Has this ever happened to you that you woke up in the middle of the night feeling scared, your eyes are wide open you can see some evil surrounding you and still you can’t do anything? You are fully conscious but can’t move, nor shout, feeling heavy and having a scary feeling like someone is choking you. So, does some evil possess you, or is it something else?
This sensation of being awake but immobile during sleep and having hallucinations of being with something/someone scary is sleep paralysis. It is a state of atonia or paralysis of the skeletal muscles that occurs at the start and end of sleep. The person is highly aware of his or her surroundings despite being temporally immobile (i.e., semi- or fully conscious). It happens while a person transitions from being awake to being asleep. It normally lasts from a few seconds to 1 or 2 minutes but can extend up to 6 minutes and in rare cases longer than that.
It may also be an indication of other sleep disorders, such as narcolepsy. The overwhelming need to sleep that characterizes narcolepsy is brought on by a malfunction in the brain's capacity to control sleep.
It can affect anyone irrespective of age and gender but is most commonly observed in adolescents, students, and patients in psychiatric facilities. Given these incidence rates, it is important to test sleep paralysis more frequently and consistently to understand how it affects an individual's functioning and how it relates to psychiatric and other medical disorders.
It can usually be
Hypnagogic or predormital sleep paralysis - When alpha waves are waning but you haven't yet entered the first stage of sleep, hypnagogia occurs. This is the phase between being awake and asleep. or,
Hypnopompic or postdormital sleep paralysis - Less common as compared to hypnagogic and hallucinations occurs midway between dreaming and being fully awake.
It can occur due to several reasons like
Sleep deprivation
Irregular sleep cycle
Mental disorders like bipolar disorder or stress
Drug abuse
Sleep disorders like narcolepsy, insomnia, PTSD (post-traumatic stress disorder)
Sleeping on back
Family history
Treatment
Most often it does not require any treatment as it isn’t life-threatening and usually subsides with time and even if it occurs it lasts for a very short time.
It can be prevented by
By fixing the sleeping schedule i.e going to bed at the same time and taking proper sleep regularly for at least 6-8 hours
Avoid sleeping on your back
Do not have heavy meals, caffeine, or alcohol before going to sleep
It can be treated with relaxing techniques like Meditation-Relaxation Therapy which is one of the first MR therapy developed by Dr. Baland Jalal. According to a report published in the journal Frontiers in Neurology, 2020, by Dr. Baland Jalal in the Department of Psychiatry, the University of Cambridge in collaboration with Italy's Istituto delle Scienze Neurologiche di Bologna/IRCCS Department of Biomedical and Neuromotor Sciences, and Dr. Giuseppe Plazzi's team.
Ten narcolepsy patients, suffering from sleep paralysis, participated in a pilot trial of meditation-relaxation therapy in which patients were instructed to perform the following four steps:
Reevaluating the attack's meaning and telling oneself that the attack was normal, benign, and brief and that the hallucinations were a common side effect of dreaming.
Distancing oneself psychologically and emotionally by telling oneself there is no cause for fear or worry and that doing so will only make the experience worse.
Focusing on other positive aspects i.e such as a beloved person or event, a hymn or prayer, or God.
They should practice muscle relaxation, refrain from trying to control their breathing, and under no circumstances move.
For four weeks, participants were advised to journal every day in order to track the frequency, severity, and feelings associated with sleep paralysis. In total, 66% of the 10 patients reported hallucinations throughout the course of the first four weeks, with hallucinations occurring more frequently when rising from sleep (51%), and less commonly upon going asleep (14%).
For the next 8 weeks, six volunteers filled out mood/anxiety questionnaires, learned the therapy procedures, and practiced them twice a week for 15 minutes during regular wakefulness.
The reported disruption in the first four weeks by their hallucinations during sleep paralysis was 7.3. (rated on a ten-point scale where the greater the score greater the severity).
The number of days with sleep paralysis decreased to 5.5 (down 50%) and the total number of episodes decreased to 6.5 (down 54%) in the last month of treatment. Additionally, there was a discernible trend toward a decrease in the disturbance brought on by hallucinations, with ratings falling from 7.3 to 4.8.
The same procedure was followed by a control group of 4 people where instead of receiving therapy, they practiced deep breathing by taking slow, deep breaths while repeatedly counting from one to 10. The total number of episodes and the number of days the control group spent with sleep paralysis (4.3 per month in the beginning) remained unchanged (4.5 per month initially). The disruption brought on by hallucinations remained the same as well (rated 4 during the first four weeks).
However, you can consult a sleep medicine specialist in case your symptoms make you extremely exhausted throughout the day and keep you up at night and make you feel anxious.
MedBound Times reached out to Dr Abhinav Singh for his insights on sleep paralysis.
Sleep paralysis is often frightening to the individuals who suffer these instances and often they vividly recall them as they are associated with very clear imagery of imminent danger impending to being chased, often some individual being present in the room is what these individuals feel. At times the patient may try to scream but only a whisper may produce. I often described it to my patient as a state of being stuck between sleep and wake and often this is an intentional transition. The patient is trying to come out of sleep to wake in the mornings and often finds some stuck in sleep paralysis. Their sensorium is intact they can hear, see and even feel things but just can't move and this is important to distinguish it from cataplexy which is the loss of voluntary muscle tone seen in narcolepsy. Anytime you start having a recurrence of these you must prompt the patient to seek medical evaluation.
Dr Abhinav Singh – MD, MPH, FAASM, D.ABIM-SM (Sleep Medicine) Facility Director
With the help of polysomnography, your doctor can make a diagnosis related to sleep paralysis and disorders related to it. Polysomnography/sleep study is a thorough examination performed to identify sleep abnormalities. During a polysomnography study, your eye and leg movements, blood oxygen levels, heart rate, respiration, and brain waves are all recorded. It can be done at a sleep center or a hospital.
There is no such specific treatment for sleep paralysis but it may be related to other sleep disorders. Therefore, a sleep medicine specialist may suggest some medications depending on the relation of sleep paralysis with other associated disorders.
Tricyclic antidepressant (TCA)Clomipramine is generally used in treating certain aspects of narcolepsy, as it suppresses REM sleep and thereby prevents sleep paralysis and hallucinations.
Long-acting BZD (benzodiazepine), Clonazepam increases the level of gamma-amino-butyric acid (GABA) in the brain by functioning as a positive allosteric modulator on GABA-A receptors. GABA is a calming chemical in the brain, and a reduced level of it may result in panic attacks, seizures, anxiety, etc.
Methylphenidate may be prescribed in patients with Attention-deficit hyperactivity disorder (ADHD) and narcolepsy by inhibiting dopamine uptake. However, this is an off-label drug i.e not approved by the FDA for the treatment of sleep paralysis.
One should not take any medication without a prescription. As these drugs have adverse effects too and can cause other ailments or disorders.
However healthy lifestyle and diet can always do wonders no matter what disorder or disease is so i.e one thing you can follow without any doubt.
