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Today, we will learn how to prevent sleep paralysis.
Sleeping is an essential activity in our daily lives. It is a state of reduced muscle activity and active functioning of the brain. While we are awake, the brain releases adenosine chemicals 1that induce drowsiness and put us to sleep.
Sleep paralysis, on the other hand, interferes with these two boundaries by temporarily disabling muscle control, also called muscle atonia resulting in paralysis.
1. What are the Stages of Sleep?
The standard sleep cycle involves two stages Rem Sleep and Non-rem sleep. Rem sleep or rapid eye movement sleep is a stage where you have vivid and intense dreams followed by low muscle activity, which prevents you from acting out in your dream.
2. What is Sleep Paralysis?
Sleep paralysis is a condition affecting REM sleep which causes parasomnia.2 In parasomnia, a person experiences disruptive sleep followed by abnormal behaviors such as talking, sleepwalking, etc. sleep paralysis can occur in one of the two phases
- when sleep paralysis happens as one is falling asleep, it is known as hypnagogic or preorbital form, which is the transition phase of consciousness between wakefulness and sleep
- Sleep paralysis occurs before waking up, and it is called hypnopompic, a transitional stage just before waking up.
3. Types of Sleep Paralysis
A person who has sleep paralysis experiences certain episodes of sleep paralysis where he cannot move his muscles or perform any action while still being connected to the environment.
One can breathe and move their eyes and sometimes experience or see things that don’t exist, creating hallucinations and making them more frightening.
Isolated sleep paralysis: In this type, the episodes of sleep paralysis aren’t connected to any neurological or sleep disorder.
Recurrent sleep paralysis involves multiple episodes of sleep paralysis, which can be an underlying cause of narcolepsy.
Recurrent isolated sleep paralysis is Parasomnia which involves all the ongoing undesired events of sleep paralysis without any symptoms of narcolepsy.3
4. Events During Sleep Paralysis Episodes
Sleep paralysis involves a sense of wakefulness and the conscious inability to move muscles. This symptom is known as muscle atonia. 4Usually, people in their early 20s,30s, adolescents, and people entering adulthood experience these kinds of episodes.
Hallucinations often accompany muscle atonia in sleep paralysis. During a hallucination, one can visualize things that don’t exist. These are often unpleasant nightmares that involve one experiencing a dangerous presence in a room followed by suffocation.
One can only return from this mixed conscious state upon receiving an outside stimulus to come back to consciousness. An episode can typically last for a few seconds to 20 mins.
4.1 Types of Hallucination
Intruder hallucinations: the feeling of a presence of an intruder or someone who doesn’t exist.
Incubus hallucinations: a sense of being choked due to severe pressure on the chest
Vestibular motor Hallucinations5: This can involve out-of-body sensations such as floating or flying.
4.2 Sleep Demons
Sleep disorder specialist Dr. Alicia Roth addressed the issue of seeing an unsettling image or presence as a kinetic hallucination. 6These hallucinations are experienced because the body is bringing rem sleep to wakefulness. Hallucinations are not necessarily visual. They may be auditory, olfactory, or tactile.
An easy way to control these nightmares is to practice focused breathing with a strong intention to wake up. Hallucinations are also often associated with other sleep disorders and neurological disorders like bipolar disorder and schizophrenia. People hear things such as voices that tell them to do something.
Visual hallucinations include seeing flashes of light or insects crawling upon one’s hand. These may also include seeing things like the face of someone known and shifting objects in the wrong direction.
5. What Triggers Sleep Paralysis?
Sleep paralysis doesn’t have a particular reason, but it is often linked with neurological sleeping disorders. Obstructive sleep apnea patients have reported experiencing this disorder. Around 38% of people with sleep apnea show a risk of sleep paralysis. People suffering from leg muscle cramping also have been reported to experience these disorders.
Other factors include sleep disorders, lack of quality sleep, jet lag, or substance use. People whose circadian rhythms don’t align with the day-night cycle also experience sleep paralysis. This includes people who shit work and often lack proper quality sleep.
Post-traumatic stress disorder, anxiety, and panic disorders are some causes of sleep paralysis. Generally, people who have a past family history of sleep disorders and addiction returning or relapsing suffer from this disorder.
Sudden stoppage of alcohol or drugs can lead to REM rebound, which results in a person spending most of the time in the Rapid eye movement rem stage that shows similar brain activity patterns to being awake.
5.1 How to Determine If You Are Experiencing a Rem Rebound
During rem sleep, people experience vivid dreams, which might be a clue to people experiencing rem rebound.
This condition can also be determined with an electro cephalogram 7which measures your brain waves as you sleep. This process of ECG measurements is known as polysomnography.
6. Sleeping Disorders Linked to Sleep Paralysis
6.1 Sleep Apnea
This usually occurs in middle-aged men when the muscles in the back of your throat relax too much to obstruct the airway resulting in a brief stoppage of normal breathing for 10 seconds or longer.
This process, in turn, causes the deposition of carbon dioxide in the airway resulting in difficulty breathing and waking you up from sleep. This pattern can repeat itself 30 times in an hour and last all night long, causing disruptive sleep.
Sleep apnea is a sleep disturbance caused by improper sleep hygiene, caffeine, and smoking. Sleep deprivation feeds sleep apnea which in turn feeds sleep paralysis.
6.2 Narcolepsy
Narcolepsy8 is a sleep disorder characterized by excessive daytime drowsiness followed by a lack of energy which makes it hard to concentrate.
Cataplexy or disruption of muscle control and body collapse are also some of the effects of narcolepsy. Since narcoleptic patients enter into a stage of Rem sleep quickly, it is often accompanied by sleep paralysis followed by muscle atonia.
6.3 Parasomnia
Parasomnias are a group of sleep disorders caught between falling asleep or waking. It can be triggered by medications, alcohol usage, sleep deprivation, and excessive stress.
Parasomnia is often characterized by sleepwalking paralysis and confusional arousal. Treatment included psychological approaches like relaxation therapy. Medications include sleep medicine like benzodiazepines and tricyclic antidepressants as prescribed.
Shift work sleep disorders are mainly caused due to rotating shifts that interfere with the normal circadian rhythm. Shift work symptoms include drowsiness, irritated mood, and insomnia.
Patients are advised to create a proper sleep environment, improve sleep hygiene, follow a regular sleep schedule, and lower the amount of exposure to daylight during their sleep hours.
7. Tests to Identify These Neurological Disorders
Multiple sleep latency tests: This test checks for daytime sleepiness in a patient. It measures how fast the patient is falling asleep or the sleep latency and how fast the person enters the rem stage. This test occurs in special clinics or labs where a patient is given 4 to 5 opportunities to fall asleep.
Polysomnogram: A polysomnography is a procedure that takes place overnight, where your brain waves are recorded to find out any problems in your sleep cycles.
8. How to Prevent Sleep Paralysis: Treatment for Sleep Paralysis
Sleep paralysis needs to be first appropriately diagnosed, whether or not it’s a sleeping disorder. ideally, the treatment for sleep paralysis would be following proper sleep hygiene
- this includes a proper bedroom setting, sleeping in a comfortable sleep environment, proper sleep schedule, and using the best pillow and mattresses.
- Avoid sleeping during odd hours and avoid napping to maintain a good sleep schedule.
- Reducing intake of alcohol and caffeine and eliminating the use of electronic devices in bed.
- Natural sunlight helps us maintain our circadian rhythm. Stepping outside and talking to natural light can help regulate the rhythm.
- Cognitive-behavioral therapy for insomnia is a treatment to improve sleep hygiene, a type of talk therapy.
- Taking care of your physical health and practicing regular exercise is the most essential and effective way of coping with sleep paralysis. Since high blood pressure is linked with sleep paralysis, investing in physical health lowers the risk.
Since rem sleep is affected in patients who experience sleep paralysis, medications that suppress rem are prescribed to stop sleep paralysis episodes.
This can be used to treat the symptoms of sleep paralysis, although there may be some side effects along with it.
8.1 Medications for Treating Sleep Paralysis :
Certain sleep medicine or anti-depressants are prescribed to prevent episodes of sleep paralysis and avoid hallucinations. These medications include a short course of tricyclic antidepressants. Tricyclic antidepressants also contain imipramine and clomipramine, which reduce hallucinations and other symptoms.
9. Risk Factors for People Experiencing Sleep Paralysis:
Studies show that people who experience sleep paralysis mostly suffer from physical and emotional distress or anxiety disorders. These conditions are most prevalent in students who tend not to follow a regular sleep schedule and psychiatric patients who have ongoing therapy.
The risk of sleep paralysis includes developing neurological disorders like narcolepsy and sleep apnea which may cause PTSD(post-traumatic stress disorder). Cataplexy and muscle atonia are already common symptoms.
Intake of sedative medicines that contain benzodiazepines can put you at risk of sleep paralysis. You should ask your doctor before taking up such medicines.
10. Cognitive-behavioral Therapy
Cognitive-behavioral therapy is a talk therapy performed by trained individuals to treat insomnia and sleep-related problems. This treatment addresses the dysfunctional thoughts regarding sleep and reinforces them. Usually, it takes 6 to 8 sessions to complete the treatment depending on the person’s need.
According to Dr. Jalal, focused inward attention and muscle relaxation are direct and effective treatments for sleep paralysis. To treat the panic disorder which comes along with sleep paralysis and hallucinations, this intervention is followed by four steps.
- Reappraisal of the meaning of the attack: Involves revisiting the mental imagery and remembering the thoughts of distress during paralysis. Patients are required to reassess their thoughts.
- Psychological and Emotional distancing: This intervention requires shifting attention from unpleasant external or internal stimuli, the ones causing terrifying hallucinations. The attention is shifted towards a more positive memory. Catastrophizing the benign episode will only worsen the condition, so patients are advised to associate it with being temporary and not a thing to be afraid of.
- Inward-focused attention meditation: Hallucinations should be ignored, and upon distraction, the attention should be brought back to a positive hymn or memory and reflect on all the positive aspects.
- Muscle relaxation: An individual is expected to accept the condition and take it nonjudgmentally. One should control flexing their muscles while the paralysis and try to relax for a few minutes. This method shifts dominance from the sympathetic to the parasympathetic nervous system and facilitates a relaxed meditative state. This method might also induce drowsiness and puts people to sleep. Overall the treatment reduces somatic symptoms such as chest pressure and muscle spasms and prevents hallucinations. Thus resulting in fewer sleep paralysis episodes.
11. Conclusion
There can be multiple reasons why a person would have sleep paralysis. There might be certain neurological disorders associated with it, or it could be simply because of stress, anxiety disorder, and improper sleep quality. In this case, patients are required to visit a sleep specialist to get the sleep paralysis diagnosed.
One should give positive assurance to oneself. It is natural to feel emotionally overwhelmed after an episode, so it is advised not to hold back and talk to your loved ones regarding the whole episode or write it down and face the fear. Talk therapy works wonders as it helps the brain cope with such distress.
Get some extra sleep if necessary and get medical attention. Sometimes patients with PTSD and depression have paralysis because of the side effects of their medicines. Following a healthy sleep routine and improving sleep hygiene are also to be counted.
However, despite proper care, if the episodes frequently happen with a sudden loss of muscle control, one should seek medical help and consult a sleep expert for proper guidance and possible medicative treatment.
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12. FAQs
12.1 Is There a Connection Between Sleep Paralysis and Other Sleep Disorders?
Yes, other sleep disorders including narcolepsy, sleep apnea, or insomnia can coexist with sleep paralysis. If you think you might have a sleep disorder, it’s crucial to see a doctor so you can get a proper diagnosis and the right care.
12.2 Can Anxiety and Stress cause Sleep Paralysis?
Yes, anxiety and stress can be causes of sleep paralysis. The probability of having episodes of sleep paralysis can be increased by high levels of stress, anxiety, and disturbed sleep habits. The incidence of sleep paralysis may be decreased by putting stress management strategies into practice and taking care of underlying anxiety problems.
12.3 Can the Posture in which You Sleep Increase Your Chance of Getting Sleep Paralysis?
Sleep position can have an impact. The likelihood of experiencing sleep paralysis episodes is increased when you sleep on your back. Try to sleep on your side or stomach to lessen the likelihood of experiencing sleep paralysis.
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