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The waking nightmare of sleep paralysis

A common sleep disorder can cause much agitation, but it can be treated, say doctors

Actor Tom Holland, who became a Marvel superhero and took on the role of Spider-Man in six movies, has to cope with sleep paralysis, a common condition where a person is between wakefulness and sleep and is conscious, but unable to move for a few minutes.

Sleep paralysis is a temporary loss of muscle function while you’re sleeping. It typically occurs when a person is falling asleep, shortly after they have fallen asleep, or while they’re waking up.

In sleep there are two phases — rapid eye movement (REM) sleep and non-REM (NREM) sleep which alternate in cycles during the entire duration of sleep. Abnormal sleep-related movement disorders can occur in either of these phases and are referred to as parasomnias.

“Sleep paralysis is a form of REM-related parasomnia which generally occurs at the onset or upon awakening and is characterized by qualities of both sleep and wakefulness, wherein the person can open their eyes and is aware of their physical environment but is unable to move and may start seeing, hearing, feeling or sensing something,” says Dr. Viswesvaran Balasubramanian, Senior Interventional Pulmonologist and Sleep Medicine Specialist, Yashoda Hospitals.

The effect
“It is associated with the experience of fear, terror or panic and can have a negative effect on the quality of life. In a few cases, such experiences may result in post-traumatic stress disorders and can create a vicious cycle of negative emotional association with sleep, including an aversion to going to bed,” adds Dr Viswesvaran.

Generally, sleep paralysis is confused with night terrors which are characterized by sudden awakening in an agitated state, anxiety, body motility and general amnesia with regard to underlying cognitive experiences. These generally occur in the NREM phase of sleep. “The disorder may occur in isolation or it can be a part of other sleep disorders like narcolepsy,” the doctor says.

Causes
Sleep fragmentation and insufficient sleep, shift work, jet-lag, use of sleep-disrupting medication, stress, anxiety, alcohol consumption, post-traumatic stress disorders, childhood sexual abuse and anxiety disorders can precipitate this phenomenon. In a few instances, there may be no precipitating factor, in which case it is referred to as idiopathic sleep paralysis.

Importance of awareness
Generally, sleep paralysis is harmless and the management involves first identifying underlying conditions. “In most cases, creating awareness amongst patients about symptoms and educating them about the disorder is sufficient to overcome this problem. However, if the disorder is secondary to certain psychiatric disorders, then addressing underlying mental illnesses can improve the outcomes,” says Dr Viswesvaran. In addition, educating patients on sleep hygiene measures like maintaining consistent sleep and wake time, daily exercise, abstinence from alcohol, smoking and caffeinated drinks, avoiding mobile phones and blue light-emitting devices at least a few hours prior to sleep, having a light dinner and utilising the bed for only sleep and sexual activity are important.

Sleep paralysis is usually diagnosed on the basis of history and also studies/tests including sleep studies.

l It is usually treated by improving sleep habits, treating psychiatric issues, treating other sleep disorders like narcolepsy and treating patients for substance abuse if necessary.
l Regular exercise and lifestyle changes can help.
l Certain sleep positions and sleep hygiene are also helpful.

Symptoms
The most common characteristic of sleep paralysis is the inability to move or speak. An episode may last for a few seconds to about 2 minutes.

You may also feel
l As if something is pushing you down
l As if someone or something is in the room
l Fear
l Paranoia
l As if you’re going to die

Physical symptoms
l Sweating
l Muscle aches
l Headaches
l Difficulty in breathing

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