Sleep paralysis

File:Fuseli nightmare.jpg

The Nightmare, by Henry Fuseli (1781) is thought to be one of the classic depictions of sleep paralysis perceived as a demonic visitation.

Sleep paralysis is a common condition characterized by transient partial or total paralysis of skeletal muscles and areflexia that occurs upon awakening from sleep or less often while falling asleep. Stimuli such as touch or sound may terminate the episode, which usually has a duration of seconds to minutes. This condition may occur in normal subjects or be associated with narcolepsy, cataplexy, and hypnagogic hallucinations. The pathophysiology of this condition is closely related to the normal hypotonia that occur during REM sleep. When considered to be a disease, isolated sleep paralysis is classified as MeSH D020188.

Physiologically, it is closely related to the paralysis that occurs as a natural part of REM (rapid eye movement) sleep, which is known as REM atonia. Sleep paralysis occurs when the brain awakes from a REM state, but the bodily paralysis persists. This leaves the person fully conscious, but unable to move. In addition, the state may be accompanied by terrifying hallucinations (hypnopompic or hypnagogic) and an acute sense of danger . Sleep paralysis is particularly frightening to the individual due to the vividness of such hallucinations. The hallucinatory element to sleep paralysis makes it even more likely that someone will interpret the experience as a dream, since completely fanciful, or dream-like, objects may appear in the room alongside one's normal vision. Some scientists have proposed this condition as a theory for alien abductions and ghostly encounters.

The paralysis can last from several seconds to several minutes "after which the individual may experience panic symptoms and the realization that the distorted perceptions were false" . When there is an absence of narcolepsy, sleep paralysis is referred to as isolated sleep paralysis (ISP) . "ISP appears to be far more common and recurrent among African Americans than among White Americans or Nigerian Blacks" , and is often referred to within African American communities as "the witch riding your back" .

Symptoms

Symptoms of sleep paralysis can be either one of the following or a combination:

• Paralysis: this occurs after waking up or shortly before falling asleep. The person cannot move any body part, cannot speak, and only has minimal control over blinking and breathing. This paralysis is the same paralysis that occurs when dreaming. The brain paralyzes the muscles to prevent possible injury during dreams, as some body parts may move during dreaming. If the person wakes up suddenly, the brain may still think that it is dreaming, and sustains the paralysis.

• Hallucinations: Images or speaking that appear during the paralysis. The person may think that someone is standing beside them or they may hear strange sounds. These may be dreamlike, possibly causing the person to think that they are still dreaming. Often it is reported as feeling a weight on one's chest, as if being underneath a person or heavy object.

These symptoms can last from mere seconds to several minutes (although they can feel like much longer) and can be frightening to the person. There may be some body movement, but it is very unlikely and hard for a person to accomplish.

Possible causes

Sleep paralysis occurs during REM sleep, thus preventing the body from manifesting movements made in the subject's dreams. Very little is known about the physiology of sleep paralysis. However, some have suggested that it may be linked to post-synaptic inhibition of motor neurons in the pons region of the brain. In particular, low levels of melatonin may stop the depolarization current in the nerves, which prevents the stimulation of the muscles, to prevent the body from enacting the dream activity (e.g. preventing a sleeper from flailing his legs when dreaming about running).

Several studies have concluded that many or most people will experience sleep paralysis at least once or twice in their lives.

Many people who commonly enter sleep paralysis also suffer from narcolepsy. In African-Americans, panic disorder occurs with sleep paralysis more frequently than in Caucasians. Some reports read that various factors increase the likelihood of both paralysis and hallucinations. These include:

• Sleeping in a face upwards or supine position
• Irregular sleeping schedules; naps, sleeping in, sleep deprivation
• Increased stress
• Sudden environmental/lifestyle changes
• A lucid dream that immediately precedes the episode.

Treatment

Clonazepam is highly effective in the treatment of sleep paralysis. The initial dose is 0.5 mg at bedtime, while an increase to 1 mg per night might be necessary to maintain potency.

Ritalin has been used successfully as a daytime medication to promote structured sleep patterns and the prevention of sleep paralysis in some adults. Care should be taken to monitor blood pressure along with other appropriate tests. Dosage starts at 20mg per day (morning) increased weekly until episodes diminish.

Folklore

Complete references to many cultures are given in the References section

• In African American culture, isolated sleep paralysis is commonly referred to as "the devil riding your back"
• In the Cambodian, Laotian and Thai culture, sleep paralysis is referred to as "pee umm" and "khmout sukkhot". It describes an event where the person is sleeping and dreams that ghostly figure(s) are either holding him/her down or the ghosts can just be near. The person usually thinks that they are awake but is unable to move or make any noises. This is not to be confused with "pee khao" and "khmout jool" which refers to a ghost possession.
• In Hmong culture, sleep paralysis describes an experience called "dab tsog" or "crushing demon" from the compound phrase "dab" (demon) and "tsog" (crush). Often the sufferer claims to be able to see a tiny figure, no larger than a child, sitting on his or her chest. What is alarming is that a vast number of American Hmong, mainly males, have died in their sleep prompting the Centers for Disease Control to create the term "Sudden Unexpected Nocturnal Death Syndrome" or "SUNDS" for short.
• In Vietnamese culture, sleep paralysis is referred to as "ma de", meaning "held down by a ghost". Many people in this culture believe that a ghost has entered one's body, causing the paralyzed state.
• In Chinese culture, sleep paralysis is known as "鬼壓身" (simplified: 鬼压身) (pinyin: guǐ yā shēn) or "鬼壓床" (simplified: 鬼压床) (pinyin: guǐ yā chuáng), which literally translate into "body pressured by a ghost" or "bed pressured by a ghost."
• In Japanese culture, sleep paralysis is referred to as kanashibari (金縛り, literally "bound or fastened in metal," from kane "metal" and shibaru" to bind, to tie, to fasten"). This term is occasionally used by English speaking authors to refer to the phenomenon both in academic papers and in pop psych literature.
• In Hungarian folk culture sleep paralysis is called "lidércnyomás" ("lidérc pressing") and can be attributed to a number of supernatural entities like "lidérc" (wraith), "boszorkány" (witch), "tündér" (fairy) or "ördögszerető" (demon lover). The word "boszorkány" itself stems from the Turkish root "bas-", meaning "to press".
• In Iceland folk culture sleep paralysis is generally called having a "Mara". Mara is an old Icelandic word for a mare but has taken on the meaning for a sort of a devil that sits on ones chest at night, trying to suffocate the victim.
• In Malta,folk culture attributes a sleep paralysis incident to an attack by the "Haddiela" who is the wife of the "Hares", the entity in Maltese folk culture which haunts the individual in similar ways as to those of a poltergeist. As believed in folk culture, to rid oneself of the Haddiela, one must place a piece of silverware or a knife under the pillow prior to sleep.
• Kurdish people call this phenomenon a "mottaka", they believe that some one, in a form of a ghost or perhaps an evil spirit, turns up on top the of the person in the middle of the night and suffocates him/her. Apparently this happens usually when some one has done something bad.
• In New Guinea, people refer to this phenomenon as "Suk Ninmyo", believed to originate from sacred trees that use human essence to sustain its life. The trees are said to feed on human essence during night as to not disturb the human's daily life, but sometimes people wake unnaturally during the feeding, resulting in the paralysis.
• In Turkish culture, sleep paralysis is often referred to as "karabasan" ("The dark presser/assailer"). It is believed to be a creature which attacks people in their sleep, pressing on their chest and stealing their breath.
• In Mexico, it's believed that sleep paralysis is in fact the spirit of a dead person getting on the person and impeding movement, calling this "se me subió el muerto" (the dead person got on me).
• In many parts of the Southern United States, the phenomenon is known as a "hag", and the event is said to often be a sign of an approaching tragedy or accident.
• Ogun Oru is a traditional explanation for nocturnal disturbances among the Yoruba of Southwest Nigeria; ogun oru (nocturnal warefare) involves an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming. Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer's earthly spouse and a ;spiritual' spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements.

• In Zimbabwean Shona culture the word Madzikirira is used to refer something really pressing one down. This mostly refers to the spiritual world in which some spirit--especially an evil one--tries to use its victim for some evil purpose. The people believe that witches can only be people of close relations to be effective, and hence a witches often try to use one's spirit to bewitch one's relatives.

• In Ethiopian culture the word Dukak is used. Dukak is believed to be some form of evil spirit that possesses people during their sleep. This experience is also believed to be related to use of Khat. Most Khat users experience sleep paralysis when quitting after a long time of use.

• In Ireland it is also known as "the hag." The expression originates from reports of an old woman that was believed to be seen near the sufferer during paralysis.

• Several studies have shown that African-Americans may be predisposed to isolated sleep paralysis also known as "the witch is riding you," or "the haint is riding you." In addition, other studies have shown that African-Americans who have frequent episodes of isolated sleep paralysis, i.e., reporting having one or more sleep paralysis episodes per month coined as "sleep paralysis disorder," were predisposed to having panic attacks. This finding has been replicated by other independent researchers

• In Pakistani culture, it is an encounter with evil jinns and demons. It is also assumed that it is due to the black magic performed by enemies and jealous persons. Curses could also result in ghoul haunting a person. Some homes and locations are also haunted by these satanic beings.

• In Korean Culture, sleep paralysis is known as 가위 ("ga-ui", pronounced /kah-wee/). It literally translates to "scissor" in English.

• In Sri Lankan Culture, this particular phenomenon is referred to as 'Amuku Be" or 'Amuku Pei' meaning the ghost that forces one down.

• In Filipino Culture, this is treated as a superstition that unmarried adults over 30 usually experience sleep paralysis after eating a large dinner. It is also a myth that Filipinos who experience this usually die, leaving their neighbors to find them dead the next morning. Because of Filipino's importance to marriage, Filipinos usually share this myth so that their children, and other members of their expansive family, will marry well into their 20s.

References

• Culhane-Pera, Kathie (2003). Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers. Vanderbilt University Press.
• Bower, Bruce (July 9, 2005). "Night of the Crusher." Science News.
• Conesa, J. (2000). Geomagnetic, cross-cultural and occupational faces of sleep paralysis: An ecological perspective. Sleep and Hypnosis, 2, (3), 105-111.
• Conesa, J. (2002). Isolated Sleep Paralysis and Lucid Dreaming: Ten-year longitudinal case study and related dream frequencies, types, and categories. Sleep and Hypnosis, 4, (4), 132-143.
• Conesa, J. (2003). Sleep Paralysis Signaling (SPS) As A Natural Cueing Method for the Generation and Maintenance of Lucid Dreaming. Presented at The 83rd Annual Convention of the Western Psychological Association, May 1 - 4, 2003 in Vancouver, BC, Canada.
• Conesa-Sevilla, Jorge (2004). Wrestling With Ghosts: A Personal and Scientific Account of Sleep Paralysis. Pennsylvania: Xlibris/Randomhouse.
• Firestone K. The “Old Hag”: sleep paralysis in Newfoundland. The Journal of Psychoanalytic Anthropology 1985; 8:47-66.
• Fukuda K, Miyasita A, Inugami M, Ishihara K. High prevalence of isolated sleep paralysis: kanashibari phenomenon in Japan. Sleep 1987; 10:279-286.
• Hartmann E. The nightmare: the psychology and biology of terrifying dreams. New York:Basic,1984.
• Hufford D.J. The terror that comes in the night: an experience-centered study of supernatural assault traditions. Philadelphia:University of Pennsylvania Press, 1982
• Kettlewell, N; Lipscomb, S; Evans, E. (June, 1993). "Differences in neuropsychological correlates between normals and those experiencing "Old Hag Attacks'." Perceptual and Motor Skills. 76 (3 Pt 1): 839-45; discussion 846. PMID 8321596
• Ness RC. “The Old Hag” phenomenon as sleep paralysis: a bicultural interpretation . Culture, Medicine and Psychiatry 1978; 2:15-39.
• Ohayon MM, Zulley J, Guilleminault C, Smirne, S. Prevalence and pathologic associations of sleep paralysis in the general population. Neurology, 1999; 52:1194-1200.
• Sagan, Carl (1997). The Demon-Haunted World: Science as a Candle in the Dark.
• Schneck JM. Sleep paralysis and microsomatognosia with special reference to hypnotherapy . The International Journal of Clinical and Experimental Hypnosis 1977; XXV:72-77.
• Takeuchi T, Miyasita A, Sasaki Y, Inugami M, Fukuda K. Isolated sleep paralysis elicited by sleep interruption. American Sleep Disorders Association and Sleep Research Society, 1992; 15: 217-225.

External links

• Sleep Paralysis Information Service
• Sleep information and links from Stanford University
• Sleep Paralysis and Associated Hypnagogic and Hypnopompic Experiences from University of Waterloo
• Waking Up to Sleep Paralysis