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Sleep Disorders

Sleep Paralysis

07/06/2009

Question:

Hello. I am a 34 year old female and I have sleep paralysis every once in a while. I try to explain to people what happens when I do experience it but I see it in their eyes that they think I am crazy. Anyways, the onset of my episode last night happened relatively quickly. I was conscience and aware when it starts and I try to ride it out as long as I can until I just get frightened. I know I fell asleep very quickly. I `awoke` to the sensation of something rubbing up my legs which was a bit strange because there was no one in the room so I tried to move to check it out. I was sleeping on my back with my right arm up under my pillow and I was unable to move (which I have experienced before so I understand that part) but it was different this time. It felt like I was being held down. This frightened me so I do as I always do and make any noise to wake my body out of this. Such a weird gutteral sound I make to do this (of course I can hear myself all the while). Strangely enough I don`t know if my eyes are open or not but I can see everything during my experience as if I were awake. Then after with a racing heart and calming my nerves I try to go back to sleep and hope it doesn`t happen again because it is not so restful.

As much as I would like to attribute this to stresses I might have in my life whether it is work, lack of sleep, etc. I don`t think this is the case for me. I am mentally fit and don`t really do any one thing in excess that may explain this.

It is a weird and strange thing when it happens. I am just glad to be able to tell anyone that might understand some of this. Not really looking for answers because I feel it is different for each person. At least for me, sharing this is good enough. Thank you.

Answer:

I am glad you have written about your experience with sleep paralysis. As you said, it is different for everyone. And as you have experienced, sleep paralysis can be different from one episode to another. You describe an undesirable, frightful event that occurs during the transition between wakefulness and sleep. In general this is called a “parasomnia”.

You seem to have experience a combination of parasomnias, namely two: sleep paralysis and hypnopompic hallucination.

Sleep paralysis is a common finding in the general population. Ten percent of healthy adults experience one or more attacks during their lifetime. It is usually described as waking up from sleep but being completely paralyzed and unable to move other than the eyes and the breathing muscles. This lasts a few seconds to a few minutes (although it may feel like a longer duration). It is terminated suddenly, either by an external stimulus (such as an alarm clock or another person touching you) or spontaneously. Sleep-related hallucinations are a prominent, vivid, dream-like mentation that occur at sleep onset (called hypnagogic), or while waking up (called hypnopompic). These phenomena are also common (10-20% of the population) and may be associated with sleep paralysis. These hallucinations are visual most of the time, but may take the form of auditory and tactile equivalents such as hearing a “roaring” sound or feeling tingling or numbness.

The most common cause of parasomnias is sleep deprivation or sleep restriction. Inadequate sleep is becoming a common problem in our 24-hour active society. But sometimes, parasomnias may be caused by underlying sleep or neurological disorders. Probably the most common sleep disorder associated with the 2 symptoms of sleep paralysis and hypnopompic hallucinations is narcolepsy. This is invariably accompanied by excessive daytime sleepiness. However, other sleep disorders, such as sleep apnea (due to breathing disturbance during sleep), can precipitate and worsen parasomnias. Nocturnal partial seizures are seizures that occur only during sleep and may mimic certain parasomnias. Drugs, substances, and medical conditions may precipitate or may exacerbate many of these disorders of sleep.

Although disturbing, many people with parasomnias learn to adapt to their disorder, and don’t need any particular treatment. Rarely, certain medications are needed. These medications work by suppressing dream sleep.

The best bet against parasomnias is to get adequate amount and quality of sleep, and to keep regular sleep/wake schedule. If these problems persist despite getting 7-8 hours of sleep per day, further history, examination and possibly sleep investigation may be needed. This type of evaluation often starts with a visit to the primary care physician, but may require the help of a specialist in Sleep disorders.

For additional information and to find a sleep center close to you, please visit the American Academy of Sleep Medicine website.

Good luck and thank you for sharing.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University