Imagine waking up but you cannot move a muscle. You know that your mind is awake and your body is not - so you are essentially trapped. The scary inability to move may make you feel anxious and afraid.
Imagine waking up but you cannot move a muscle. You know that your mind is awake and your body is not — so you are essentially trapped. The scary inability to move may make you feel anxious and afraid.
Some people also hallucinate during this episode. They may ‘see’, ‘hear’ or ‘feel’ things that are actually not there. Others may even think that another person is in the room with them. This weird phenomenon is known as sleep paralysis.
For some people, sleep paralysis can be a once-in-a-lifetime experience, while for others, it can be a frequent or even nightly phenomenon.
What really is sleep paralysis?
Dr Rachna Pande, a medic at Ruhengeri Hospital, describes sleep paralysis as a condition where a person falling asleep or waking from sleep experiences inability to move.
She explains that sleep paralysis doesn’t cause one any harm, although being unable to move can be very frightening.
"Sleep paralysis may be associated with a feeling of tightness over one’s chest, auditory or visual hallucinations, sense of fear or numbness over the body,” Dr Pande says.
So many myths surround the cause of this disorder, with many believing that it could be associated with supernatural or evil powers.
Dr Jean Paul Mizero, a medic at Plateau Polyclinic, however, says although how and why the condition happens isn’t clear, it is mythical to attribute sleep paralysis to evil presence.
"People have for long sought explanations for this mysterious sleep-time paralysis and the accompanying feelings of terror; but despite those beliefs, the paralysis is not caused by supernatural powers.
"This sleeping problem may run in families although it is often first noticed in the teen years,” he says.
Dr Pande notes that although anyone can experience sleep paralysis, it occurs commonly in young adults. She adds that despite the exact cause being unknown, behaviour, both voluntary and involuntary can lead to its occurrence.
"Although the exact cause is not known, it is said to occur due to stress, lack of sleep and use of stimulant drugs like amphetamine. Sleeping in a supine position is another risk factor for sleep paralysis,” she says.
According to several studies, people with mental disorders such as anxiety and depression are more likely to experience sleep paralysis.
According to the American Academy of Sleep Medicine, a lack of sleep can make you more likely to have sleep paralysis. It is also more likely to occur if you have a sleep schedule that often changes, although it should be noted that mental stress may also be a risk factor.
Breaking the episode
Dr Mizero says an episode can last seconds or minutes although recurrent isolated sleep paralysis is fairly common. In most cases, it does not affect your sleep or overall health. You are still able to breathe normally and are also fully aware of what is happening.
"During the attack it is important to stay calm and realise that it will pass soon because there’s not much you can do during an attack. It can be quite scary to experience, especially if you’ve never had one before.
"An easy way to stop these nightmares is to control one’s breath. Controlled breathing does several things at once because it lessens the feeling of chest pain. A few moments of focused breathing with a strong intention to wake up is effective,” he advises.
Dr Pande also advises on how to awake from sleep paralysis.
"Sleeping in a supine position is a risk factor for sleep paralysis. Wiggling toes can help one wake up when one feels paralysed. It may also end when someone touches you or speaks to you. Making an intense effort to move can also end an episode,” she says.
Ideally, doctors do not need any tests to treat most patients with recurrent isolated sleep paralysis. The episode usually ends on its own.
For Dr Mizero, the key to breaking the recurrent isolated sleep paralysis is to prevent and seek treatment of any underlying causes such as narcolepsy as this may help if you are anxious or unable to sleep well. After one episode of sleep paralysis, it may not be necessary to get a doctor’s appointment right away.
"If one has rare episodes of sleep paralysis, but hasn’t visited a sleep specialist, they should make sure that their sleep hygiene is solid. For example, sleep paralysis can be a sign that you don’t sleep enough,” he says.
Dr Mizero also advises that one gets enough sleep on a regular basis; avoid alcohol, nicotine and drugs all night, starting three hours before bedtime to avoid the condition. They should also limit caffeine after and keep electronics out of the bedroom, he says.
He further suggests that if these don’t help, and one continues having episodes that are somewhat more frequent, they should consult a sleep specialist to see if there’s any underlying medical disorder.
Treatment
Sleep paralysis is "isolated” when it appears without any other signs of narcolepsy (a condition characterised by an extreme tendency to fall asleep whenever in relaxing surroundings). Treatment of sleep paralysis should be aimed at whatever causes it to occur.
Dr Pande says, "Antidepressant drugs are used in serious cases but no drug has been found to be completely effective. The treatment consists of having a consistent timetable for sleeping, waking up and taking at least 8 hours of sound sleep.”
Sleep paralysis can sometimes be a symptom of another sleep disorder called narcolepsy, which causes severe daytime sleepiness and an inability to stay alert for more than a few hours. People with narcolepsy often have sleep paralysis. They normally need antidepressant medication to reduce or eliminate dream sleep.
Dr Mizero also suggests that although sleep paralysis is not dangerous, those experiencing it in extremes may be prescribed a short course of antidepressant medication such as clomipramine.
It is also important to talk to your doctor if episodes of sleep paralysis make you anxious. You should see a sleep specialist if the episodes keep you up at night or make you very tired during the day, he says.
Dr Mizero explains that taking an antidepressant drug does not mean that you are depressed. It is simply a method to help reduce sleep paralysis.
"Although there’s no cure for narcolepsy, the condition can usually be managed with appropriate medication. A number of lifestyle adjustments may help, including, taking frequent brief naps during the day, sticking to a strict bedtime routine where you go to bed at the same time each night, ensuring you get at least eight hours of sleep every night, avoiding stressful situations, eating a healthy, balanced diet and taking regular exercise - but not too close to bedtime,” he says.
Dr Pande says sleep deprivation may also trigger sleep paralysis. People with psychiatric problems may suffer from sleep paralysis. An example is someone who has bipolar disorder. This person would need ongoing treatment with medication which would be overseen by a physician or psychiatrist.
"The doctor will need to know when the sleep paralysis started. They will want to know how often it occurs and how long it lasts. The doctor will need to know your complete medical history. Be sure to inform them of any past or present drug use or medication.
"Also tell your doctor if you have ever had any other sleep disorder. Find out if you have any family members with sleep problems. It will also be helpful if you fill out a sleep diary for about two weeks. The sleep diary will help the doctor assess your sleeping patterns. This data gives the doctor clues about what is causing your problem and how to correct it,” Dr Mizero advises.
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Common causes of insomnia include:
- Stress. Concerns about work, school, health or family can keep your mind active at night, making it difficult to sleep. Stressful life events — such as the death or illness of a loved one, divorce, or a job loss — may lead to insomnia.
- Anxiety. Everyday anxieties as well as more-serious anxiety disorders, such as post-traumatic stress disorder, may disrupt your asleep. Worry about being able to go to sleep can make it harder to fall asleep.
- Depression. You might either sleep too much or have trouble sleeping if you’re depressed. Insomnia often occurs with other mental health disorders as well.
- Medical conditions. If you have chronic pain, breathing difficulties or a need to urinate frequently, you might develop insomnia. Examples of conditions linked with insomnia include arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson’s disease and Alzheimer’s disease.
- Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body’s circadian rhythms, making it difficult to sleep. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature.
- Poor sleep habits. Poor sleep habits include an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment, and use of your bed for activities other than sleep or sex.
- Medications. Many prescription drugs can interfere with sleep, including some antidepressants, heart and blood pressure medications, allergy medications, stimulants (such as Ritalin), and corticosteroids. Many over-the-counter (OTC) medications — including some pain medication combinations, decongestants and weight-loss products — contain caffeine and other stimulants.
- Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeine-containing drinks are well-known stimulants.
Drinking coffee in the late afternoon and later can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can cause insomnia. Alcohol is a sedative that may help you fall asleep, but it prevents deeper stages of sleep and often causes you to awaken in the middle of the night.
- Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
Insomnia and aging
Insomnia becomes more common with age. As you get older, you may experience:
- A change in sleep patterns. Sleep often becomes less restful as you age, and you may find that noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, which means you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
- A change in activity. You may be less physically or socially active. A lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.
- A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, menopausal hot flashes can be equally disruptive.
Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
Agencies
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Their experiences...
Reagan Kabera, events planner
Sleep paralysis happens to me so many times, especially when I take a nap. I cannot scream even when I want to. I still believe this to be a spiritual occurrence. All I do is wiggle my toe and pray, which helps me wake up from it.
Vestine Mahoro, office administrator
I have been experiencing sleep paralysis since I was 15 years and it is very frightening. It happens to me when I lie on my back, but now I have learnt not to sleep on my back now and control my fears and emotions. This helps me control my mind.
Simon Kalisa, student
It mostly happens to me when I’m extremely tired and attempting to stay in bed longer than normal. It is a terrifying experience and it happens again when I go back to sleep after a bad dream. Trying to focus on moving some part of my body normally works for me.
Annet Agaba, accountant
I seem to get these episodes when I go to bed exhausted. When I feel sleep paralysis coming back, I don’t fight it because it only makes it worse. Putting much focus into moving a part of my body triggers the brain and stops it immediately.
Compiled by Sharon Kantengwa