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 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
Dr. Ahmed
BaHammam
Director Sleep Disorders Center
King Khalid University Hospital
Associate Professor, College of Medicine, King Saud University
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