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Sleep deprivation in the dominant/hypervigilant horse UPDATE 11/4

3-month update…horse still isn’t sleeping and I’m a bit frustrated/confused. Long story short, two different vets have examined him since then and they disagree about musculoskeletal pain. The internal med vet with interest in neurology says he has significant neck pain and gait abnormalities, most likely caused by cervical arthritis. The sports med vet who did a full lameness exam (flexions, longeing on hard/soft ground, ridden exam) says he looks great and he wouldn’t do further diagnostics. Eyes, Lyme test, and EPM test were all normal. As far as sleep he said I could try trazadone, a bute trial, or powdered omeprazole, which he said wouldn’t be enough to cure ulcers if he has them but might make them feel better enough to indicate a scope.

Neck X-rays were blessedly clean but to be sure I asked for an ultrasound also, and he said they literally never see such clean necks—to the point that he asked if the vet student could spend some extra time looking at a normal neck ultrasound. I was obviously VERY relieved because the first vet had made it sound like my horse is crippled. Then the first vet looked at the X-rays and says they aren’t sufficient to rule out her concerns.

Both vets agreed on consulting an equine behaviorist at New Bolton, Dr Sue McDonnell, who does “sleep studies” by analyzing video of the horse in a stall and looking for environmental causes vs pain indicators. I kept the boys in overnight and mailed her 24 hours of video on a flash drive. It cost $275, for anyone who might be interested. You can also do it at New Bolton but she said the home environment is preferred.

Her report says he seems generally at ease in his stall and in sync with his neighbor, and that his behavior patterns are generally normal other than shorter standing rest periods (and of course, sleep crashing). The only sign of physical discomfort was of the RF leg (pointing/off-loading, nuzzling, and some “visible muscle fasciculations over that elbow and shoulder area”). A week before the video he had violently yanked his RF shoe off by hooking it on a lip in the rear stall door and then pulling back (also caught on video). He was a bit bruised in the heel/frog area from that, to the point that we had to change from frog pads to leather, and the pulling back may have caused some body soreness.

I read the report as generally positive (seems comfortable in his environment and doesn’t show signs of major discomfort), though ultimately not very enlightening as to why he won’t lie down. I talked to vet #1 again and she read it as supportive of her theory that he has neck issues that need further investigation and might be manifesting in RF discomfort. She believes I should take him to New Bolton for another neuro exam, another lameness eval, and a neck CT.

My insurance company won’t reimburse any of these expenses yet because there’s no diagnosis. Meanwhile, my policy is up for renewal next month and they’re proposing an exclusion for “issues involving the cervical spine and/or neurological deficits, subject to full diagnosis pending additional results.” So basically they want it both ways: no coverage AND an exclusion! My agent and the adjuster are both very supportive, but they do need a vet to say there’s something specific wrong with him.

I’m at a loss here. I have one good vet saying he looks great and the other saying he’s practically crippled. Through all this he’s been sound in work, competing at Modified and schooling Prelim. He loves jumping and I have a hard time believing he would be so enthusiastic about it if he were in pain? I could be wrong though.

Clearly something is not right if he won’t lie down, but I’m not yet convinced it’s physical vs “emotional,” even if his hypervigilance didn’t happen to manifest during that 24-hour period. Sigh. I’m not sure where to go next.

So sorry this is a continuing challenge for you.

Two comments …

I used Dr. McDonnell to do analysis on my boy when he was at New Bolton a few times, and that’s when it became clear he was micro-colic-ing about every hour. That was a really useful investment.

I have been in a similar place where I had multiple sets of xrays from sports medicine vets who all said no way is this a problem, but then Vet #1 requested additional xrays and ultrasound at my farm which led to an injection at C5-6 and my horse changed quickly into quite a different animal. Looking at him now, I can see his neck is soft at the base and he extends it significantly more. It was nothing short of dramatic.

I know how frustrating it is to have a lone voice saying ‘neck’ and everyone else is saying ‘no way’. I of course DO hope it’s not neck and he’s absolutely just a weirdo about laying down, but with my own experience of so many saying ‘nope’, and one vet saying ‘yes’, and the ‘yes’ actually being a treatable and primary cause of pain … well … I’m glad I crossed that last bridge.

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This must be incredibly frustrating!

My take as a complete amateur: The fact that the horse is actively eventing at a pretty high level (Prelim looks high to me!), combined with the clean x-rays of the neck, would say to me that the cervical spine isn’t the problem. Has Vet 1, who still insists that the horse is nearly crippled, ever talked to the other vet? To me, Vet 1’s insistence that no, it must be the neck, seems like someone who has gotten stuck on a “pet” diagnosis and refuses to be budged by little things, like x-rays and other vets’ reasoned opinions. (Again, speaking as an outsider).

Is the horse like this consistently, all year round, regardless of competitions, levels of work, etc.? I am wondering if the stress of competition (with all the trailering, new barns, unknown horses, etc.) might be creating stress that surfaces as hyper-vigilance when he’s at home. Maybe this is something you’ve already thought about and discarded as a possibility, but I thought it might be worth raising.

Good luck!

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Completely understand your frustration - I suggested up-thread the trazodone as it was recommended to me when I was on my own mission regarding sleep-crashing.

My horse was evaluated by Dr. McDonnell as well, but at NBC. I thought she was very nice but she, along with the other vets there, missed the boat entirely on his initial diagnosis, so I have lost quite a bit of faith in NBC. My horse had lymphangitis in his left front - which no one identified until it completely blew up, and despite the fact that upon arrival, I noted to the resident that it was starting to fill and he had lymphatic fluid seeping from his leg already, so please put him on antibiotics straight away (which they ignored while pursuing a possible neuro diagnosis). So yes, he was in extreme pain and I really don’t think I needed Dr. McDonnell to tell us that!

Anyway, I was lectured quite a bit about how he sleep crashes, and I was made to feel like I am negligent that I am not treating the potential causes of his reluctance to lie down. His neck x-rays are good. He does have knee & stifle arthritis: they are both injected, he gets Pentosan, magna-wave and every oral supplement for arthritis. He is not by any means crippled with arthritis - we do hunters, and he’s been champion or reserve every time out this year :slightly_smiling_face: What no one at New Bolton noted - believed? - understood? - was that he has shivers in the front (which is, admittedly, unusual). I can only guess that no one at NBC could recognize that he had shivers because the pain in his left front was so bad that it was hard to separate out the behavior. I told them repeatedly that he has shivers but I note that it was not included anywhere in his discharge report, so I think it is safe to say that was as disregarded as well.

When I was on my own mission to see if I could get him to lie down, and tried trazodone with no luck - I finally found that horses with shivers often do not lie down - this is according to Dr. Valberg at Michigan State University - who is widely accepted as the expert on shivers.

This long story is to say: there are other reasons horses won’t lie down and, at least depending on who you see at NBC, they don’t know all of them. If I had unlimited time and money, I’d take him for another neuro exam to see if Dr. Johnson would identify shivers under normal circumstances. Oh wait, still not doing that: I am not giving them another dime to examine my horse without me present to see what they are seeing too. (Can you tell I am really over NBC? :roll_eyes:) I’ll go with the shivers diagnosis from two of our area’s top sports med/lameness vets. Anyway, in the case of my guy, there is nothing I can do about shivers. I can’t stop him from sleep crashing, so I just try to make it as “safe” (lol) as possible for him, and keep his legs wrapped quite often so he doesn’t bang them up when he goes down. The shivers is extra pronounced actually when he does lie down to roll - it can be disturbing to watch because his front legs shake so badly.

It’s hard because in general, I am very proactive with treating my horses but I have had to accept that there may not be a treatment for this condition. OP, it sounds like you are the same way with your horses. Please share if you do end up finding something that helps your guy!

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Sounds peculiar, but can you post a picture of your horse while he is just standing, with a focus on the base of his neck on each side?

@starsandsun, that’s interesting, thanks. Do you know what the difference was between the x-rays/ultrasound that showed no problem and the ones that finally did? I wonder why Vet #1 is recommending a full New Bolton extravaganza for my horse but yours was resolved with field x-rays/ultrasound. Maybe she felt the views taken were as good as it’s going to get in the field, in my case? Or she thinks the issue is deeper/more caudal? She keeps saying he’s a big horse and hard to image, but he’s only a 15.2 1/2 hh TB, which isn’t particularly large in my book. Vet #2 said he has a big/prominent shoulder so maybe that’s what she means.

Honestly, the same thought crossed my mind. However, it’s the same vet who was right about @starsandsun’s horse so she’s been vindicated at least once! It’s been weird and frustrating to feel bounced back and forth. The vets have talked, and to me they each say they respect each other greatly and they’re not disagreeing with the other – just basing their opinion on their own observations the day they saw him. But when I talk to Vet #1, who is much more communicative than Vet #2, I feel like I’m getting Vet #2’s words through her filter, if that makes sense…

Definitely a good thought but he was the same when I gave him 2.5 months off last winter. He does trailer often but never stables away from home overnight because we’re lucky to have lots of events nearby. I wonder about cause and effect with the hypervigilance – as in, is he hypervigilant because he’s in pain or is it purely environmental? I’ve tried as many environmental tweaks as I can short of borrowing a dominant mare or boarding him elsewhere for a month. I feel like I could spend infinite time/money trying things, and it’s a little overwhelming.

@awaywego, wow, what a nightmare! I’m so sorry you went through that. It makes sense that your horse won’t lie down if he gets that shaky. I can see why you lost trust and I hear you on that. This was not at New Bolton, but a few years ago I went through a lot with a lame young horse who ended up having DSLD. I asked about DSLD within the first month of lameness and was told not to worry about that. A year and $10k in vet bills later, he was euthanized and yes he did have it. Then there was the horse I was told was neuro and probably a Wobbler who should be put down, when actually he failed the neuro eval because they had sedated him (also not New Bolton but an expensive and well-regarded sports med clinic). So, yeah, I’m a little lacking in blind faith, especially when the vets can’t even agree amongst themselves!

Yeah, I’m not sure. She had all the images from Leesburg EMC and from NBC from the past 3 years, and there was something from the very earliest that caused her concern. The xrays and ultrasound done here did show the same small arthritic change at C5-6. I wonder if because of the size/mass of your horse’s shoulder it’s not as clear down to C6-C7 and T1. CT will show a sensitivity to mineralization beyond xray’s ability so maybe that’s why she wants it done?

I’ll tell you that I fought hard against a ‘neck’ diagnosis. I told my trainer ‘nope, that’s not it’, I told my regular vets, ‘nope, that’s not it’, I told vet #1 "nope’, that’s not it.’ I wanted to be RIGHT so badly … I had already spent so much time and $$$ … so I did that last series somewhat from the frame of ‘damm it, I’m right and this will prove it’. Then, I agreed to treat, and holy cow I ended up with a different horse. So I had to eat a giant pile of crow. LOL

FWIW, my horse is extremely talented - like yours - and you would never imagine he was in pain or any discomfort. His ‘signs’ were very, very small. But having his neck treated has elevated our ‘game’ (ha, what a joke with me riding).

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Curious - what symptoms did the neck injection treat?

First and most obvious was he would stand square up front … did not ‘choose’ to stand that way before. Next, and also very obvious, was how much farther out he holds his neck. His neck now visibly extends both on the ground and under tack in ways it did not before. Also the musculature is much softer both in the neck and over his withers.

ETA: he’s always been super flexible and could touch his croup and even farther back with his nose. But before his neck treatment, he didn’t turn right and left with his head on an even/equal plane. One direction was fine - head stayed perpendicular to the ground. The other direction he swiveled his head and it went sideways. Anyhow, the injection changed that and he is now the same on each side.

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I have no advice, you just have my continued jingles. This is such a frustrating situation for you both. :heart: :chains:

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When you tested for EPM, what was the result?

I’ve got a horse that tested “negative” in that his titer was very low, vet said exposure only, and she wouldn’t treat at that value. There were some weird, non specific things going on with him, so we treated anyway. The weird stuff has resolved AND he’s lying down overnight again.

Unless the titer was truly nothing, maybe it’s still worth tossing 30 days of EPM treatment at this?

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I think you might need to try 24/7 turnout at a low key barn +/- another dominant herd mate. My older horse with sleep deprivation started laying down to sleep his first week at the retirement farm while he was in quarantine with one other horse. He was out 24/7 at that farm and the horse he was quarantined with wasn’t a dominant horse. But something about the drastically changed environment helped him feel comfortable enough to start sleeping. He spent several months catching up on sleep.

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Interesting! This has been bouncing around in my head the last few days too. His SAG 2,3,4 Titer was 1:500, which the results say “indicated exposure to S. neurona, a causative agent of equine protozoal myelitis (EPM). It does not confirm clinical disease. Serum titers range from <1:250 (negative) to >1:4000 (high).”

When we discussed the results, Vet #2 said I could try treating though he didn’t think it was the issue. I can’t seem to get an appointment with New Bolton very soon anyway, so I just called to order a month of meds. It would suck to do a bunch of other diagnostics if the issue is actually EPM. Earlier this year my friend’s horse had a low titer but responded amazingly to treatment, though his issues were different and more dramatic. I don’t want to get my hopes up since he has no asymmetry, ataxia, etc but it feels worth trying! So expensive though, ughhhhhhh…

The other thing I would like to look into is ulcers, which was the reason I called Vet #1 in the first place, but she is adamant that it’s the neck and says ulcers wouldn’t cause him to not lie down. However, I have of course done a lot of my own reading and other horse owners have reported sleep deprivation resolving with ulcer treatment. I hate being the owner who cites Dr Google, but…

I also was wondering if shockwaving his neck could give some idea of whether that’s the problem, while we wait for an appointment. It’s overwhelming how many things there are to try when your horse is NQR.

He’s on 24/7 turnout Oct - May or so, until the bugs get bad and I stall them during the day. I keep my three boys at home so it’s very low-key but I’ve actually wondered if he needs more horses around to feel comfortable!? Like I said, I feel like there are almost infinite things to try. I was thinking about emailing a friend who runs a large boarding barn with many different stall/turnout options. I’m sure she has a waitlist but maybe he could slide in for a week or two between permanent boarders. The only thing that makes me nervous is quick integration into a new, unknown herd – well, that and I haven’t boarded in 10 years so I would have to try not to be a control freak!

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Shockwave has been VERY useful for us.

If you’re thinking it might be ulcers, get him on ulcerguard (full tube for 2 weeks, then taper off for 2 weeks). If he’s better at 10-ish days, then get a gastroscopy.

Maybe try that first, then try EPM meds?

That’s where my horse tested, too. He had no attaxia or asymmetry. He had been very unusually afraid for the farrier, and had gotten weird about his hind legs and tail. When he tested positive for Lyme, I figured that was it, but he didn’t really get better with Lyme treatment. He just really wasn’t himself, although there was nothing really concrete to point to or workup.

He’s done super with EPM treatment. The compounded ponazuril powder from Farm Vet is so cheap. I also used levimasole for two weeks, and dosed the ponazuril with oil (per this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255669/)

That’s great to hear! My regular vet (Vet #3 in this story) was able to come out and shockwave today already!! Love him. He said for necks and backs he typically does 4 treatments every 10 days. How soon did you see an improvement? My horse definitely had some sensitivity and muscle twitching on the right side, which is where he has the more limited range of motion too.

I did try Nexium in the past with no change. He’s almost a month into the Succeed Challenge right now, also with no change so far. At least he likes the taste of it and supposedly if it doesn’t help I can get my money back. I’m really trying to do one thing at a time so I know what helps, but when you need a month + of any given treatment that gets tough because I don’t want him to be suffering longer than he needs to, you know?

That’s fascinating and so helpful—thank you! Mine has been a little weird about some things the last few months too, like shadows/light on the ground or movement on the horizon. He was a little tough his last farrier appointment too, which is not like him.

I’d call it worth a shot :woman_shrugging: You’ve certainly been down a LOT of other paths.

I don’t know if it’s just my year for epm or what, but I’m treating each of my horses. Two had a BIG titer. One had really typical epm symptoms, although briefly–she was knuckling over on one hind when I went to pick her feet one morning. This guy and another mare had weird NQR stuff.

I also found Benadryl to make a difference, too. I don’t know why. The symptomatic horse is on antihistamines for most of summer because of bugs. I started her on Benadryl, noticed she looked brighter, switched to Zyrtec, which is usually more effective for her bug stuff, and thought she looked duller. Switched back to Benadryl, thought she brightened up again.

On a lark, tried it on the gelding I’ve talked about here–this was pre treatment–and HE looked brighter.

Super weird, I really have no idea why, although I read somewhere that an antihistamine was used as a part of early EPM treatment. So if you wanna toss something at the wall to see if it sticks, a few days of Benadryl could also be interesting.

I think Nexium is an esomeprozole, which doesn’t always work. i tried the Succeed Challenge also and they’re great at giving you your $ back.

I did shockwave in conjunction with injection at C5-6, and weekly massage. At a minimum, if you’re doing shockwave, try to do those neck stretches I mentioned above - turning right and left and keeping face perpendicular to ground and nose at same level - see if you can help him go slowly in each direction a few times each way.

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