Ever experienced trepidation or intense anxiety with the inability to move at night? Felt para-normal or had hallucinations? You might have experienced an episode of what is called sleep paralysis. In earlier days it was believed to be due to demons, evil spirits, and aliens. About 8% of the population experience this condition at least once in their lifetime.
According to Dr. Silas, sleep paralysis can be defined as a phenomenon in which the patient wakes up to the consciousness of his or her environment but is incapable of moving a muscle. He was the first scientist to describe this condition in 1867. These episodes last anywhere between seconds to 20 minutes. The average is 6 or 7 minutes. According to recent studies, it’s nothing but an abnormal overlap of REM sleep and the waking stage of sleep. REM sleep sets in after half an hour to 1 hour after falling asleep.
This phenomenon is very common in adults. It also has a great genetic predisposition. The genetic component is almost 50%. It is also common in people who were exposed to recent traumatic events.
Studies show that the female population experience this phenomenon more than the male counterparts. Episodes usually begin at late childhood, adolescence and frequent thereafter.
These are some of the symptoms that a person can experience,
- The feeling of being outside your own body
- It is obviously an unpleasant experience
- Pressure over the chest region (Like someone is standing or sitting over the chest, strangling, etc.)
- Sense of suffocation or breathlessness due to hypercapnia.
- Transient inability to move or speak during the sleep transition.
- Experiencing hallucinations and the feeling of the presence of an intruder or an impending danger. It could also include an incubus phenomenon.
- Unlike dreams which are vague, episodes that the person experiences are well recollected. This is because the brain is fully active and alert. It can be remembered with great clarity.
- This condition is also common in patients with post-traumatic stress disorder (PTSD). People under emotional or physical distress also experience this phenomenon. Some other factors include fatigue, long travels with jet- lag, substance use, certain drugs, shifts, etc. Further, it’s common in people with obstructive sleep apnea and narcolepsy (extreme tendency to fall asleep often at inappropriate places and times).
- It’s pretty common for this paralysis to occur near the early morning hours. The explanation behind this is that the body gets the most rest and deepest sleep close to the early morning hours. Further, the brains try to become alert and awake during these early hours.
MECHANISM OF SLEEP PARALYSIS:
During a sleep paralysis episode, a combination of your body’s fear response to a perceived attack by an evil creature takes place. Your brain being wide awake, while your body is in a REM sleep state. It triggers a response for you to take in more oxygen. This might make you gasp for air. But, this is not possible because REM atonia has removed control of your breath.
In simple words, the brain wakes before the body. This leaves us paralyzed but lucid. When we sleep, certain neurotransmitters like GABA and glycine turn off our body’s muscles so we don’t try to act out our dreams. This prevents us from hurting ourselves and potentially others. Therefore when the brain wakes up it eventually turns on the muscles of the body. In this condition, the brain kind of forgets to turn on the muscles, leaving us paralyzed and living our nightmares.
Neurologically speaking, the sublet row dorsal nucleus of the pontine (pons) of the brainstem plays an important role. This region in particular is responsible for the muscle atonia during the REM sleep stages. This wrong firing of the neural circuits is a major reason. This is also possible when you consume large amounts of alcohol near bedtime. In addition, being sleep deprived for longer periods of time, and certain other above-mentioned factors like a long haul, etc.
There are three main types namely,
- Isolated – the one’s not associated with narcolepsy
- Recurrent- frequent episodes occur eventually
- Recurrent isolated sleep paralysis (RISP)- a combination of the above 2 types. This is a chronic condition. This variant especially can last more than an hour.
In contrast, the types of hallucinations experienced in sleep paralysis can be categorised as,
- Intruder hallucinations: In this type, the victim always feels the presence of a dangerous intruder in the room
- Chest pressure hallucinations: Here, the person feels pressure over the chest region. This is also called the incubus hallucination. This often occurs in continuation with intruder hallucination.
- Vestibular motor hallucination: Out of the body or floating sensations are often due to vestibulo-motor hallucinations.
DIAGNOSING SLEEP PARALYSIS:
These conditions are easily diagnosed by the doctor through the set of symptoms that the person explains. Further, there a lot of questionnaires prepared for this purpose. (Sleep paralysis experience and phenomenology questionnaire- SP-EPQ, The unusual sleep experience questionnaire- USEQ).
MANAGING SLEEP PARALYSIS:
It is very relaxing to know that this condition is preventable. It is very important to have knowledge about managing this condition. But oftentimes, we are always stranded alone or helpless when experiencing this condition. We realize this at a later time. So to begin with, let’s break this down, try to understand, and remember in simple steps. First of all,
AVOID FIGHTING THE SENSATION:
Relax and understand. Take your time to understand what’s actually happening. Never try to fight back the sensation. As we already saw, there is a feeling of suffocation and breathlessness associated with an episode of this. So, fighting back might make you apprehensive spiking fear and panic. It aggravates the feeling of being trapped. This also starts an adrenaline rush and releases cortisol setting up a fight or flight reaction.
KEEP YOUR EYES CLOSED:
Try to remain calm and keep your eyes closed. These episodes often present with scary dreams rather than hallucinations that seem very real and thus increase terror.
TRY MILD MOVEMENTS:
Start by mild wiggling and clenching. Try wiggling your toes and fingers. Clench your fingers as much as possible. This breaks you out of the episode quickly.
Understanding or rationalizing is a very important part of overcoming sleep paralysis. Taking slow and deep breaths as in any other panicky situation have proved to be very useful. Reassuring ourselves that what we are experiencing is not real and couldn’t hurt us and is not real makes us recover faster and makes the experience less painful.
AVOID SLEEPING ON THE BACK:
Try lying down and sleeping in a side pose. Avoid lying on the back. Studies have shown that the majority of these episodes occur whilst lying in a supine position.
SIESTAS, A BIG NO!
Avoid daytime napping as much as possible. These kinds of people are said to experience this phenomenon very often.
PRACTISE A GOOD SLEEP HYGIENE:
Sleep hygiene is a very important part of everyone’s life. Not only for people with sleep paralysis or insomnia but it’s equally important for all of us to practice sleep hygiene. This is not something that’s very hard. It includes simple steps like,
- Having a routine bed timing and have a good full night’s sleep. (going to bed and waking up at the same timing every day)- maintains and improves the circadian rhythm greatly
- Avoid caffeinated drinks, alcohol, or smoking anywhere near bedtime.
- Electrical and electronic gadget usage near sleep time is a big no. Keeping them away from your body during sleep also improves the quality of your sleep.
- Maintaining a proper temperature and right ambiance with minimal or no lighting is important. This improves the production of melatonin, a very essential hormone in the body.
- Moreover, in case of difficulty falling asleep try taking light and early dinner (at least 4 hours before bedtime). Take a warm shower and wear skin-friendly and breathable fabric. In addition, always have the habit of changing the bed covers and maintaining them tidily.
SEEK CARE :
In case of regular recurrence of the issue, it is always advisable to seek professional help. Studies state that focused attention medication combined with muscle relaxation (MR therapy) demonstrated good benefits. The doctor might manage the condition with drugs combined with certain forms of psychiatric treatment.
Sleep paralysis does not cause any serious side effects. But certain unhealthy lifestyle problems associated with this condition may cause problems.
As we already saw, there are no serious complications. But, the important point to note is that the fear that this brings along causes a negative mechanism in the body shooting up anxiety. This cycle goes on and on leading to the the condition recurring continuously.
In addition, this condition can co-exist with narcolepsy, idiopathic hypersomnia, OSA and insomnia.
To sum up, sleep paralysis is as such not a very harmful condition. However, the risk it carries is the adrenaline surge, the anxiety and panic which could prove harmful in the long run. One of the best ways to overcome this is understanding the science behind, preaching and practising it. Therefore, tackle this imaginary demon like a soldier with a shinning sword!