INTRODUCTION

Sleep paralysis is a type of parasomnia or sleep disorder. Sleep paralysis is a

feeling of being conscious but unable to move. It occurs when a person passes
between stages of wakefulness and sleep. During these transitions, we may be
unable to move or speak for a few seconds up to a few minutes. Some people may
also feel pressure or a sense of choking. According to the American Academy of
Sleep Medicine, people with sleep paralysis usually experience this condition for
the first time between the ages of 14 and 17 years old. It’s a fairly common sleep
condition. Researchers estimate that between 5-40% of people experience this
condition. Episodes of sleep paralysis may occur along with another sleep
disorder known as narcolepsy. Narcolepsy is a chronic sleep disorder that causes
overwhelming drowsiness and sudden “sleep attacks” throughout the day.
However, many people who don’t have narcolepsy can still experience sleep
paralysis. This condition isn’t dangerous. Though it can feel alarming to some,
no medical intervention is usually necessary. It can be very scary when we are
unable to move. we may feel anxious and afraid. Some people also hallucinate
during an episode. They may see, hear or feel things that are not there. They
may even think that another person is in the room with them. These
hallucinations may also appear without the sleep paralysis.

Sleep paralysis occur during the transition between sleeping and waking, and
they consistently fall into one of three categories:

• Intruder: There are sounds of doorknobs opening, shuffling footsteps, a

shadow man, or sense of a threatening presence in the room.
• Incubus: Feelings of pressure on the chest, difficulty breathing with the
sense of being smothered, strangled or sexually assaulted by a malevolent
being. The individual believes they are about to die.
• Vestibular-motor: A sense of spinning, falling, floating, flying, hovering
over one’s body or another type of out-of-body experience.
Episodes in sleep paralysis typically end on their own, or when another person
touches or moves us. We may be aware of what’s happening but are still unable
to move or speak during an episode. we may also be able to recall the details of
the episode after temporary paralysis disappears. In rare cases, some people
experience dreamlike hallucinations that may cause fear or anxiety, but these
hallucinations are harmless

When Does Sleep Paralysis Usually Occur

Sleep paralysis usually occurs at one of two times. If it occurs while you are falling
asleep, it's called Hypnagogic or predormital sleep paralysis. If it happens as you
are waking up, it's called Hypnopompic or postdormital sleep paralysis.

What Happens With Hypnagogic Sleep Paralysis

As you fall asleep, your body slowly relaxes. Usually you become less aware, so you
do not notice the change. However, if you remain or become aware while falling
asleep, you may notice that you cannot move or speak.
What Happens With Hypnopompic Sleep Paralysis
During sleep, your body alternates between REM (rapid eye movement) and NREM
(non-rapid eye movement) sleep. One cycle of REM and NREM sleep lasts about 90
minutes. NREM sleep occurs first and takes up to 75% of your overall sleep time.
During NREM sleep, your body relaxes and restores itself. At the end of NREM, your
sleep shifts to REM. Your eyes move quickly and dreams occur, but the rest of your
body remains very relaxed. Your muscles are "turned off" during REM sleep. If you
become aware before the REM cycle has finished, you may notice that you cannot
move or speak.
What are the symptoms of sleep paralysis?
Sleep paralysis isn’t a medical emergency. Being familiar with the symptoms can
provide peace of mind.
Signs and symptoms include:

• an inability to move the body when falling asleep or on waking, lasting for
seconds or several minutes
• being consciously awake
• being unable to speak during the episode
• having hallucinations and sensations that cause fear
• feeling pressure on the chest
• having difficulty breathing
• feeling as if death is approaching
• sweating
• having headache, muscle pain, and paranoia.

What are the causes and risk factors of sleep paralysis?

Sleep paralysis is also usually caused by a disconnection between mind and

body, which happens during sleep. Having a disrupted sleep schedule has also
been linked to sleep paralysis. Examples where your sleep schedule can be
disrupted include working night shifts or being jet lagged.

In some cases, sleep paralysis seems to run in families. However, this is rare.
There’s no clear scientific evidence that the condition is hereditary .Sleeping on
your back may increase your chances of an episode. Lack of sleep may also
increase the risk of sleep paralysis. There are some factors that may be linked to
sleep paralysis include:

• Lack of sleep
• Sleep schedule that changes
• Mental conditions such as stress or bipolar disorder
• Sleeping on the back
• Other sleep problems such as narcolepsy or nighttime leg cramps
• Use of certain medications, such as those for ADHD
• Substance abuse

Children and adults of all ages can experience sleep paralysis. However, certain
groups are at a higher risk than others. Groups that are at an increased risk
include people with the following conditions:

• insomnia
• narcolepsy
• anxiety disorders
• major depression
• bipolar disorder
• post-traumatic stress disorder (PTSD)

Brain and hormones involved In sleep paralysis

Several structures within the brain are involved with sleep.

The hypothalamus, a peanut-sized structure deep inside the brain, contains

groups of nerve cells that act as control centres affecting sleep and
arousal. Within the hypothalamus is the suprachiasmatic nucleus (SCN) –
clusters of thousands of cells that receive information about light exposure
directly from the eyes and control your behavioural rhythm. Some people with
damage to the SCN sleep erratically throughout the day because they are not
able to match their circadian rhythms with the light-dark cycle. Most blind
people maintain some ability to sense light and are able to modify their
sleep/wake cycle.

The brain stem, at the base of the brain, communicates with the hypothalamus
to control the transitions between wake and sleep. (The brain stem includes
structures called the pons, medulla, and midbrain.) Sleep-promoting cells
within the hypothalamus and the brain stem produce a brain chemical
called GABA, which acts to reduce the activity of arousal centre in the
hypothalamus and the brain stem. The brain stem (especially the pons and
medulla) also plays a special role in REM sleep; it sends signals to relax muscles
essential for body posture and limb movements, so that we don’t act out our
dreams.

The thalamus acts as a relay for information from the senses to the cerebral
cortex (the covering of the brain that interprets and processes information from
short- to long-term memory). During most stages of sleep, the thalamus
becomes quiet, letting you tune out the external world. But during REM sleep,
the thalamus is active, sending the cortex images, sounds, and other sensations
that fill our dreams.

The pineal gland, located within the brain’s two hemispheres, receives signals
from the SCN and increases production of the hormone melatonin, which helps
put you to sleep once the lights go down. People who have lost their sight and
cannot coordinate their natural wake-sleep cycle using natural light can stabilize
their sleep patterns by taking small amounts of melatonin at the same time each
day. Scientists believe that peaks and valleys of melatonin over time are
important for matching the body’s circadian rhythm to the external cycle of light
and darkness.

The basal forebrain, near the front and bottom of the brain, also promotes sleep
and wakefulness, while part of the midbrain acts as an arousal system. Release
of adenosine (a chemical by-product of cellular energy consumption) from cells
in the basal forebrain and probably other regions supports your sleep
drive. Caffeine counteracts sleepiness by blocking the actions of adenosine.

The amygdala, an almond-shaped structure involved in processing emotions,

becomes increasingly active during REM sleep.

How is sleep paralysis diagnosed?

Recurrent sleep paralysis is fairly common. In most cases, it does not affect your
sleep or overall health. Talk to your doctor if episodes of sleep paralysis make
you anxious. You should see a sleep specialist if the episodes keep you up at
night or make you very tired during the day. The doctor will need to know when
the sleep paralysis started. He or she will want to know how often it occurs and
how long it lasts. The doctor will need to know your complete medical history.
Be sure to inform him or her of any past or present drug and medication use.
Also tell your doctor if you have ever had any other sleep disorder. Find out if
you have any family members with sleep problems. It will also be helpful if you
fill out a sleep diary for two weeks. The sleep diary will help the doctor see your
sleeping patterns. This data gives the doctor clues about what is causing your
problem and how to correct it.

Doctors do not need any tests to treat most patients with recurrent isolated
sleep paralysis. Your doctor may have you do an overnight sleep study if your
problem is disturbing your sleep. This study is called a polysomnogram. It charts
your brain waves, heart beat, and breathing as you sleep. It also records how
your arms and legs move. An Electromyography(EMG) recording will show the
level of electrical activity in your muscles. This level will be very low during an
episode of sleep paralysis.

If you tend to be very sleepy during the day, then your doctor may also have you
do a daytime nap study. This is called a Multiple Sleep Latency Test (MSLT). The
MSLT will measure how fast you fall asleep during the day. It will also show what
kind of sleep you have when you take a nap. It will help to show if your sleep
paralysis is a sign of narcolepsy.

What are the treatment options for sleep paralysis

There is no cure for sleep paralysis. The treatment consists of managing the risk
factors that trigger the condition. In many cases sleep paralysis is a one-off
occurrence and the person does not have a recurrence. Most of us may expect
to experience sleep paralysis at least once in our lives. However, for people who
experience the condition frequently, it would make sense to see a doctor to get
a formal diagnosis.

The first step in treating the condition is to identify any underlying cause that
may be triggering the sleep paralysis. There could be a number of reasons for
such an entity. Common reasons include insomnia or lack of sleep at night,
narcolepsy or daytime sleepiness and loss of muscle control, family history of
sleep paralysis in other relatives, sleeping on the back, disrupted sleep patterns
due to work shifts or jet lag, sleep apnea, and other psychiatric mental disorders.

Once the primary issue and underlying cause has been identified, the doctor will
suggest ways and means of eliminating these triggers. He may eliminate some
of the medications being currently used. He may suggest counselling if the
person is undergoing post-traumatic stress disorder. Physical exercise is also a
good means of ensuring that the body is tired enough to sleep through the entire
REM cycle without disruption.

The most commonly prescribed medications are stimulants and selective

serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac). Stimulants
help us to stay awake. SSRIs help manage symptoms associated with narcolepsy.
Doctor may order a sleep study called a polysomnography.

The study results will help the doctor to make a diagnosis, if we’re experiencing
sleep paralysis and other symptoms of narcolepsy. This type of study requires
an overnight stay at a hospital or sleep centre. In this study, a healthcare
provider will place electrodes on our chin, scalp, and at the outer edge of your
eyelids. The electrodes measure electrical activity in our muscles and brain
waves.

They’ll also monitor our breathing and heart rate. In some cases, a camera will
record your movements during sleep. The key to mitigating sleep paralysis is
improving sleep hygiene by sticking to a good bedtime routine, which includes:
avoiding blue light prior to sleep and ensuring the room temperature is kept
low. These bedtime routines can help ensure that we get a better night’s rest.

How can Someone prevent from sleep paralysis

We can minimize symptoms or the frequency of episodes with a few simple

lifestyle changes, such as:
 • Reduce stress in life.
• Exercise regularly but not close to bedtime.
• Get sufficient rest.
• Maintain a regular sleep schedule.
• Keep track of medications you take for any conditions.
• Know the side effects and interactions of your different medications so
you can avoid potential side effects, including sleep paralysis.

• therapy
• trauma counselling
• yoga and breathing exercises to reclaim this sense of agency over your
body

If we have a mental health condition, such as anxiety or depression, taking an

antidepressant may diminish episodes of sleep paralysis. Antidepressants can
help reduce the number of dreams we have, which lessens sleep paralysis.

Tips for better sleep

There is no specific treatment for sleep paralysis, but stress management,

maintaining a regular sleep schedule, and observing good sleep habits can
reduce the likelihood of sleep paralysis.

Strategies for improving sleep hygiene include:

• keeping bedtime and wake-up time consistent, even on holidays and

weekends
• ensuring a comfortable sleep environment, with suitable bedding and
sleepwear and a clean, dark and cool bedroom
• reducing light exposure in the evening and using night-lights for bathroom
trips at night
• getting good daylight exposure during waking hours
 • not working or studying in the bedroom
• avoiding napping after 3.00 p.m. and for longer than 90 minutes
• not eating a heavy evening meal, or eating within 2 hours of going to bed
• not sleeping with the lights or television on
• abstaining from evening alcohol or caffeine products
• exercising daily, but not within 2 hours of bedtime
• including a calming activity in the bedtime ritual, such as reading or
listening to relaxing music
• leaving phones and other devices outside the bedroom
• putting electronics aside at least 1 hour before going to bed

The following additional measures may help:

• managing any depression or anxiety disorder

• reducing intake of stimulants
• practicing meditation or regular prayer
• not sleeping on your back

CONCLUSION

Understanding the physiology of sleep and the mechanism for sleep paralysis is
an important step to overcoming it. Ongoing stress and disruption in the sleep
cycle can have serious health implications. Healthy sleep habits are not just
necessary for sleep paralysis management, but for overall health and wellness.