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The ‘Monstrous’ Sleep Paralysis

By Adaobi Rhema Oguejiofor

Ever woken up in the middle of the night, feeling paralyzed, unable to move or even speak, feeling trapped in your own body and unable to scream or cry out for help despite wanting to? Well, according to medical science, such a terrifying occurrence is not a monster or nightmare but a sleep disorder referred to as sleep paralysis, a condition marked by a brief loss of muscle control, known as atonia.

Normally, during the Rapid Eye Movement (REM) sleep, which is also referred to as dream sleep, a healthy brain triggers temporary muscle atonia, essentially paralyzing the body to prevent people from acting out their dreams and potentially injuring themselves. However, when someone wakes up during REM sleep while this muscle atonia is still taking place, sleep paralysis happens. The person is aware of their surroundings but cannot move their body and this situation can be a very frightening experience.

Sleep paralysis usually occurs just as a person is falling asleep, which is referred to as a hypnagogic state or while waking up, which is called a hypnopompic state; and it is a result of the body and mind being out of sync. What makes it more terrifying is that, while experiencing sleep paralysis, a person might encounter audio and visual hallucinations, as well as a sensation of suffocation, which can cause significant distress.

When this happens to a person, he/she may feel like someone is holding him/her down in the sleep or like they are touching, hearing, smelling, or seeing people or things that are not really there. This can last for seconds to minutes, leaving the victim feeling anxious, scared, or even with a feeling like he/she will die or is already dead. When sleep paralysis takes place, the victim is aware of the ongoing experience, but is incapable of doing anything to control it. Sleep paralysis episodes can last for a period of 30 seconds to some minutes, although those experiencing it might feel it lasted for a longer time.

According to a neurologist and sleep medicine specialist, Dr. Brandon Peters, most people who experience sleep paralysis do not normally experience it often and when they do, the cause is most often fairly harmless with no serious risks. However, some conditions that can affect the health may also cause sleep paralysis, which is why victims should see a healthcare provider if they experience it.

Medical experts have grouped sleep paralysis cases into two categories comprising the isolated sleep paralysis and the recurrent sleep paralysis. The isolated sleep paralysis is a one-off sleep paralysis episode that is not connected to an underlying diagnosis of narcolepsy, a neurological disorder that prevents the brain from properly controlling wakefulness, which often leads to sleep paralysis. The recurrent sleep paralysis on the other hand, is a condition involving multiple sleep paralysis episodes over time and it can be associated with narcolepsy.

In many cases, these two defining categories are combined to describe a condition called Recurrent Isolated Sleep Paralysis (RISP), which involves ongoing instances of sleep paralysis in someone who does not have narcolepsy.

Although this condition is not life-threatening for most people, it can lead to anxiety and emotional distress. It is classified as a mild or harmless condition that usually does not happen frequently enough to cause significant health effects. However, an estimated 10 per cent of people have more recurrent or bothersome episodes that make sleep paralysis a troubling condition, which could result in victims developing negative thoughts about going to bed, reducing time allotted for sleep or provoking anxiety around bedtime which makes it harder to get restful sleep. This, resulting in sleep deprivation, can further lead to excessive daytime sleepiness and numerous other consequences for a person’s overall health.

While sleep deprivation and irregular sleep schedules can increase the risk of sleep paralysis, people with certain mental health conditions like anxiety or depression may be more prone to the condition.

The main symptom of sleep paralysis is atonia, or the inability to move the body or speak. However, victims have even reported difficulty breathing, chest pressure, and distressing emotions like panic or helplessness as symptoms experienced during sleep paralysis episodes. It is also common to feel excessively sleepy or fatigued the day after experiencing sleep paralysis. Likewise, during sleep paralysis, hallucinations could occur. Such hallucinations fall into three categories, namely, intruder hallucinations, chest pressure hallucinations, and vestibular-motor hallucinations.

Intruder hallucinations involve the perception of a dangerous person or presence in the room, while chest pressure hallucinations, which is also called incubus hallucinations, may incite feelings of suffocation or the sensation that someone is sitting on the victims’ chest. This type of hallucination frequently occurs in line with intruder hallucinations. The Vestibular-motor (V-M) hallucination on the other hand, can include feelings of movement, such as flying, or out-of-body sensations.

It is estimated that 75 per cent of sleep paralysis episodes also involve hallucinations that are distinct from typical dreams. These can occur as hypnagogic hallucinations when falling asleep or as hypnopompic hallucinations when waking up.

The prevalence of the condition varies. It can occur at any age, but the first symptoms often show up in childhood, adolescence, or young adulthood. After starting during teenage years, episodes may occur more frequently in a person’s 20s and 30s. According to a Dr. Niyi Iyizoba, four out of 10 people will experience at least one sleep paralysis episode in their life time.

A psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine, Dr. Alex Dimitriu, in an article on sleep disorders noted that, the first step in treating sleep paralysis is speaking with a doctor in order to identify and address any underlying problems that may be contributing to the frequency or severity of episodes.

Generally, there is limited scientific evidence about the most effective treatment for sleep paralysis. Many people are unaware that the condition is relatively common and therefore, feel ashamed after episodes. As a result of this, acknowledgment and normalization of their symptoms by a doctor can be beneficial.

Improving sleep hygiene is a common focus in preventing sleep paralysis because of the connection between sleep paralysis and general sleeping problems. There are a number of sleep hygiene techniques that can contribute to better sleep quality and more consistent nightly rest. It is also important to establish a routine. This can be implemented by following the same schedule for going to bed and waking up every day, including on weekends. A soothing pre-bed routine can help one get comfortable and relaxed.

Optimizing one’s sleep space can also be a way to treat as well as prevent sleep paralysis. Getting the best mattress and pillow that suits a person’s needs is of utmost importance. It is also useful to design the bedroom to have limited intrusion from light or noise. People should also restrain from substance use by reducing alcohol and caffeine consumption, especially in the evening. It is also essential to remove distractions like putting away electronic devices, including smartphones, for at least an hour before going to sleep.

Improving sleep hygiene is frequently incorporated into cognitive behavioral therapy for insomnia (CBT-I), a type of talk therapy that works to reframe negative thoughts and emotions that detract from sleep. A specific form of CBT has been developed for sleep paralysis, but more research is needed to validate its effectiveness. CBT has an established track record in addressing mental health conditions like anxiety and Post Traumatic Stress Disorder (PTSD) that may be factors influencing the risk of sleep paralysis.

Also, few medications are known to suppress REM sleep, and they may help to stop sleep paralysis. These medications can have side effects, and may cause a rebound in REM sleep when someone stops taking them. For these reasons, it is important to talk with a doctor or sleep specialist before taking any medication in order to discuss its potential benefits and downsides.

In Nigeria, studies suggest that sleep paralysis is a fairly common phenomenon. In one study, which was carried out on the patterns of isolated sleep paralysis among Nigerian medical students, it was revealed that only about 26.1 per cent of the 164 students the study was carried out on were affected.

While sleep paralysis is not considered a disease on its own, it is not a monster either. It is a sleep disorder that is real but manageable. It is important to consult a doctor or sleep specialist to discuss treatment options and improve one’s sleep hygiene if one experiences it frequently. Overall, it is a condition that can be overcome.