Sleep paralysis is a sleep disorder during which the affected person is completely unable to move his or her body for a short period of time. The disorder is not dangerous and usually occurs in isolation, but sometimes occurs in conjunction with other sleep disorders such as narcolepsy.
What is sleep paralysis?
Sleep paralysis refers to the condition of temporary inability to move that begins during or just before falling asleep. Sleep paralysis sets in when the person transitions between periods of wakefulness and sleep. For seconds or even minutes, sufferers are unable to move or speak. It is not uncommon for them to feel a state of shock or panic during this time. A sleep disorder, such as sleep paralysis, often occurs together with other sleep disorders, such as narcolepsy. Physical and psychological symptoms combine during sleep paralysis to create a horrific state for those affected. Individuals often report physical rigidity in the twilight state, combined with an uneasy feeling that an intruder is entering the room. Sleep paralysis may occur in association with psychological or physical disorders such as anxiety disorders or migraines.
Causes
It is estimated that one in three people will experience sleep paralysis during their lifetime. To understand the causes of sleep paralysis, it is important to keep in mind that a transitional phase still exists between the awake and asleep states of consciousness. In this phase, components of the waking state still exist, such as information about the environment, but information from the dream state already overlaps here. Normally, this transition proceeds without problems. Sleep paralysis is associated with the REM phase. Also during this phase, dreams are acted out only through the eyes. It is believed that some psychological disorders or disturbances in sleep behavior may contribute to sleep paralysis. These include depression, anxiety disorders, stress, narcolepsy, and drug or alcohol abuse.
Symptoms, complaints, and signs
During sleep paralysis, the affected person cannot move. Doctors speak of clinical sleep paralysis in the sense of a sleep disorder only when this condition occurs while the affected person is awake. Prolonged sleep paralysis can occur alone or as part of another sleep disorder. If another sleep disorder is present, additional symptoms are possible, for example, problems falling asleep and staying asleep or daytime sleepiness. In predormitory sleep paralysis, sleep rigidity occurs before falling asleep, whereas postdormitory sleep paralysis is characterized by paralysis after waking. The affected person is often aware of his or her surroundings during this process, but he or she is unable to move or speak. Some sufferers feel as if they are outside their own body, looking down at their body from above or to the side. Neuropsychological symptoms such as hallucinations may occur during sleep paralysis. In a hallucination, the patient perceives sensory impressions for which there is no adequate stimulus. For example, affected individuals may hear voices or see objects, people, and movements that are not real during sleep paralysis. Patients may also have the impression that they are being touched or poked with a pointed object. Such and similar perceptions fall into the realm of tactile hallucinations. Other possible symptoms of sleep paralysis include fear, panic, and anxiety. Some sufferers feel their breathing unusually clearly or have the sensation of not being able to breathe.
Diagnosis and course
Sleep paralysis is diagnosed by ruling out other sleep disorders by their individual symptoms. Special focus is placed on narcolepsy, as this disorder is associated with sleep paralysis in many cases. However, the genetic test for narcolepsy makes it easy to rule out this disorder. When other possible sleep disorders are to be ruled out, the individual’s experiences and symptoms are compared with well-documented experiences of countless other patients. If there is a match in several aspects, sleep paralysis can be diagnosed.Furthermore, the physician may ask the patient to keep a journal of his or her sleep habits and experiences; discuss his or her own and family’s medical history of sleep disorders; recommend a referral to a sleep specialist, who may perform some tests that require overnight stays in a sleep laboratory.
Complications
Sleep paralysis does not usually cause major complications. Many affected individuals panic when they are awake but unable to move. Combined with the hallucinations and nightmares that sometimes occur, this can cause a state of shock in some circumstances. Recurrent sleep paralysis may cause sleep disturbances. In the long term, the symptomatology may promote anxiety, stress, and possibly depression. Very rarely, sleep paralysis can cause an acute panic attack. The sudden startling can cause accidents, leading to further health complications. Physically weakened individuals may suffer cardiovascular problems as a result of the sleep paralysis. When treating sleep paralysis, the risks come from inappropriate self-treatment. For example, sufferers tackle the sleep disorder with the help of sleep medications or alcohol, which can lead to addictive behaviors and eventually addiction. Natural sedatives such as valerian can cause itching, reddening of the skin, and headaches if overdosed. Last, individuals with recurrent sleep paralysis often stay awake longer or sleep too little – sleep deprivation occurs and stress levels increase. In addition, lack of sleep promotes mental illness and often leads to accidents in everyday life and at work.
When should you go to the doctor?
If the affected person experiences periods of immobility, he or she should talk to a doctor. A diagnosis is necessary so that serious illnesses can be ruled out and education can be provided for dealing with the symptoms in everyday life. In case of anxiety, panic feelings or a sleep disorder, the affected person needs help. If stressful situations arise in everyday life due to the inability to move, or if there is a change in sleeping habits, a doctor is needed. Fatigue, loss of concentration or attention are worrisome. If there is a decrease in cognitive or physical performance, a consultation with a physician should take place. If the daily demands can no longer be met, if the affected person has headaches or migraines, and if he or she suffers from a general feeling of illness, help is needed. The disease manifests itself in connection with the natural sleep process. Therefore, the complaints present themselves immediately before falling asleep and should be presented to a doctor. If the limbs can no longer be controlled voluntarily, this is a sign of a health irregularity. Sensory disturbances, irregularities in sensitivity, or changes in breathing perception are characteristic of sleep paralysis and should therefore be discussed with a physician. Hearing voices, hallucinations or regional paralysis are considered indications of the disease. If the symptoms occur repeatedly, a physician is needed.
Treatment and therapy
Sleep paralysis is not dangerous. For most people who have this unfamiliar experience, it is already enough to be basically educated about the disorder and thereby know that nothing dangerous is happening to them. In most cases, sleep paralysis occurs in isolation and without symptoms of other disorders. However, when it occurs along with narcolepsy, a disorder that causes severe fatigue and periods of sleep during the day, sometimes associated with hallucinations, special treatment must be provided. A major problem in sleep paralysis is certainly the lack of understanding of what is happening to the affected person. Many experience panic, shock, and fear of going back to sleep. It is advisable to work with a specialist to find out what the individual causes are that can trigger sleep paralysis. Sleep paralysis sets in more often in people when they are lying on their backs; well-regulated sleep hygiene should also be observed.This includes various factors, for example : in bed should be exclusively asleep, no late meals, etc.
Prevention
In addition to individual treatment of sleep paralysis, many components of healthy sleep hygiene are also considered solid prevention of the disorder. These include scheduling adequate sleep during the night. Most people need 7 to 9 hours. Heavy meals, alcohol or caffeine before sleep also have a negative effect, as does watching television in bed.
Aftercare
Sleep paralysis, even if it has occurred regularly, has no physical health consequences. Nevertheless, follow-up treatment may be indicated, especially if sleep paralysis occurs repeatedly. It depends on whether or not psychological sequelae have resulted from the sleep paralysis. The conscious experience of one or more sleep paralyses may trigger anxiety disorders and depression, fear of falling asleep, and even fear of a waking coma. If such a mental illness has developed as a result of the sleep paralysis, it must be treated. Treatment should consist of drug therapy with anti-anxiety medications and, if necessary, antidepressants, as well as non-drug therapy in which the fears associated with sleep paralysis are intensively worked through. In particular, if there is a fear of sleeping, the administration of sleeping pills (Z-drugs, benzodiazepines) may additionally be necessary at the beginning of the therapy to enable the affected person to fall asleep. Behavioral therapy to learn to cope with the anxiety may also be helpful. In addition, certain breathing, meditation, and relaxation techniques (Jacobsen progressive muscle relaxation, yoga) can be learned to help combat the anxiety and actively enable the person to fall asleep.
Here’s what you can do yourself
Sleep paralysis is usually harmless and subsides on its own after a few minutes. Sufferers can combat the paralysis by consciously moving a part of their body. The eyes should be opened and moved so that the body can adjust to the unfamiliar situation. Likewise, mantras recited after waking up help. In 60 percent of cases, sleep paralysis occurs in the supine position. Affected people sleep best on their stomach or side to reduce the likelihood of sleep paralysis. A sleep phase alarm clock helps to wake up during the sleep phases in which sleep paralysis occurs. An active daily routine with enough exercise and variety can also reduce nighttime paralysis symptoms. Similarly, calming teas and relaxation exercises before bedtime help. Progressive muscle relaxation relieves tension and prevents the body from tensing up during sleep. If sleep paralysis occurs repeatedly, a visit to the doctor is recommended. Sometimes the unpleasant paralysis is due to an illness or the use of medication. The physician can clarify and treat the causes. If the symptoms persist, brain waves are measured in a sleep laboratory, which can identify psychological triggers of the sleep disorders. In individual cases, psychological complaints underlie the sleep paralysis, which must be clarified.