WHAT IS SLEEP PARALYSIS?
Sleep paralysis, a disorder of the nervous system that affects individuals both young and old, which is a temporary loss of control during sleep also known as atonia, is a widely mysterious disorder but recognized as a medical condition, which happens shortly after falling asleep or waking up. In this disorder an individual is aware but unable to move or talk, the individual can also experience hallucinations or suffocation during this period of time. It is also known as a sleep disorder.
Recurrent isolated sleep paralysis is a type of parasomnia (abnormal behaviors during sleep) it is considered to be a Rapid Eye Movement (REM) parasomnia which involves undesired events that come along with sleep. An episode of sleep paralysis lasts for a few seconds or minutes and causes one to be unable to speak, or to move the arms and legs, body, and head. The patient can still breathe normally and be aware of what is happening.
The episode usually ends on its own, or when someone touches or speaks to the person having the dream. Most sleep paralysis occurs when individuals sleep on their back, and when they lay in a supine position. It can also be a form of substance abuse and mental disorder. Research has shown that sleep paralysis involves a mixed state of consciousness, which blends both wakefulness and REM sleep.
TYPES OF SLEEP PARALYSIS
The various types of sleep paralysis are:
- Hypnagogic Sleep Paralysis /Wakefulness-sleep transition (WST): it occurs when and individual is drifting off to sleep which is the transitional state from wakefulness to sleep and typically people become less and less aware of the fact that they are conscious until they slip into the first non REM stage of sleep, in this type of paralysis the brain is conscious while the body is in a paralytic state. Symptoms include having the imagery that they spent so much time on showing in their image (Tetris effect) and sudden involuntary contraction of the muscle (hypnic jerk).
- Hypnopompic Sleep Paralysis/Postdormital sleep paralysis: it occurs when the individual is waking up from sleep which is the transitional state from sleep to wakefulness, the mind of the individual is awake before the muscles become awakened, as the individual nears the end of the REM stage of sleep. Symptoms include excessive daytime drowsiness and loss of muscle control.
CAUSES OF SLEEEP PARALYSIS
The condition is rarely caused by any directly life-threatening conditions, but there are some related factors which could cause the occurrence, which are listed below:
- Anxiety disorders, panic disorder and post-traumatic stress disorder (PTSD).
- Obstructed sleep apnea
- Nighttime leg cramps
- Narcolepsy(chronic disorder of sleep, characterized by overwhelming daytime drowsiness and sudden attacks during sleep)
- Insomnia(having difficulty in sleeping)
- Sleeping on your back(supine position)
- Sleep Deprivation
- Substance abuse
- Irregular sleeping patterns; shift workers or jet lag
- Bipolar disorder especially the manic disorder( feeling of euphoria)
SYMPTOMS OF SLEEP PARALYSIS
The main symptom of sleep paralysis is the inability of waking up, moving and talking until someone taps on the individual. Other symptoms are:
- Intruder hallucinations (feeling of a dangerous person in the room)
- Vestibular-motor (V-M) hallucinations( it includes the feeling of movement or things flying in the rom)
- Chest pressure hallucinations also known as incubus hallucination (feeling of suffocation of the individual)
- Difficulty in breathing
- Sense of death or doom
- Conscious wakefulness while paralyzed
DIAGNOSIS OF SLEEP PARALYSIS
Diagnosing sleep paralysis is done by thorough observations and running various tests which are listed below:
- History taking: it is done by the medical personnel asking various questions regarding the onsets, duration and how frequent the sleep paralysis has been occurring. Also questions relating to medical history, psychiatric history, family history and drug history are asked.
- Physical examination: it is required to do this examination to assess the individual thought and hear what the person has to say if there speech is coherent, their gait and other necessary things.
- Polysomnogram: It is an overnight sleep study done to access the brain waves, heartbeat, respiration, oxygen saturation, chin muscle activity and leg activity of the individual as they sleep.
- Electromyogram (EMG): it is a test done to record the electrical activities of the muscle, which seems to be low during an episode of sleep paralysis.
- Multiple Sleep Latency Test (MSLT): it is a test done to measure how often you sleep and the type of sleep you experience done during the day when an individual is taking a nap to differentiate between the narcolepsy and sleep paralysis.
- Sleep diary: it is tracking the time you went to bed, how frequent you woke up during the night and when you woke up in the morning.
- Actigraphy: it is a noninvasive method of monitoring human rest/activity cycles. A small actigraph unit, also called an actimetry sensor, is worn for a week or more to measure gross motor activity records and monitors the activities that go on during sleep.
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI) of the brain
- Electrocardiogram (ECG)
PREVENTION OF SLEEP PARALYSIS
Sleep paralysis can be prevented through the following means highlighted below:
- Adopt a good and regular sleeping pattern, by maintain the normal sleeping hours of six to eight hours.
- Go to bed at roughly the same time each night, and get up at the same time each morning.
- Sleep in a comfortable environment, cool and dark not hot and everywhere with light.
- Avoid heavy meals, smoking, or drinking alcohol or caffeine shortly before going to bed.
- Exercise regularly.
- Avoid sleeping on your back, sleep on your side to avoid the sleep paralysis.
- Putting away electronic devices, including cell phones, for at least a half-hour before bed.
WHAT TO DO WHEN THE SLEEP PARALYSIS HAS OCCURRED
- Stay calm during a sleep paralysis attack by trying to relax and breathe normally. This is the most important factor to reduce the length and intensity of an attack.
- Begin by intensely moving one small muscle, such as the little finger of your hand or toe, which can lead to a tiny movement that can break the paralysis and end the attack.
- Try and disengage yourself from the attack. Instead of allowing yourself to become immersed and victimized in the attack, adopt a third person stance by observing your body and the environment as clear as possible. This makes the experience less overwhelming and frightening.
TREATMENT OF SLEEP PARALYSIS
The treatment of sleep paralysis is cause specific. If, sleep deprivation is the cause, maintain a regular sleep pattern of six to eight hours every day. So sleep paralysis is treated according to the causes of the disorder said by the individual.
When sleep paralysis becomes very severe, antidepressant medications are prescribed like clomipramine to help reduce or eliminate deep sleep; it is usually prescribed in low dose to an individual.
Foe an individual with sleep paralysis, cognitive behavioral therapy for insomnia is recommended to be carried out, a type of talk therapy that works to reframe negative thoughts and emotions that detract from sleep.
Antimanic agent such as Lithobid ( Pro) are recommended by the doctor, which are used to manage bipolar disorder as it is one of the causes of sleep paralysis.