Sleep Paralysis

Old Hag Syndrome or Alien Abduction? The Truth about Sleep Paralysis

The Nightmare

You awaken with a heavy feeling on your chest, unable to breathe, scream or move. You hear, see and feel different sensations — but you are helpless to do anything about it. This sort of experience has been reported in popular literature as alien abduction. While not extraterrestrial, the truth behind these events is just as interesting — sleep paralysis!

What is Sleep Paralysis?

Sleep paralysis (SP) is a sleep disorder recognized by the American Academy of Sleep Medicine in “The International Classification of Sleep Disorders (ICSD)”. In this classification, sleep paralysis is categorized as a parasomnia associated with rapid eye movement (REM) sleep. A parasomnia is a sleep disorder that interrupts or occurs during sleep.

The ICSD defines sleep paralysis as “a transient, generalized inability to move or speak during the transition between sleep and wakefulness”. The paralysis may occur just as you are falling to sleep or as you are beginning to wake up. During normal REM dreaming sleep, the brain has turned off most of the body’s muscle function so you cannot act out your dreams — SP is a protective mechanism in which you are temporarily paralyzed. The paralysis typically only lasts for a few seconds to a few minutes, but it is common to feel extreme anxiety during the episode.

In addition, the victim of sleep paralysis may experience vivid hallucinations called hypnagogic hallucinations. The hallucinations may involve seeing, hearing and even touching ghosts or other haunting figures. If you have hypnagogic hallucinations, you should understand that these hallucinations do not mean that you have a mental or psychological disorder. If the hallucinations are ONLY associated with sleep, relax…the good news is that sleep paralysis tends to decrease over time and once the disorder disappears, the hallucinations will, too.

In the professional literature, sleep paralysis may be called by many different names: Isolated sleep paralysis, familial sleep paralysis, hypnagogic paralysis, and pre- or post-dormital paralysis. Reports of sleep paralysis have been documented in the popular press for years — and the phenomenon has historically been called “old hag syndrome” by the general public. This name has been associated with sleep paralysis because of the belief that an old hag was sitting on the sufferer’s chest — causing shortness of breath and the inability to move. People with SP frequently report feeling an evil or threatening presence in the room — again, contributing to the “old hag” myth.


Sleep Paralysis Statistics

Sleep paralysis occurs in both women and men; however, in the familial (inherited) form of the disorder, females seem to be affected more often than males. It is estimated that 40 to 50 percent of all people will experience SP at least once during their lives; however, it is a frequent complaint in only about 5 percent of all people. The exception to this is in the case of narcoleptics. If you suffer from narcolepsy, you should know that as many as 40 percent of all narcoleptics also suffer from sleep paralysis. About 65 percent of people who suffer from SP will also occasionally suffer from hallucinations; however, only about 5 percent suffer from hallucinations during every episode.

Sleep paralysis typically starts during adolescence or young adulthood, but there are reports of earlier and later ages of onset. The acute form of SP usually lasts for less than a month and may involve only one episode; in the chronic form, you may suffer repeated episodes for six months or longer. Some people have reported episodes nightly for long periods of time.


Signs and Symptoms of Sleep Paralysis

Signs and symptoms of sleep paralysis vary from person to person and may include some or all of these symptoms:

  • The inability to move your body when you are going to sleep.
  • Waking up is a hallmark of the disorder and is a symptom always present in the disorder.

Typically, you can move your eyes to look around the room. Symptoms of SP usually happen when you are sleeping on your back. You may have vivid hallucinations that may include hearing, feeling, seeing or smelling things that do not exist in reality. You may experience a feeling of shortness of breath or pressure in or on your chest especially as anxiety and panic set in. Finally, you may have a feeling of a threatening presence in the room.


Diagnosis of Sleep Paralysis

If you think you may have sleep paralysis, what can you expect when you go to your doctor?

First, your doctor will ask you for a detailed history of the experiences you are having. Often, your history of the events is the only evidence of the disorder and the diagnosis may be made solely on the signs and symptoms you report.

Lab work will be done to be sure you are not suffering from a physical disease that is causing similar symptoms. For example, epilepsy and low potassium levels may result in symptoms that are similar to sleep paralysis. These physical disorders must be excluded as causes of the paralysis and are generally relatively simple to diagnose.

If you have frequent episodes of SP, your doctor may want you to be tested in a sleep lab where you will be connected to a polysomnograph to document what occurs during your sleep experience. In sleep lab studies, people with SP have been shown to have decreased muscle tone but a brain pattern of wakefulness. These studies also indicate that heart and breathing rates may be increased during the episode, and rapid eye movement is almost always present.

Causes & Effects

Causes and Risk Factors for Sleep Paralysis

What are the causes and risk factors associated with sleep paralysis? During REM sleep, your body shuts down all muscle activity to keep you from getting out of bed and acting out your dreams. This is true of everyone. When you develop sleep paralysis, this normal mechanism malfunctions and your brain takes too long to recognize that you are waking up so the signals to your muscles are delayed.

There are some factors that may increase your risk for developing acute or chronic SP:

  • In the familial or inherited form of the disorder, heredity will determine whether an individual is at risk for SP. This form of the disorder is very uncommon.
  • Narcoleptics are very prone to sleep paralysis; there are other issues associated with narcolepsy, so if you think you have this disorder, you should go to your doctor.
  • Irregular sleep habits resulting in sleep deprivation will increase your risk for SP; this is particularly true for those with the inherited form of SP or for those with narcolepsy.
  • Shift work, jet lag, or other life events that interrupt your normal circadian (sleep/wake) rhythm may increase your chances of having an episode of sleep paralysis.
  • You may be more likely to have problems with sleep paralysis if you suffer from severe anxiety, panic disorders or other psychological problems, particularly those that interrupt sleep.
  • Taking sleep or anti-anxiety medications may increase your risk for SP.
  • Finally, most cases of SP are reported in people who sleep on their backs!

Effects of Sleep Paralysis

There really are not very many effects of sleep paralysis. One of the most common effects of sleep paralysis is the anxiety and terror that may result from the disorder. In extreme cases, SP can cause (and be caused by) sleep apnea. In rare cases, cardiac problems may be caused by frequent or very intense emotions that happen during the paralysis.

If the sleep paralysis recurs often enough, the acute anxiety may develop into chronic anxiety and depression; however, this is unusual and typically only occurs in individuals who have underlying psychological issues. Episodes of SP do not cause other complications since most sufferers have normal sleep patterns between the episodes of sleep paralysis.

The obvious exception to this rule is for those people with narcolepsy who also experience sleep paralysis. In that case, the effects of cataplexy, or sudden loss of muscle tone associated with the narcolepsy, may cause severe problems. Even in these cases, however, it is not the sleep paralysis that causes serious effects.


Prevention and Treatment of Sleep Paralysis

Because it is a phenomenon that occurs naturally in the sleep process, sleep paralysis is not harmful and no treatment is usually needed. When the paralysis episodes happen frequently or are very disruptive to your sleep, your doctor might prescribe a sleeping medication or antidepressant. Over the counter sleep aids such as melatonin or valerian root may be effective in promoting sound sleep and preventing sleep paralysis. Any medication should be used only under the direction of your physician. Obviously, the most effective treatment is prevention.

What can you do to prevent sleep paralysis? Really, not much since everyone experiences the disorder, but only a few people are ever consciously aware of the paralysis. There are a few things you can do to ensure that your sleep is deeper and that you don’t awaken during the period of sleep when paralysis normally occurs. Limit naps during the day. Stick with a sleep schedule. Keep your bedroom dark and quiet. Avoid eating large meals and drinking caffeine late in the evening. Exercise — but not right before bedtime. Try taking a warm bath before you go to bed.

Additionally, you should avoid sleeping on your back since you are five times more likely to suffer sleep paralysis if you sleep in that position. Although some people have sleep paralysis when sleeping in other positions, research shows that most people with SP sleep on their backs.

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