Recently, thanks to television series and books on the subject, an increase in knowledge and interest from the general public regarding the phenomenon of sleep paralysis (Sharpless, 2016) was able to appreciate.
The feeling of being conscious during sleep while the body remains paralyzed is a phenomenon known since ancient times and reported in various peoples in the world. So present that almost explanations and related remedies have been provided in every human culture.
Historically the sleep paralysis He has always taken on magical and supernatural contours. The difficulty of explaining this condition of mental supervision, while the body remains dormant has favored the emergence of theories and explanations linked to the presence of demons, called nightmares and juiches, evil or alien kidnappings (clancy, 2007).
In recent years, however, the interest in this disorder has also increased in the scientific world allowing to identify physiological causes and potential therapeutic interventions (Sharpless & Grom, 2015).
What is sleep paralysis?
Sleep paralysis is defined as a period of time, during falling asleep or awakening, in which the voluntary musculature is inhibited, but the ability of voluntary eye movements is present (Aasm, 2005).
It is characterized by a persistence of muscle atony typical of the REM stages of sleep during (semi-) vigil.
In this state, the person can experience bizarre phenomena such as visual and hearing hallucinations, feeling of being out of the body, a sense of levitation, warning the presence of intruders (often shadows) inside the bedroom (Jalal, 2016).
In addition, the sensations of oppression to the chest and difficulty breathing are common to breathe which, however, can be explained by the respiratory rhythm taken by the body during the Rem phase and which persists despite the vigil.
The association between somatic symptoms of the Rem phase combined with the awareness of not being able to move produces a response of fear in the brain (attack-attack response) which, given the immobility, not infrequently exacerbates symptoms and agitation.
Prevalence of the phenomenon
According to a recent prevalence study that considered about 36000 participants 7.6% of the general population experienced at least once in a life an episode of night paralysis (Sharpless & Barber, 2011).
The highest rates of prevalence in the course of life are detected in psychiatric patients (31.9%) with a greater frequency in women than men.
Causes and disorders associated with paralysis in sleep
On the physiological level, during deep sleep (REM), some parts of the brain (dorsolateral bridge and the ventromedial marrow) inhibit the motor neurons of the spine, reducing the tone of the skeletal muscles. This in order to prevent movements that could hurt the person while sleeping.
However, it may happen that muscle inhibition on the one hand and perceptual system, eye and respiratory movements on the other, are not synchronized, leaving the person awake, but unable to move. State that invariably resolves in a few minutes of waiting.
On the clinical level, night paralysis can be present in some disorders such as narcolepsy, of which it is a possible indicator, the abuse of substances or in convulsive syndromes. Often, however, it can present itself without other related disorders and in such cases it is called isolated sleep paralysis (PSI).
As mentioned, the episodes of sleep paralysis are characterized by the vividness of the senses and commonly associate with hallucinatory phenomena during the REM phase of the sleep cycle.
When hallucinations are present, literature indicates that about 30% of the time the contents of these phenomena are very frightening for the person and, more generally, sleep paralysis is associated in 90% of cases with intense emotions of fear and terror.
In a 2010 study, Sharpless and colleagues found that in 12.8% of cases the anniversary of paralysis episodes was associated with panic attacks.
Diagnosis of isolated and recurring sleep paralysis
In itself there is no international coding that identifies the diagnosis of isolated sleep paralysis episodes. However, these episodes are necessary to put a diagnosis of Recurrent isolated sleep paralysis (Sharpless, 2016).
In other words, the single episode of sleep paralysis is not considered indicative of a diagnosis, it assumes relevance when it is repeated over time.
The diagnostic investigation is mainly based on semi-structured interviews and questionnaires that investigate the characteristics of the episodes and their frequency, as well as the possible presence of other psychiatric disorders.
Two elements are necessary in particular to do diagnosis of recurring isolated sleep paralysis:
- The presence of multiple episodes of isolated sleep paralysis: at least 2 episodes in the last 6 months.
- The discomfort (anxiety or fear) tried before bedtime or during each episode. Some examples of this discomfort concern the catastrophic implications of an episode (“I am going crazy”, “the paralysis will be permanent”), avoidance behaviors (minimize sleep hours) and any negative consequences of these episodes such as shame, anxiety attacks or daytime sleepiness.
Risk factors
Compared to the factors that favor the onset of this disorder, it is not surprising that several sleep disorders are associated with sleep paralysis. Among these, idiopathic hypersonnia, sleeping insufficiency syndrome and apnea/sleep hypopneous sleep.
As far as a general association with psychiatric disorders has been traced, the strongest relationship, although not necessarily causal, was established with the Post-traumatic stress disorder and with a story of repeated trauma.
Furthermore, the provisional sensitivity to experience anxiety (Anxiety Sensitità) that is, the fear of the cognitive and physical consequences of the states of anxiety seems a potential etiological factor.
In fact, sleep paralysis is traced in many anxiety disorders such as the panic disorderThe Generalized anxiety disorder and the social anxiety disorder (Jalal, 2016).
Finally, it seems that some personality traits can represent risk factors for sleep paralysis, for example the propensity for dissociation or to believe in paranormal or supernatural experiences.
The treatment of recurring isolated sleep paralysis
Literature shows how only a limited amount of people with a recurring isolated sleep paralysis looking for a treatment (Jalal, 2016).
On the other hand, an intervention is recommended exclusively in cases where subjective suffering reaches levels such as to interfere with daily life (Sharp, 2016).
To date, there are mainly two types of treatments: pharmacological and psychotherapeutic.
Pharmacological interventions
On the pharmacological level, some antidepressant drugs such as Triciclicles and inhibitors of the Ricapation of serotonin (SSRI) (Sharpless, 2016) showed a certain effectiveness.
However, it is necessary to say that these drugs have been mainly studied in people with concomitant narcolepsy therefore limiting their clarity regarding therapeutic mechanisms.
In addition, to date there is no drug that can totally eliminate the appearance of episodes of sleep paralysis.
Psychotherapeutic interventions
On the psychotherapeutic level, the cognitive-behavioral treatment of recurring isolated sleep paralysis is the only one that reports promising scientific evidence (Sharpless & Doghramji, 2015; Jalal, 2016).
In 2015 Sharlects and Doghramji developed a cognitive-behavioral protocol for the treatment of isolated sleep paralysis episodes (CBT-ISP) which is structured in four phases.
Phase 1
First of all, it provides for the sharing of accurate and reliable information on the syndrome. In summary it is important to remember that:
- It is a frequent phenomenon and many people experience at least one episode of sleep paralysis in their lives;
- However deeply unpleasant each episode is harmless and passenger;
- It is not indicative of a worsening of one’s mental health.
Phase 2
The second step is to intervene on the proximal causes of sleep paralysis, that is, the alteration of the regularity of sleep.
Therefore, clinical and patient discuss the appropriate behavioral changes in order to recover a good sleep quality.
In this sense, cognitive-behavioral of sleep hygiene strategies and techniques are very used (e.g. to bed and get up at the same time, avoid taking alcohol and stimulating, avoid the supine/prone position during sleep).
If the presence of insomnia is detected, it can be considered a specific treatment for it.
Phase 3
The third phase provides an accurate monitoring of the episodes and the sharing of the elements that support the discomfort connected to the sleep paralysis.
In other words, the maintenance factors that contribute to the unleashing of panic and fear during the episode are identified, for example the catastrophic interpretation of physical sensations.
Phase 4
The fourth phase focuses on the increase in the person’s ability to manage fear during episodes and reactivate the voluntary movements of the body as soon as possible.
This is obtained through the teaching of diaphragmatic breathing, the progressive muscle relaxationthe calming internal dialogue and the conscious use of distraction.
In addition, in order to manage hallucinations, the management of attention is taught through the Mindfulness meditation.
Some research (Jalal, 2016; Jalal et al., 2020), in fact, seem to indicate that focusing attention on positive internal aspects (e.g. pleasant memories) during the paralysis drastically reduces the presence of hallucinations that, we remember, are the by -product of the state of sleep of Rem and, in all, assimilable to dreams.
Conclusions
Sleep paralysis is an experience that can upset those who experience it, especially in the event that they cannot give it a rational explanation.
However, to date, sleep paralysis is a known phenomenon for which increasingly effective management therapies are developing.
Therefore, if you suffer from it, it is important to contact a professional who can evaluate the situation and guide the person towards an improvement in his own quality of life.
Bibliography
- American Academy of Sleep Medicine. (2005). International Ranks of Sleep Disorders: Diagnostic & Coding Manual (2nd ed.). Darien, the: American Academy of Sleep Medicine.
- Jalal, B. (2016). How to make the ghosts in My Bedroom Disappear? Focused-Attention Meditation Combined with muscle relaxation (Mr Therapy) —A Direct Treatment Intervention for Sleep Paralysis. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00028
- Jalal, B., Moruzzi, L., Zangrandi, A., Filardi, M., Franceschini, C., Pizza, F., & Plazzi, G. (2020). Meditation-Relaxation (Mr Therapy) For Sleep Paralysis: A Pilot Study in Patients with Narcolepsy. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.00922
- Sharpless, B. (2016). A clinician & rsquo; s guide to recurrent isolated sleep paralysis. Neuropsychiatric dull and triatment, Volume 121761-1767. https://doi.org/10.2147/ndt.s100307
- Sharpless, B., & Barber, J. (2011). Lifetime previore Rates of Sleep Paralysis: A Systematic Review. Sleep Medicine Reviews, 15(5), 311-315. https://doi.org/10.1016/j.smrv.2011.01.007
- Sharpless, B., & Doghramji, K. (2015). Sleep Paralysis: Historical, Psychological, and Medical Perspectives (1st ed.). Oxford University Press.
- Sharpless, B., & Grom, J. (2014). Isolated Sleep Paralysis: Fear, Prevention, and Disruption. Behavoral Sleep Medicine, 14(2), 134-139. https://doi.org/10.1080/15402002.2014.963583
