The phenomenon of sleep paralysis

A hundred years ago, sleep paralysis, an abnormal sleep behaviour, had a supernatural meaning. It would be called by many names like demonic possession, black magic, witchcraft and dark spirits. Even today, scientific explanations of sleep paralysis are overwhelmed by misconceptions in many parts of the world.

What is sleep paralysis?

Sleep paralysis has been identified as a deviation from normal sleep patterns. A concerted effort to scientifically study it started only a few decades ago. It is defined as a state when the individual feels that he/she is conscious, yet his/her body refuses every mental command to move.

It happens during the transition between sleep and wakefulness. If sleep paralysis occurs when we are going to sleep, it is known as ‘hypnagogic’ or ‘predormital’. If it occurs while we are waking up, it is called ‘hypnopompic’ or ‘postorbital.’ Experts say sleep paralysis is actually a delicate stage where we are neither fully awake nor fully asleep. So it is basically a mixed state.

Sleep paralysis is considered a type of ‘parasomnia’ which is an umbrella term for different types of abnormal sleep behaviours. There are two main stages of sleep, REM (Rapid Eye Movement) and non-REM sleep. As sleep paralysis is linked to REM sleep, it is categorised as REM parasomnia.

Terrible experience

REM sleep is the stage when we experience dreams. To prevent acting out on our dreams, our brain causes our muscles to move to a state of relaxation, known as atonia or hypotonia. Normally, this state should end as soon as we become fully conscious. However, in the case of sleep paralysis, this state persists even when we are awake.

Apart from muscle paralysis and inability to speak, victims of sleep paralysis may also suffer from hallucinations. They see or perceive things which are not really there.

Interestingly, during sleep paralysis episodes, many people experience an inexplicable terror. They feel helpless and want to cry out for help but to no avail. Some patients claim that they felt that there was someone else lying on the bed. In such circumstances, they may also develop a sense of choking or pressure on the chest.

Usually, these symptoms go away as quickly as they come when the patient suddenly gains control over his/her body or rolls out of bed. Sometimes, the paralysis is broken by someone coming into the room or waking up the victim.

Frequency

It has been estimated that sleep paralysis affects at least 8.0 per cent of the general population of the world. Researchers argue that 30 per cent of people would experience at least one episode of sleep paralysis in their lifetime. But it is the adolescents, young adults, and psychiatric patients who are the hardest hit.

Approximately 28 per cent of students and 32 per cent of psychiatric patients suffer from this condition. There is also some ethnic variation. Sleep paralysis is reported more in people of African and Asian descent. Asian college students are one of the worst suffering groups.

Causes

The exact cause of sleep paralysis has not yet been figured out. Currently, it has been linked to a combination of experiential and genetic factors. Mental disorders like depression, anxiety, social phobia, panic disorders may also precipitate sleep paralysis.

McNally and Clancy also posited a relation between sleep paralysis and trauma. A research by McNally and Clancy published in ‘Journal of Anxiety Disorders’ revealed that people with a history of childhood sexual abuse have a higher likelihood to develop sleep paralysis.

Some medications, e.g .anxiolytics can increase the risk of sleep paralysis as well. In the case of psychiatric disorders, though some of these have been found to increase the risk of sleep paralysis, the overall impact is not definitively explored.

Lack of sleep, poor quality, frequent awakenings, sleep disruptions, etc. are some other causes researchers have referred to. Things like jet lag, shift work, stress, medications causing insomnia, alcohol and caffeine can also lead to sleep paralysis. Sleeping in a completely supine position is another precipitating factor.

Severity

Sleep paralysis is a distressing condition, but generally it is not a very serious health issue. But it does have a negative impact on the quality of life. If it continues to happen frequently, it can cause significant health issues. About 10 per cent of patients with sleep paralysis fall in this category. Due to the adverse impact of sleep paralysis, they start to show deficiencies in their professional and personal lives.

Treatment

There is no specific treatment for sleep paralysis. It is all about identifying what factor may be causing the episodes and taking steps to address them. If this is some underlying psychiatric condition, it needs to be treated. If it is due to lifestyle factors, those need to be modified. No medication will help, and consulting a doctor is advised if sleep paralysis starts to significantly hamper daily life.

Additionally, people experiencing sleep paralysis may try a few things. Even though victims cannot move their muscles during an episode, they can still move their eyes. So, some sleep experts suggest trying to look around. Having a sense of familiar surroundings may help to reduce the stress and terror.

Also, sometimes it is possible to move some parts of the body. As a preventive measure, it is important to have a sound sleep, sleeping in a dark room, avoiding heavy exercise, meals, and stimulating beverages just before going to sleep, staying away from phones and television before bedtime. Regular exercise during the daytime, even walking half an hour in the morning will also go a long way to facilitate sleep.

In the end, sleep paralysis is something that many of us do not often talk about. Probably some people may not even differentiate it from a nightmare. But sleep paralysis is a separate entity; and while it may not be physically serious, in our mind, it may have a very negative impact. Brushing off the old superstitious beliefs and learning and implementing preventives measures are imperative to get rid of this.

Imtiaz Ahmed has completed MBBS from Dhaka Medical College.

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