Home HealthTopics Health Centers Reference Library Research
Join us on Facebook Join us on Facebook Share on Facebook

Sleep Disorders

Stress or a deeper problem?

06/30/2010

Question:

About three years ago, right before starting college, I had my first episode of the strangest dream. I fell asleep but every time I woke up, I would suddenly realize that I was still asleep. I was trapped and needed to get out. However, every time I pushed myself to wake up I would feel terrible increasing pain all over my body. I finally got out after about 4 tries and to break out, I had to endure the increasing pain for quite some time and bear through it. Since then, my sleeping problem has progressed. I can actually feel myself falling into paralysis and know exactly what to expect as I`m wholly conscious. Once about 30 seconds of the pain of falling into paralysis pass, I enter my dreamworld. Usually my dreams lead me to frightening things, though I have tried and partially succeeded in steering them into a certain direction. I know exactly what`s happening to me and I know what to do to get out of it. To get out, I have to endure extreme pain. It`s not a pain like any other, it feel both physical and emotional. I push hard as the pain increases and once it reaches a certain level, I snap out. I`ve tried experimenting to see if I can transition into full sleep but haven`t been very successful. I have also spent up to an hour in my dreams. From my research, this looks like a strange combination of hypnagogic hallucinations and sleep paralysis. I do also tend to experience this when my schedule is off and I`m going to sleep really late and very often when I sleep in daytime. What alarms me is the pain and exhaustion I feel after snapping out. My head feels extremely heavy and I can`t go back to sleep for some time. Actually, after getting out if I don`t continue to wake myself, I slip right back into paralysis and dream watching. Both of my temples feel like someone just drilled a hole in them. So is this all quite common due to stress and irregular time schedules or should I seek medical help? Also, is it normal to have the extreme headache afterwards?

Answer:

You are correct. You have sleep paralysis that is associated with hypnagogic/hypnapompic hallucinations. But you have 2 unusual features to your story: your paralysis occurs during sleep onset, and you experience pain during paralysis. 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. 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. But falling into paralysis as you are falling into sleep is not common. This is an indication of sleep-onset rapid eye movement (REM) sleep. Sleep onset REM can be a sign of a particular sleep disorder called: Narcolepsy.

Sleep related hallucinations are a prominent, vivid, dream-like mentation that occur at sleep onset (called Hypnagogic), or while waking up from sleep (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 tactile equivalents such as feeling tingling or numbness. But “pain” has not been described as one of those hallucinations. But remember, enough emotional pain may be difficult to handle and may appear to be quite physical for you.

The most common cause of parasomnias is sleep deprivation or sleep restriction as you mention. 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. For example, Sleep Apnea, which causes 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. This is similar to you when you try to “steer” these events into a certain direction. Rarely, certain medications are needed. These medications work by suppressing REM sleep.

The best bet against parasomnias is to get adequate amount and quality of sleep, and to have regular sleep/wake schedule. But because of the unusual features of your story the best approach starts with a visit to your doctor for a thorough history, and examination. Most likely, you will also need 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 we wish you the most restful sleep.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

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