sleep paralysis
sleep paralysis is a state during falling asleep or waking up, wherein the person is conscious but is in full-body paralysis. In such an episode, the individual can hallucinate and might even hear, feel, or see things that are not present, causing fear in many. Episodes generally last no longer than a few minutes. It may recur several times or it may be an isolated event.
It may occur in healthy individuals or those with narcolepsy or it may be familial due to specific genetic changes. The condition may be triggered by sleep deprivation, psychological stress, or abnormal sleep cycles. It is thought that the condition involves a dysfunction in REM sleep. Diagnosis is based on a person’s description. Other conditions that can also appear similarly include narcolepsy, atonic seizure, and hypokalemic periodic paralysis. Treatment options for sleep paralysis have been poorly studied. It is advisable to reassure patients that the condition is common and not serious. Other efforts that may be attempted include sleep hygiene, cognitive behavioral therapy, and antidepressants.
Signs of sleep paralysis
Some of the sounds that people experience during an episode of sleep paralysis include humming hissing static zapping and buzzing. Besides these other sounds include voices whispers, and roars. It has also been known that pressure may be felt on one’s chest and that an individual may experience intense pain in their head during an episode
. These symptoms are normally accompanied by intense emotions such as fear and panic. People also feel sensations of being dragged out of bed or flying, numbness, and even feelings of electric tingles or vibrations running through their bodies. Sleep paralysis may even include hallucinations, an intruding presence, or a dark figure in the room. These are very commonly known as sleep paralysis demons. It can also incorporate suffocation or the individual’s feeling of terror, including a sensation of chest compression and difficulty in breathing.
Epidemiology
Sleep paralysis is also similarly experienced among males and females. Lifetime prevalence rates obtained from 35 aggregated studies suggest that approximately 8% of the general population, 28% of students, and 32% of psychiatric patients experience at least one episode of sleep paralysis sometime in their lifetime. The rates of recurrent sleep paralysis are less known, but 15–45% of those with a lifetime history of sleep paralysis might meet the diagnostic criteria for Recurrent Isolated Sleep Paralysis.
In surveys from Canada, China, England, Japan and Nigeria, 20% to 60% of respondents reported having had an episode of sleep paralysis at least once in their lifetime. In general, non-whites seem to have higher rates of sleep paralysis than whites, but the size of the difference is somewhat small. About 36% of the population that suffers isolated sleep paralysis begins experiencing it between 25 and 44 years of age.
Isolated sleep paralysis is the phenomenon that is most often encountered during the diagnosis of narcolepsy. About 30–50% of subjects diagnosed with narcolepsy have reported sleep paralysis as an accessory symptom. Almost all the patients with a history of sleep paralysis manifest sporadic episodes occurring yearly to monthly.
Treatment for sleep paralysis
Medical treatment begins with education regarding the sleep stages and the incapability of moving muscles when in REM sleep. It is necessary to evaluate for narcolepsy if the symptoms persist. The safest treatment for sleep paralysis would be to adopt healthier sleeping habits. Medications
Although no major studies have been done that center specifically on sleep paralysis treatment, several medications have promise from case reports. Two clinical trials of GHB for the treatment of narcolepsy patients have shown to have decreased frequency of sleep paralysis attacks.
Cognitive-behavior
The earliest work of the treatment for sleep paralysis has been done through cognitive-behavior therapy referred to as CA-CBT. Work is psycho-education in addition to changing catastrophic cognitions about the attack from sleep paralysis. Such therapy has previously been employed for the treatment of sleep paralysis in Egypt but lacked clinical trials.
The first published psychosocial treatment for recurrent isolated sleep paralysis was cognitive-behavior therapy for isolated sleep paralysis. It begins with self-monitoring of symptoms, cognitive restructuring of maladaptive thoughts relevant to ISP, the paralysis will be permanent, and psychoeducation about the nature of sleep paralysis. Prevention techniques include ISP-specific sleep hygiene and the preparatory use of various relaxation techniques, diaphragmatic breathing, mindfulness, progressive muscle relaxation, and meditation.
Prevention of sleep paralysis
Several factors have been observed that are linked to an increased risk of sleep paralysis. These include insomnia, sleep deprivation, an irregular sleep schedule, stress, and physical exhaustion. It is also thought that there might be a genetic predisposition in the development of RISP because there is a high concurrent incidence of sleep paralysis in monozygotic twins. Sleeping in the supine position has been found an especially prominent instigator of sleep paralysis.
Supine sleep position is perceived as causing episodes of sleep paralysis for a person since sleep in this position facilitates easy dropping of the relaxed and dropped soft palate, possibly closing off the airways these situations can occur with, without being diagnosed as sleeping with or being a sufferer from sleep apnea. There is also a possible increased rate of microarousals during sleep when one sleeps in the supine position because there is more force exerted by gravity on the lungs. Though several risk factors exist for ISP or RISP, these are avoided if minor lifestyle adjustments are adopted.
Diagnosis
Episodes of sleep paralysis occur in the context of several medical conditions, including narcolepsy, and hypokalemia. When the episodes occur independent of those conditions or substance use, it is termed isolated sleep paralysis. When ISP episodes are more frequent and cause clinically significant distress or interference, it is classified as recurrent isolated sleep paralysis. Episodes of sleep paralysis, regardless of classification, are generally short 1–6 minutes, but longer episodes have been documented.
It can be very hard to differentiate between cataplexy triggered by narcolepsy and true sleep paralysis because the two phenomena are physically indistinguishable. The best way to differentiate between the two is to note when the attacks occur most often. Narcolepsy attacks are more common when the individual is falling asleep ISP and RISP attacks are more common upon awakening.