Caught Between
Sleep and Paralysis
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
Ahmed BaHammam, FRCP, FCCP
Professor of Medicine
Director, Sleep Disorders Center
College of Medicine, King Saud University
Associate Editor, Ann Thoracic Med
