSRI use). But what about emotional lability? The reason I thought it might be a factor is that, much like uncontrollable laughter and crying, people yawned even when they weren’t sleepy and had difficulty with inhibition. Emotional lability is also found to be much more common in the bulbar-onset form of ALS relative to limb onset forms. Our own stats show a moderate but significant correlation between the two symptoms (r=~0.3) , and at the recent ALS/MND International Symposium in Toronto one of the speakers mentioned that they also consider yawning a sign of lability.

Why is all of this important? For one thing, the fact that yawning can be painful for ALS patients means we should try and stop it, but our discussions on PatientsLikeMe brought to light another reason entirely: people were losing friends because of it as they were intepreting their frequent yawning as a sign of boredom or rudeness! So, my interest now is for two things to happen; first for patients and healthcare professionals to be more sensitive to the presence of excessive yawning and clarify to patients that it can be a symptom, and second for researchers to investigate potential treatments that might target emotional lability and excessive yawning in order to improve the quality of life of our patients.


21 Comments

  1. very interesting.
    i’m adding in RSS Reader

  2. Hello – I am from your patientslikeme MS site .. I find this very interesting because for years I had this “habit” , and since gettingdx’d with MS and taking different meds for my mood problems , had noticed a significant decrease ..

    I still yawn, but for years and years prior to dx’ing , people often asked if I was tired , my ex would say stop , you yawn too much and I basically would have to sneak off somewhere to try to stop ..

    My 1st MRI that showed the lesions, also showed one that was termed “older” , and now I am thinking that this may be a connection .. thanks , agserra

  3. Hi Adrian, thanks for letting me know. You might be interested in this website which is run by a french doctor and has a lot of content about yawning: http://www.baillement.com/

    All the best

    Paul Wicks, PhD
    Research Scientist
    PatientsLikeMe

  4. I have bulbar onset ALS and in retrospect excessive yawning along with emotional lability were symptoms starting a couple of years before I sought a diagnosis for an ongoing cough and husky voice.

    I still suffer excessive yawning and emotional lability but the cough disappeared when I lost my voice.

  5. I’m in your mood community for depression. Something that has always happened on SSRI’s for me has been uncontrollable yawning. They aren’t pleasant yawns, rather I’m left with jaw and tongue tension much like I would have just before vomiting.

    Doing some research today and was surprized that more research hasn’t been done about yawning.

    I’ll be adding it to my symptoms.

  6. I have bulbar onset form of ALS with the crying and laughing spells. Fortunately it does’nt usually happen at real inappropriate times, but they do last for a l-o-n-g time. Like it was’nt THAT funy.

    Also I have noticed excessive yawning and involuntary sighing(taking in a deep breath)Maybe to get air in the lungs I do’nt know. My FVC is 86%

  7. I am the mother of Rudie. This is actually funny, since I just stumble upon this article. I don’t have ALS (as far as I know) and I suffer from excessive yawning. It irritates me, because people do think that I am bored with them. Well, that’s what my family told me.

  8. hi

    just wanted to comment about excessive yawning. i do this quite often and alot of the times it seems to go on forever. just wanted to check if this happens because of ms.

    thanks

  9. I have PD & yrs, and have been prescribed numerous ssri”s for depression. Often I can get into a extensive amount of uncontrolable yawning. However, it can go away for weeks at a time. I believe there is a definite correlation betwqeen ssri’s and excessive yawning. thx

  10. Hi there, quick question I was hoping you might have some thoughts on. My Dad has limb onset ALS (early stages) and has started yawning ALOT. I just wondered whether other people have it as a symptom of limb onset ALS or whether my Dad is just finding us all increasingly boring!
    Many Thanks

  11. I have excessive yawning but I never experienced the yawning issued until I had an (intentional)overdose of an anti-depressant that I was taking: celexa. Since that time, which was the early fall of 1999, I have had “excessive yawning”. I notice however that it is more “excessive” when I am in moments of extreme depression or mania, or beginning a new medicine. So, in summary it could be at times of new stress perhaps. I was wondering if any of your theory covered this topic. Thank you. Christine

  12. In response to comments:

    There seems to be some kind of interaction between SSRI’s and excessive yawning, that’s what the original study we were responding to had reported. Further references can be found here: http://www.baillement.com/ssri.html

    All the best,

    Paul

  13. Did anyone else go to the research section labeled “Avanir Pharmaceuticals”? There is a trial for emotional lability.

  14. i have noticed that i do yawn alot but not thought about it,but for some years now many people have brung it to my attention that i sigh with every pause in work, thinking,sentance.any time i stoped doing anything, i thougth it was just a way i was releasing tention.

  15. I have had excessive yawning for years. I’ve never told a doctor about it, I thought they’d think I’m crazy.
    There are also times I feel I can’t get in enough air so I yawn more. Any ideas?

  16. Heidi, there are a few doctors who might be able to help; an ear nose and throat (ENT) specialist might be the best person to talk to. There are some disorders of the inner ear that can cause a problem with yawning. You might also like to check out this site by Dr Olivier Walusinski, one of the world’s most prominent leaders in yawning research: http://www.baillement.com/

    Best wishes,

    Paul

  17. [...] (as well as clinicians and researchers) in the design of each new community. We’ve also done novel research this way, collaborating directly with a group of previously unmeasured ALS patients to ensure their [...]

  18. [...] 2007: Your contributions lead to PatientsLikeMe’s first scientific discovery. PatientsLikeMe publishes a paper in Acta Psychiatica Scandinavica showing that some PALS experience uncontrollable bouts of [...]

  19. Gran aporte,lo difundo

  20. A sensação de poder compartilhar das minhas dificuldades atuais com a saúde é como descobrir o Brasil, estou com alguns problemas em comum aos que li aqui,adorei o saite e assim que estiver em condições de sentar nesta cadeira eu acessarei novamente(estou me recuperando de uma cirugia a saber histerectomia total doa abdome) e ainda sinto dores terrivéis (28/03) foi muito bom encontra-los.

  21. hola a todos

    Soy cubana, vivo en lisboa y mi marido tiene ELA.
    Él tenía muchos bostezos y después que le empecé a dar aceite de coco virgen nunca má ha bostezado.

    espero ayudar con esta información.

    un saludo,
    teresita

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