Sleep paralysis: All you should know

Did you ever wake up suffocated, in the middle of the night, under a weighted chest while rigorously trying to move and scream? If so, chances are that you have encountered sleep paralysis.

But you are not alone. It is a very common condition. 7.6% of the general population suffers from sleep paralysis. Well, that's a huge number of people.

In this post, you will come to know all about what sleep paralysis is, its symptoms, types, causes, risk factors, and how you can cope with it.

So wasting no time, let’s dig in.

What is sleep paralysis?

Sleep paralysis is the state in which your body cannot move while you are awake. It occurs while waking up (hypnopompic or post dormital) or falling asleep (hypnagogic or predormital).

But why can't your body move?

That’s because of atonia. Sleep paralysis occurs during the REM phase of the sleep cycle. And atonia also occurs during this phase.

Because of atonia, there is a loss in your muscle strength. That’s why your body is unable to move.

So what can you do to break the paralysis?

Sleep paralysis is temporary and usually lasts from 1 to 6 minutes. But it may end suddenly because of your intense effort to break the paralysis, or by someone else's touch or voice.

It has always revolved around paranormal stories of demons, or evil shadow intruders, or alien abductors. Even the old hag in William Shakespeare's ‘Romeo and Juliet’ was a portrayal of this condition.

Since it falls under the category of parasomnias and occurs during the REM phase, we often term it as sleep parasomnia or REM parasomnia.

Types of sleep paralysis

· Hypnopompic: It occurs when the person is waking up from sleep. In this state, the person wakes up before the end of the REM stage of the sleep cycle. Thus, the body remains paralyzed because of atonia.

· Hypnagogic: It occurs when the person is falling asleep. During this stage, the mind and body relax. The body tends to enter the NREM( non- rapid eye movement) stage of the sleep cycle. If the body wakes up during this phase it won’t be able to move.

· Isolated sleep paralysis (ISP): It occurs in patients who don’t have narcolepsy or narcoleptic syndrome. Narcolepsy is a chronic disorder where a person sleeps excessively during the daytime.

· Recurrent isolated sleep paralysis (RISP): In this case, the person encounters multiple episodes of sleep paralysis a day. It is less common compared to the ISP.

What are the symptoms of sleep paralysis?

The inability to move when you are awake is one of the major symptoms of the disorder.

Other symptoms, in general, are divided into three categories:

Intruder: It includes hallucinations accompanied by hearing sounds (humming, hissing, etc.), seeing certain figures often referred to as evil shadows, demons, or threatening intruders.

Incubus: This includes symptoms of intense fear, sweating, pain, and suffocation.

Many people even experience feelings of physical and sexual assault. The victim feels like he is about to die.

Vestibular motor: In this case, some people experience impossible experiences of floating/ flying in the air, spinning, feelings of bliss, or out of

body experiences.

Who can develop sleep paralysis?

It can develop in both teens and adults. 23.8% of students have been through at least one episode of sleep paralysis.

A completely healthy person can also become a victim of this phenomenon.

So, what triggers sleep paralysis?

Here are some risk factors that would help you diagnose this condition better:

· It is genetic. In a recent study, out of 862 people aged 22-33 yrs., 53% showed genetic inheritance of sleep paralysis. This means if someone in your family tree has the disorder chances are that you may also develop it.

· It is a symptom observed in people with narcolepsy or narcoleptic syndrome. But people with sleep paralysis might not necessarily have narcolepsy.

Other factors that may trigger sleep paralysis include-

· Sleep deprivation

· Sleeping on your back

· Abnormal sleep cycles

· Mental stress

· Insomnia, Sleep apnea, and other sleep disorders.

· Anxiety and panic attacks

· Depression and psychological stress

· Usage of drugs and alcohol

· Mental disorders such as bipolar disorder

Furthermore, people having trauma (arising from physical or sexual assaults), PTSD, are likely to have more episodes of this condition.

34.6% of patients with panic disorder are reported to have lifetime sleep paralysis.

What causes sleep paralysis?

Sleep paralysis tends to be linked with narcolepsy, sleep deprivation, and other such sleep disorders. But the exact cause for its occurrence is still unknown.

Some scientists believe that the disruption of the REM (rapid eye movement) stage of the sleep cycle can be a reason. REM is the phase that comes right after the NREM stage of the sleep cycle.

What are REM and NREM?

NREM is the first stage of the sleep cycle. It covers about 75% of the sleep cycle and lasts for about 90 minutes.

It is divided into four stages. In the first stage, your body starts to slowly fall asleep.

After passing through all the four stages, the body shifts to the REM stage.

REM is the deepest part of sleep where most of the active dreaming occurs. During REM your body enters into a state of paralysis known as REM atonia.

REM atonia causes a loss in muscle strength due to which the body gets paralyzed. The purpose behind this is to prevent your body to act out physically while dreaming. Otherwise, it may face injuries.

When you are awake before the REM phase ends, the body can’t move. That’s because even though the mind is conscious, the body is still paralyzed due to REM atonia.

Dr. Baland Jalal, Ph.D., Department of Psychiatry, University of Cambridge, and a former fellow at Harvard University says, “Sleep paralysis can unlock secrets about sleep and particularly how the transitioning of REM sleep and non-REM sleep occurs.”

Is sleep paralysis harmful?

Although sleep paralysis is associated with feelings of extreme fear and death, it isn’t harmful and can be prevented. There aren’t any such sleep demons or shadows or ghosts in real.

For instance, Dr. Michael J. Breus, Ph.D., a Clinical Psychologist and both a Diplomat of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine says, “Research has shown that sleep paralysis is not dangerous. It does not cause physical harm to the body and there are no clinical deaths known to date.”

So, you need not worry. By taking the necessary steps, you can successfully prevent this condition.

How to prevent sleep paralysis?

There are no specific reasons for its occurrence. It is only linked with improper sleep hygiene, sleep disorders, and mental health.

In most cases, by making small lifestyle changes and improving sleep hygiene, you can successfully prevent this condition.

Get treatment for sleep disorders that are linked to sleep paralysis like narcolepsy, sleep apnea, and insomnia, if you have any.

Take medications for mental health problems like depression, PTSD, anxiety, stress, and panic attacks.

In extreme cases, you may be advised to consult a doctor who specializes in sleep disorders.

What else?

Well, the best and the safest you can do is to get proper sleep, such as sleeping for 6-8 hours a day. Avoid sleeping on your back, exercise regularly, eat well, don’t eat late-night meals, and avoid alcohol and drugs.

What are some treatments for sleep paralysis?

In most cases, when you go for a doctor, it's better to take a sleep diary.

You may make it one to two weeks before you meet the doctor.

This will help the doctor to know your sleeping patterns, and detect sleep disorders, or other mental health problems, if you have any, and provide effective solutions.

There is no such drug that could completely cure the episodes of the paralysis.

In most cases, the medicines prescribed are used to treat other conditions related to sleep paralysis.

No trials have yet been made solely focussing on the treatment.

In extreme cases, tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) are prescribed. These are anti-depressants used for major depressive disorders.

Cognitive-behavioral therapy is also one of the ways adopted for the treatment of this paralysis.

Trials for GHB (gamma hydroxybutyrate) have been conducted to treat patients of narcolepsy which is an underlying condition for sleep paralysis. GHB is an anti-sleep medication.

Besides, Dr. Baland Jalal has developed one of the first-ever systemic therapies called Meditation-Relaxation Therapy, or MR, to help treat the parasomnia. Its purpose is to reduce anxiety caused as a result of sleep paralysis. He believes that it can also cure other sleep disorders like insomnia and nightmares.

Sleep paralysis is one of the most unpleasant things that can happen to anyone. And it can be scary as hell. If you are suffering from it, then begin by making small lifestyle changes, such as maintaining a good sleep schedule, regular exercise, etc. Otherwise, take help from a doctor. Although in some cases, episodes of sleep paralysis can't be completely cured, in most cases, it does get better.