Relationships between sleep paralysis and sleep quality: current insights

Abstract

Sleep paralysis is the unusual experience of waking up in the night without the ability to move. Currently little is known about the experience, despite the fact that the vast majority of episodes are associated with extreme fear and in a minority of cases can lead to clinically significant levels of distress. The aim of this work was to review the existing literature pertaining to the relationship sleep paralysis has to sleep more generally, measured both with subjective questionnaires and objective laboratory recordings. In terms of subjective sleep variables, worse sleep quality has been found in multiple studies to be associated with increased odds of sleep paralysis occurrence. In addition, insomnia symptoms (but not a diagnosed insomnia disorder) have also been found to predict sleep paralysis. Associations between sleep paralysis and other unusual and/or threatening sleep experiences such as nightmares, exploding head syndrome, and lucid dreaming have been reported. In terms of objective measurements, the limited literature to date shows sleep paralysis to be a “mixed” state of consciousness, combining elements of rapid eye movement sleep with elements of wakefulness. Future research needs to focus on longitudinal designs to disentangle the direction of effects and more typically employ a broader assessment of sleep paralysis that better captures associated features such as hallucinations, fear, and distress.

Nightmare Disorder and Isolated Sleep Paralysis

“…One should ask about excessive daytime sleepiness and cataplexy to rule out nightmares in the context of narcolepsy. Interaction between sleep quality and the occurrence of nightmares and insomnia symptoms predicting sleep paralysis is reviewed in Denis et al [8]. Scales, such as the nightmare frequency questionnaire, a nightmare distress questionnaire, and others have also been used and are reviewed in Gieselmann et al [9].…”

“…Predisposing factors include sleep deprivation and jetlag [41]. Therefore, all patients with sleep paralysis should be screened for sleep quality and insomnia symptoms [8]. Table 2 American Academy of Sleep Medicine (AASM) recommendations for the treatment of nightmare disorder in adults [34] •PTSD-associated nightmares and nightmare disorder: Recommended: imagery rehearsal therapy •PTSD-associated nightmares: Cognitive-behavioral therapy; cognitive-behavioral therapy for insomnia; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone, and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants •Nightmare disorder: May be used: cognitive-behavioral therapy; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method; nitrazepam; prazosin; and triazolam Not recommended: clonazepam and venlafaxine Criteria A-D must be met: A. Recurrent inability to move the trunk and all of the limbs at sleep onset or upon awakening from sleep.…”

“…Few families with RISP have been reported [1]. First, genetic analysis points to impaired circadian rhythm, as variations in the circadian rhythm gene PER2 have been shown to increase the odds of sleep paralysis [8]. However, genetic studies for RISP are lacking, and genome-wide association studies have not been performed.…”

Influência Da Ansiedade No Distúrbio Da Paralisia Do Sono Sob O Olhar Da Terapia Cognitivo Comportamental

“…A paralisia do sono é um distúrbio que acomete o sono e pode ser considerado relativamente comum, contudo, é pouco pesquisado e investigado. Segundo Denis et al (2018), esse distúrbio é marcado pela experiência incomum de acordar durante a noite sem a capacidade de se mover. A grande maioria dos episódios está associado a medo extremo e, em uma minoria dos casos, pode levar a níveis clinicamente significativos de sofrimento.…”

“…Indivíduos que classificam seu sono como muito bom ou bom, tem chances significativamente menores de sofrer paralisia do sono do que aquelas em que o sono é classificado como muito ruim ou ruim. A latência do sono e aumento da disfunção diurna está significativamente associada à paralisia do sono (DENIS et al, 2018).…”