Sleep paralysis: When the brain wakes up before the body

Sleep paralysis What is it

Sleep paralysis is a phenomenon that an incomplete awakening of the person occurs. It appears in the transitions between the state of sleep and wakefulness, usually at the moment of beginning to sleep or in waking up.

This sleep disorder, which is within the group of parasomnias,  according to the International Classification of Sleep Disorders, affects 1 in every 1,000 inhabitants.

In an interview with EFEsalud, Dr. Diego García-Borreguero, director of the Sleep Research Institute ( IIS ), and former president of the Spanish Sleep Society ( SES ), explains the characteristics of sleep paralysis; a phenomenon that stands out “perhaps it is more frequent than we think”.

During the REM sleep phase (rapid eye movements) there is a great activation of the cerebral cortex, dreams occur and there is generalized muscular atony. Sometimes, these physiological characteristics of REM sleep, “are somehow introduced in the NON-REM phase , that is, between the deepest sleep and wakefulness,” explains the doctor.

The person under this paralysis is cognitively awake but experiences a sensation of paralysis of practically all the voluntary muscles except the eyes and the respiratory diaphragm. Paralysis of the larynx is also characteristic, which makes it impossible for the person to speak while this sleep disorder occurs.

The duration of these episodes is usually variable. They are generally of a short duration, from twenty seconds to two minutes. After that time, the paralysis remits spontaneously and without consequences. Talking about a longer period of time is unusual.

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EFE / Gentsch Frieze

“Any of us, in a situation of chronic or continuous sleep deprivation, may at some point end up developing sleep paralysis,” says García-Borreguero.

Among the circumstances under which this phenomenon occurs, Dr. García-Borreguero maintains that it can occur as an isolated symptom or in context and / or accompanied by other symptoms.

One of the symptoms that frequently accompanies sleep paralysis is hypnagogic hallucinations (auditory, visual and/or tactile hallucinations). The most common are the sensitive (kinesthetic) and visual types, while the auditory ones are the rarest.

However, the doctor clarifies that “they are called hallucinations but in reality they are pseudo-hallucinations”, because the person who suffers them knows reliably that what he feels, sees or hears is not real.

Therefore, although this type of pseudo-hallucinations may be behind supposed paranormal experiences, those who suffer from sleep paralysis “rarely give them credibility” and it is most likely that behind these events “there are psychiatric or schizophrenic pictures “, argues the doctor.

“Sleep paralysis serves more as an indicator of other diseases than as a symptom that must be treated in itself,” says Dr. García-Borreguero.

Why does sleep paralysis occur?

In order of frequency (from highest to lowest probability), the causes for which an individual may develop sleep paralysis are:

  1. Associated with another pathology:  Sleep paralysis can be a symptom of another disease. The most common is narcolepsy, a disease in which it is difficult to stay awake during the day. These patients have very frequent attacks of cataplexy (muscle paralysis), sleep paralysis, and hypnagogic hallucinations.
  2. Isolated cause related to severe sleep deprivation: Second, sleep paralysis affects healthy subjects who are subjected to severe sleep deprivation.
  3. Cause of a family type: The cause of a hereditary type is the least frequent. It occurs when there are several members of the family who suffer from sleep paralysis as a single symptom.

To proceed with its diagnosis, it will first be necessary to rule out that the patient suffers from narcolepsy. Next, an investigation will be made on how much the patient sleeps or needs to sleep and, where appropriate, determine if there is a sleep deficit.

If these two circumstances do not occur, it will be necessary to think about whether there are more cases in the family and it presents, therefore, as a single symptom.

Therefore, if sleep paralysis appears as an isolated symptom, it is not very important and it is not usually necessary to treat it. If it persists for more than three or four weeks in a row or if it produces a loss of quality of life and does not allow you to sleep well, you will have to go to a specialist as a treatment can be carried out.

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The key is in the rest

The stress or jet lag are situations that commonly trigger episodes of sleep paralysis. This is so, to the extent that sleeping less leads to sleep deprivation and this disorder can occur as a sleep symptom.

Maintaining stable sleep schedules, sleeping at least seven and a half hours each day, avoiding shift work, staying up late, or avoiding taking drugs that influence REM sleep (such as antidepressants), will help make us less predisposed to suffer from paralysis of the dream.

Regarding antidepressants, the doctor points out that “they are a double-edged sword.” These can be drugs to treat sleep paralysis, but at the same time, the use of antidepressants can lead to sleep paralysis once treatment is stopped.

“There is a list of medications that may be relevant in this regard, therefore, we should consult the doctor if the medication we are taking interferes with this disorder,” he warns.

Are there health risks?

No, “sleep paralysis does not pose any health risk,” says García-Borreguero. The duration of these episodes is short and does not imply the paralysis of any muscle tissue necessary for vital functions.

However, the first time it occurs “the person is usually scared and think that they have had a stroke or a transient ischemic accident,” he acknowledges. If the paralysis is accompanied by hypnagogic hallucinations, the patient “may think he is going crazy.”

In short, it is a situation that is lived with some anguish and in which the patient must maintain control, since he is not in any danger and after a few seconds or minutes, the paralysis will subside without consequences.

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