Caught Between Sleep and Paralysis

Sleep paralysis refers to a terrifying experience that happens during sleep in some individuals. It is basically characterized by:

• The complaint of inability to move the trunk and limbs at sleep onset or upon awakening.
• It can be associated with frightening hallucination.

Some patients try to cry out but cannot. These episodes may last from seconds to few minutes. With time, noise or with touch of someone’s hand the episode terminates. In some cases, the problem could be familial.

Studies have shown that 2% of the population has sleep paralysis at least once a month. Sleep paralysis can happen at any age. Twelve percent of people with the disorder experience their first episode during childhood.

What is exactly happening in the brain during these bizarre experiences?

During sleep, we go through different stages of sleep. One of them is called Rapid Eye Movement (REM) stage. This is the stage where dreaming occurs. In this stage, Allah created a mechanism that protects us from acting our dreams; this is called “muscular atonia”. Muscular atonia basically means that all the muscles in our body will be suppressed during REM sleep (except the diaphragm and muscles of the eyes). So even if you are Superman in your dream, this mechanism will keep you safely in bed. This atonia terminates when we move to another stage of sleep or upon awakening. But at times something goes wrong; the individual wakes up during REM sleep and this protective mechanism “atonia” does not terminate. This creates an inability to move paralysis), and as the brain was just dreaming, this may result in frightening hallucinations.

Is sleep paralysis harmful?

Some individuals think that death has come. Others think that there is a genie pressing on their chest. The above is not supported by any scientific evidence. I am not aware of any reported death during sleep paralysis. As the diaphragm is not affected by the process of “atonia”, breathing continues to be normal with no significant change in the blood oxygen level. Sleep paralysis is an isolated phenomenon in most individuals; however, in some cases it can be associated with a disorder called “Narcolepsy”. “Narcolepsy” is a sleep disorder characterized by irresistible and uncontrollable attacks sleepiness. All patients with sleep paralysis and narcolepsy need medical attention and treatment. On the other hand, most individuals with isolated sleep paralysis need assurance only. Patients should know that this disorder is benign and does not jeopardize their life at all. Most of these individuals do not need any medical treatment.

Treatment:

Individuals with isolated sleep paralysis need to be assured that they do not have mental illness or serious medical illness. Most of them do not require any other medical treatment. During paralysis episodes, patients may be advised to try moving the facial muscles and moving eyes from one side to the other. This may hasten the termination of the attack.

In severe cases, where attacks take place at least once a week medication may be used.
It is known that stress and sleep disturbances increase the episodes of sleep paralysis. Therefore, to minimize the number of episodes, patients are advised to do the following:

• Get enough sleep.
• Reduce stress.
• Exercise regularly (but not too close to bedtime).
• Keep a regular sleep-wake schedule.
• Some claims that sleeping on the side may help.

Ahmed BaHammam, FACP, FCCP
Professor of Medicine
Director, University Sleep Disorders Center
College of Medicine, King Saud University