Sleep paralysis is a violation of the process of waking up or falling asleep, characterized by total muscular atony against the background of waking consciousness. In most patients, it develops at the moment of awakening, accompanied by a temporary impossibility of voluntary movements, a feeling of fear, threatening hallucinations. It is diagnosed clinically. Additionally, a neurologist, a psychiatrist, and a comprehensive polysomnographic study are required. Treatment consists in normalizing the lifestyle, observing the sleep regime, eliminating overloads, using various methods that allow you to relax, calm down before going to bed.
ICD 10
G47.8 G83.8
General information
For centuries, people have associated sleep paralysis with the machinations of demons, sorcerers, and evil spirits. With the advent of somnographic research methods, it was possible to find a scientific explanation for this phenomenon. Within the framework of modern neurology, sleep paralysis belongs to the group of parasomnia, including nightmares, somnambulism, sleep intoxication, bruxism, nocturnal enuresis, sleep-related eating disorders. Statistics show that 6-7% of the population experienced a state of sleep paralysis during their lifetime. Among patients with narcolepsy, paralytic parasomnia occurs in 45-50% of cases. The age of those suffering from this phenomenon varies between 12-30 years.
Causes
The pathological condition is based on a disorder of the sequence of falling asleep or awakening of consciousness and the atony of skeletal muscles that characterizes the rem sleep phase. The causes of the development are not precisely established. Predisposing factors are considered:
- Sleep disorders. The presence of insomnia, narcolepsy increases the likelihood of other pathological changes in the course and sequence of sleep phases. Chronic lack of sleep, constant regime changes, frequent change of time zones have a similar effect.
- Psychoemotional overload. Acute and chronic stresses can cause disturbances in the regulation of sleep-wake cycles. Patients with paralytic parasomnia note an increase in episodes of paralysis against the background of mental overstrain.
- Toxic effects on the central nervous system. With drug addiction, substance abuse, alcoholism, nicotine addiction, long-term use of certain pharmaceuticals (tranquilizers, antidepressants), substances entering the body have a harmful effect on the brain. The consequence may be a malfunction in the functioning of systems that regulate sleep and wakefulness.
- Sleep on your back. Paralytic parasomnia occurs mainly in patients sleeping in a supine position. Sleeping on the side proceeds without episodes of paralysis. The reason for this pattern is unclear.
- Hereditary determinism. The genetic basis of the disease has not yet been studied, but there are cases of its occurrence within the same family.
Pathogenesis
Physiological sleep begins with a slow phase (SSP), which is replaced by a fast one (FSP). The latter is characterized by a pronounced decrease in the tone of skeletal muscles, excluding respiratory ones. The rhythm of breathing becomes faster, the breath becomes shorter. Brain activity increases to the level of wakefulness. With paralytic parasomnia, the sequence of processes is disrupted, the human consciousness wakes up before muscle tone is restored, a feeling of immobility arises — sleep paralysis. The appearance of paralysis is also possible at the moment of falling asleep, when the rem sleep phase occurs, and consciousness is still in a waking state.
Since in the FSP there is a reflex setting of breathing for frequent short breaths, attempts to wake up to take a deep breath end in failure, which causes a feeling of compression in the chest. The inability to move is perceived by the brain as a life-threatening situation, a large number of neurotransmitters are released, provoking feelings of fear, panic, hallucinations. The vestibular apparatus is active, but due to the lack of movement, it does not receive information from the periphery, which causes unusual sensations of flying in the air.
Classification
Parasomnia occurs at the moment of transition from a sleepy state to wakefulness and vice versa. The classification is based on the belonging of seizures to the period of falling asleep or waking up. According to this criterion, sleep paralysis is divided into:
- Hypnopompic — observed during waking up. It is rare. Occurs as a result of the onset of FSP before the consciousness is completely immersed in a sleepy state. Patients experience a feeling of immobility prior to falling asleep.
- Hypnagogic — appears during the transition to sleep. It is observed in the vast majority of cases. It is caused by the preservation of all the physiological features of the FSP with the awakening of consciousness that has already occurred. Accompanied by a vivid clinical picture, severe emotional experiences.
Symptoms
The pathological condition is similar to a gross paresis in stroke. The patient is unable to perform arbitrary motor acts. The feeling of immobility is painful, accompanied by panic fear, visual and auditory hallucinations. The patient sees dark figures, nightmares, hears threats, noise, footsteps, a specific squeak, feels the presence of hostile creatures. There is a violation of orientation in space, there is an illusion of flying, circling, soaring in the air, being in a moving elevator.
Perhaps the feeling of false movements is an illusion of turning on its side when realizing the lack of motor ability. Typical complaints are a feeling of chest compression, suffocation, inability to inhale. Sleep paralysis has a paroxysmal course. The paralytic episode lasts from a few seconds to 2-3 minutes, there are no neurological symptoms in the post-onset period. The frequency of seizures ranges from one episode to two or three paroxysms per night. Seizures do not pose a danger to life, are not accompanied by real asphyxia and other complications.
Diagnostics
Characteristic symptoms allow you to establish sleep paralysis based on the clinical picture. The examination is carried out with the repeated occurrence of paralytic episodes, aimed at excluding neurological and psychiatric pathology. The list of diagnostic procedures includes:
- Neurologist’s examination. Neurological status without features. There may be signs of emotional lability, asthenia against the background of overwork, existing background sleep disorders.
- Polysomnography. In the presence of video surveillance, it is possible to fix a paralytic episode: the patient is motionless, the eyes are open, the face expresses fear, cardiorespiratory monitoring registers changes typical for FSP (tachycardia, tachypnea with a decrease in the volume of inspiration). Electroencephalography makes it possible to differentiate sleep paralysis from nocturnal epileptic paroxysms.
- MSLT test. The study of multiple latency is carried out when narcolepsy is suspected. The diagnosis confirms a reduction in latency time, the presence of more than 2 episodes of falling asleep.
- Consultation of a psychiatrist. It is carried out by the method of conversation, observation, psychological testing. It is necessary to exclude concomitant mental disorders.
Differential diagnosis is carried out with other somnological disorders, mental illnesses, epilepsy. Narcolepsy is accompanied by paroxysms of hypnolepsy — an irresistible daytime hypersomnia. Somnambulism is the reverse of sleep paralysis, it occurs against the background of the absence of muscle hypotension in the FSP. In the course of somnological examination, sleep apnea syndrome is excluded according to respiratory monitoring data, epilepsy is excluded according to EEG results.
Sleep paralysis treatment
In most cases, therapy includes a conversation with the patient about the causes of paralytic episodes, measures to normalize the daily routine, psychological relaxation before bedtime. Medication is prescribed in the presence of neurotic disorders and mental illnesses. Compliance with the following recommendations can prevent the occurrence of new episodes of paralysis:
- Optimization of the work regime. It is necessary to avoid physical and mental overload, find time to rest. Restorative physical exercises, walks in the fresh air are useful.
- Normalization of sleep mode. Going to bed and waking up should be carried out daily at the same time. The recommended sleep duration is 8-9 hours.
- Relaxation before going to bed. Aroma and phytovannas, sedative massage, soothing herbal preparations, calm music have a relaxing effect. Before going to bed, it is necessary to give up watching TV, mental stress, working at the computer, because they activate the activity of the brain.
- Wake up on demand. Studies have shown the occurrence of paralytic parasomnia only upon self-awakening. To prevent seizures, you should wake up with an alarm clock, ask your loved ones to wake up in the morning.
An important point is the patient’s awareness of the mechanism of occurrence of parasomnic paroxysms. The help of a psychologist is possible. Psychological consultations include the development of techniques for reducing emotional experiences, accelerated recovery from an attack. It is recommended to teach relaxation techniques, which the patient subsequently applies independently.
Prognosis and prevention
Sleep paralysis is characterized by a benign course, spontaneous disappearance of symptoms against the background of lifestyle correction. Relapse of the disease, increased frequency of attacks provoke stressful situations, non-compliance with the regime, overload. Prevention is aimed at eliminating trigger factors: stress, excessive loads, sleep deprivation, constant regime changes. The main points of primary and secondary prevention are a healthy lifestyle, calm and friendly acceptance of any life situations, reasonable professional and educational load, timely treatment of existing somnological disorders.