Sleep paralysis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
G47 sleep disorders
G47.4 Narcolepsy and cataplexy
ICD-10 online (WHO version 2019)

In the sleep paralysis , and sleep paralysis or sleep paralysis , which is skeletal muscles during sleep paralysis. This is to protect the body. It prevents dreamed movements from actually being carried out. When you wake up, the paralysis disappears immediately and you don't notice it. However, it can happen from time to time that one experiences the paralysis consciously, either shortly before falling asleep or after waking up.

If one experiences it too often consciously, one speaks of a sleep disorder ; often the word sleep paralysis is used for the disorder. The normal paralysis that one does not perceive is, rather than REM - Atonie referred.

A conscious experience of paralysis can be accompanied by nightmarish experiences. In English, sleep paralysis is used exclusively for the disorder, while natural paralysis during normal sleep is called REM atonia .

Sleep paralysis / REM atonia

During the REM sleep phase there is a natural paralysis of the muscles that are subject to volition in the waking state, which is known as sleep paralysis or REM atonia. It prevents dreamed movements from actually being carried out. The eye muscles are excluded from this. Dreamed eye movements are also carried out physically, which is easy to observe in a dreaming through the closed eyelids. On awakening, REM atony is usually broken without delay; that is, it is not consciously experienced.

The neural activities that cause the widespread muscle paralysis during REM sleep mainly originate in the pons , also known as the "bridge", part of the brain stem . The motor neurons of the brain stem and spinal cord become inhibited, resulting in profound atony .

As a sleep disorder

Basics

A consciously experienced sleep paralysis is considered a sleep disorder ( parasomnia ). This results in a decoupling ( dissociation ) of the paralysis from the state of sleep, whereby the muscle atony typical of REM sleep is extended to neighboring waking phases. This can happen when falling asleep or when waking up. In the former case one speaks of the hypnagogic or pre-normital form, in the latter of the hypnopompic or postdormital form. Within the sleep disorders, sleep paralysis belongs to the subgroup of phenomena that usually occur in connection with the sleep phases of REM sleep . It is sometimes called a waking fit . It is estimated that 40% of the total population is likely to experience this kind of paralysis consciously once in a lifetime.

"Rigidity" is only experienced by those who wake up or who fall asleep. For outsiders, the muscles are not rigid (as with muscle stiffness ) or cramped , but rather slack .

An isolated sleep paralysis (ISP) , which does not occur as an element of another disorder, can occur once, accumulated over a few weeks, or sporadically at intervals of months to years. In contrast, there is a disorder that occurs repeatedly over a long period of time (recurrent isolated sleep paralysis, RISP) , sometimes in phases with longer periods of time without events. RISP is often associated with hallucinations.

So far (as of July 2016) there are only vague assumptions and no complete theories about the neurophysiology of sleep paralysis as a disorder.

Side effects

The consciously experienced sleep paralysis is not dangerous in itself, but is perceived by many people as very uncomfortable or even frightening. Some people feel as if they are suffocating because they cannot feel their breathing, while others feel pressure on their chest, as if something heavy was there. Visual , tactile, or acoustic hallucinations also occur in around a third of those affected . The hallucinations can also have the character of out-of-body experiences and the view of one's own body from the outside ( autoscopy ).

distribution

A systematic review article from 2011, which evaluated 35 individual studies with data from a total of 36,533 people, showed an at least one occurrence of sleep paralysis during a lifetime ( lifetime prevalence ) in 7.6% of the total population, 28.3% of students and 31.9% of psychiatric patients . Women were slightly more affected than men (18.9% compared with 15.9% when all groups were added together). Only 6 of the 35 individual studies contained usable age information. No significant abnormalities were found here.

Sleep paralysis is also one of the defining symptoms of narcolepsy , a disorder that is particularly characterized by falling asleep attacks. 40-50% of patients diagnosed with narcolepsy experienced sleep paralysis as one of their symptoms.

Heredity

Twin research suggests that the likelihood of experiencing sleep paralysis has a hereditary component. If one of two identical twins is affected, the likelihood that the other will also have similar experiences is greatly increased. An autosomal dominant mode of inheritance has been reported.

diagnosis

The diagnosis is made by taking the medical history ( anamnesis ). When in doubt, other possible causes of sleep-related paralysis should be ruled out. This is particularly true of narcolepsy, where sleep paralysis is one of the characteristic symptoms as a disorder. In this case, polysomnography and multiple sleep latency tests (MSLT) in a sleep laboratory can clarify the situation if necessary .

In a polysomnography, sleep paralysis - as a disorder - is easily recognizable, since the electromyography shows a simultaneous existence of slackness of the muscles ( atony ) and a state of wakefulness (non-sleep) in the electroencephalography (EEG). An MSLT tells you whether it is an isolated - and therefore harmless - disorder or a sign of narcolepsy.

treatment

Non-drug therapy

Medical treatment begins with educating the person about the various phases of sleep and that they are naturally unable to move their muscles during REM sleep. The information that it is a harmless, well-known, natural phenomenon that is experienced by a large number of people can take away fears. It can also be helpful to encourage the person concerned to realize the harmlessness of the process during a consciously experienced sleep paralysis. Above all, the knowledge that every sleep paralysis ends by itself, that there is no danger from it and that the hallucinations that may be perceived have no real existence, facilitates the corresponding experience and is suitable for breaking through the build-up of fear and panic. Some sufferers succeed in developing techniques to actively end the state of sleep paralysis. Some are able to move toes or fingers with the utmost willpower and thus loosen themselves from the paralysis. Others alert their partner by consciously breathing loudly so that he can touch them and thus end the paralysis.

We recommend sleep hygiene with adequate sleep and regular sleep times, the use of strategies for coping with stress, dimmed lights on the bed, position training to avoid lying on your back and training to concentrate on trying to move a part of the body (fingers or hand).

Medical therapy

In severe cases, if the person concerned suffers severely from sleep paralysis, there is the possibility of drug treatment. The most commonly used drugs are tricyclic antidepressants , e.g. B. imipramine or clomipramine , which are also used to treat narcolepsy, and selective serotonin reuptake inhibitors (SSRIs). Also, L-tryptophan with simultaneous or without concomitant Amitriptyline administered (a tricyclic antidepressant). These drugs are only prescribed for very severe cases of RISP (recurrent isolated sleep paralysis) . Effective treatment cannot be guaranteed for everyone.

In art and culture

Der Nachtmahr by Johann Heinrich Füssli (1781): Artist's impression with typical features of sleep paralysis such as stress on breathing, slack muscles and hallucinations

The phenomenon of sleep paralysis has been a theme since Hellenistic times at the latest and has experienced a wide range of explanatory models and interpretations over the centuries in the different cultures and belief systems. In ancient Greece, for example, stomach and digestive problems were seen as triggering factors, while in ancient Rome and Egypt feelings of guilt were blamed for sleep paralysis. The idea that a demon sits on the chest of the sleeper and thus steals the air to breathe was very common in all cultures . In Europe there was the idea of ​​the night alb or incubus that haunted its victims in their sleep. In Mexico and the Yoruba it was witches, in Southeast Asia the spirits of the dead and in Ireland and Scotland so-called hags . Even today, sleep paralysis is known as the old hag attack in parts of the United States and Canada, especially Newfoundland . In modern Japan, the phenomenon is known as kanashibari , which roughly means "still tied up".

In art, too, sleep paralysis is often represented as a nocturnal visitation by a demon. Examples are:

  • The Nightmare , painting by Johann Heinrich Füssli (1781)
  • Guy de Maupassant : The Horla . Narrative. 1886. The author himself suffered greatly from sleep paralysis episodes and also had out-of-body experiences.
  • My dream, my bad dream , drawing by Fritz Schwimbeck (1909)
  • Francis Scott Fitzgerald : The Beautiful and the Damned . Novel. 1922.
  • The Nightmare , quasi-documentary horror film by Rodney Ascher (2015)

The first scientific approach to the subject came in 1876 by the American doctor Silas Weir Mitchell .

See also

  • Catalepsy (stiffness, freezing after moving)
  • Stupor (rigidity of the whole body when conscious)
  • Torpor (paralyzed sleep in some animals)

literature

Guidelines

Introductions

  • Brian Sharpless, Karl Doghramji: Sleep Paralysis. Historical, Psychological, and Medical Perspectives . Oxford University Press, Oxford 2015, ISBN 978-0-19-931382-2 .
  • Sricharan Moturi, Poojitha Matta: Recurrent Isolated Sleep Paralysis (RISP) . In: Sanjeev V. Kothare, Anna Ivanenko (ed.): Parasomnias. Clinical Characteristics and Treatment . Springer, New York 2013, ISBN 978-1-4614-7626-9 , pp. 201-206.
  • BA Sharpless, JP Barber: Lifetime prevalence rates of sleep paralysis: a systematic review. In: Sleep medicine reviews. Volume 15, number 5, October 2011, pp. 311-315, doi: 10.1016 / j.smrv.2011.01.007 , PMID 21571556 , PMC 3156892 (free full text) (review).
  • James Allan Cheyne: Recurrent isolated sleep paralysis . In: Michael J. Thorpy, Giuseppe Plazzi (Eds.): The Parasomnias and Other Sleep-Related Movement Disorders . Cambridge University Press, Cambridge UK 2010, ISBN 978-1-139-48572-2 , pp. 142-152.
  • Geert Mayer: Sleep paralysis . In: Helga Peter, Thomas Penzel, Jörg Hermann Peter (eds.): Encyclopedia of Sleep Medicine . Springer Medizin Verlag, Heidelberg 2007, ISBN 978-3-540-28840-4 , pp. 1093-1095.

counselor

history

  • EJ Kompanje: 'The devil lay upon her and held her down'. Hypnagogic hallucinations and sleep paralysis described by the Dutch physician Isbrand van Diemerbroeck (1609-1674) in 1664. In: Journal of sleep research. Volume 17, number 4, December 2008, pp. 464-467, doi: 10.1111 / j.1365-2869.2008.00672.x , PMID 18691361 (free full text).

Web links

Individual evidence

  1. ^ Geert Mayer: Narcolepsy. Georg Thieme Verlag, Stuttgart 2006, ISBN 978-3-13-134431-1 , p. 18.
  2. ↑ JA Fleetham, JA Fleming: Parasomnias. In: CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne. Volume 186, number 8, May 2014, pp. E273 – E280, doi: 10.1503 / cmaj.120808 , PMID 24799552 , PMC 4016090 (free full text) (review).
  3. ↑ Heinz-Walter Delank, Walter Gehlen: Neurology. 12th edition. Georg Thieme Verlag, Stuttgart 2010, ISBN 978-3-13-160002-8 , p. 422.
  4. ↑ Boris A. Stuck: Practice of sleep medicine. Springer-Verlag, 2017, ISBN 978-3-662-54383-2 , p. 238 ( limited preview in Google book search).
  5. ↑ James Allan Cheyne: Recurrent isolated sleep paralysis. In: Michael J. Thorpy, Giuseppe Plazzi (Eds.): The Parasomnias and Other Sleep-Related Movement Disorders. Cambridge University Press, Cambridge / UK 2010, ISBN 978-1-139-48572-2 , pp. 142-152.
  6. ↑ JJ Fraigne, ZA Torontali, MB Snow, JH Peever: REM Sleep at its Core - Circuits, Neurotransmitters, and Pathophysiology. In: Frontiers in neurology. Volume 6, 2015, p. 123, doi: 10.3389 / fneur.2015.00123 , PMID 26074874 , PMC 4448509 (free full text) (review).
  7. ↑ James Allan Cheyne: Recurrent isolated sleep paralysis. In: Michael J. Thorpy, Giuseppe Plazzi (Eds.): The Parasomnias and Other Sleep-Related Movement Disorders. Cambridge University Press, Cambridge / UK 2010, ISBN 978-1-139-48572-2 , pp. 142-152.
  8. ↑ German Society for Sleep Research and Sleep Medicine (DGSM): S3 guideline - non-restful sleep / sleep disorders . (PDF; accessed July 13, 2016) Section 5.11.5 on pp. 110–111: Recurrent isolated sleep paralysis (RISL) . In: Somnologie - Schlafforschung und Schlafmedizin (Suppl 1), Volume 13, 2009, pp. 4–160, doi: 10.1007 / s11818-009-0430-8 .
  9. ↑ James Allan Cheyne: Recurrent isolated sleep paralysis. In: Michael J. Thorpy, Giuseppe Plazzi (Eds.): The Parasomnias and Other Sleep-Related Movement Disorders. Cambridge University Press, Cambridge / UK 2010, ISBN 978-1-139-48572-2 , pp. 142–152, here pp. 145–147.
  10. ^ BA Sharpless, JP Barber: Lifetime prevalence rates of sleep paralysis: a systematic review. In: Sleep medicine reviews. Volume 15, number 5, October 2011, pp. 311-315, doi: 10.1016 / j.smrv.2011.01.007 , PMID 21571556 , PMC 3156892 (free full text) (review).
  11. ^ Geert Mayer: Narcolepsy . Georg Thieme Verlag, Stuttgart 2006, ISBN 978-3-13-134431-1 , p. 14.
  12. ↑ A. Sehgal, E. Mignot: Genetics of sleep and sleep disorders. In: Cell. Volume 146, number 2, July 2011, pp. 194-207, doi: 10.1016 / j.cell.2011.07.004 , PMID 21784243 , PMC 3153991 (free full text) (review).
  13. ↑ E. Mignot: Genetics of narcolepsy and other sleep disorders. In: American Journal of Human Genetics . Volume 60, number 6, June 1997, pp. 1289-1302, doi: 10.1086 / 515487 , PMID 9199548 , PMC 1716121 (free full text) (review).
  14. ↑ German Society for Sleep Research and Sleep Medicine (DGSM): S3 guideline - non-restful sleep / sleep disorders . (PDF; accessed July 13, 2016) Section 5.11.5 on pp. 110–111: Recurrent isolated sleep paralysis (RISL) . In: Somnologie - Schlafforschung und Schlafmedizin , (Suppl 1), Volume 13, 2009, pp. 4–160, doi: 10.1007 / s11818-009-0430-8 .
  15. ^ MJ Howell: Parasomnias: an updated review. In: Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics. Volume 9, number 4, October 2012, pp. 753-775, doi: 10.1007 / s13311-012-0143-8 , PMID 22965264 , PMC 3480572 (free full text) (review).
  16. ↑ German Society for Sleep Research and Sleep Medicine (DGSM): S3 guideline - non-restful sleep / sleep disorders . (PDF; accessed July 13, 2016) Section 5.11.5 on pp. 110–111: Recurrent isolated sleep paralysis (RISL) . In: Somnologie - Schlafforschung und Schlafmedizin (Suppl 1), Volume 13, 2009, pp. 4–160, doi: 10.1007 / s11818-009-0430-8 .
  17. ↑ James Allan Cheyne: Recurrent isolated sleep paralysis . In: Michael J. Thorpy, Giuseppe Plazzi (Eds.): The Parasomnias and Other Sleep-Related Movement Disorders . Cambridge University Press, Cambridge / UK 2010, ISBN 978-1-139-48572-2 , pp. 142-152.
  18. ^ JM Schneck: Henry Fuseli, nightmare, and sleep paralysis. In: JAMA. Volume 207, Number 4, January 1969, pp. 725-726, PMID 4883518 .
  19. ↑ Brian Sharpless, Karl Doghramji: Sleep Paralysis. Historical, Psychological, and Medical Perspectives. Oxford University Press, Oxford 2015, ISBN 978-0-19-931382-2 , chapter 3.
  20. ↑ Brian Sharpless, Karl Doghramji: Sleep Paralysis. Historical, Psychological, and Medical Perspectives. Oxford University Press, Oxford 2015, ISBN 978-0-19-931382-2 , chapter 4.
  21. ↑ Film description and trailer on firstshowing.net
  22. ↑ Brian Sharpless, Karl Doghramji: Sleep Paralysis. Historical, Psychological, and Medical Perspectives . Oxford University Press, Oxford 2015, ISBN 978-0-19-931382-2 , pp. 57f.