Abstract

Sleep paralysis (SP) is a condition associated with the inability to move, which occurs when a person is about to fall asleep or just waking up. It may occur as an isolated SP in healthy individuals. It has also been linked to other underlying psychiatric, familial, and sleep disorders. Statistics show that 8% of the general population is suffering from SP.

Although this value has been described as inaccurate, there is no standard definition or etiology for the diagnosis of SP. In the current literature, there are many speculations describing SP. These descriptions can be seen as culturally based or medically based.

The disparity between cultural or ethnic groups and medical professionals in identifying SP has led to different approaches to the management of the condition. The purpose of this review is to describe SP clinically and how it is interpreted and managed among different cultural groups.

Keywords: Culture, dream, phobia, ghost, rapid eye movement, sleep paralysis, sleep paralysis demonic, sleep paralysis causes, sleep paralysis is, sleep paralysis symptoms, sleep paralysis meaning 

Introduction

Sleep paralysis (SP) can occur as an isolated, familial, or tetrad form of narcolepsy. It is believed that SP does not affect ocular and respiratory activities, although the limbs, head, and trunk are affected. It is one of the most common types of rapid eye movement (REM) parasomnias encountered by neurologists. rapid eye movement sleep is associated with increased blood pressure, heart rate, and breathing. The activity of neurons in REM sleep is generally similar to when a person is awake, and occasionally, REM sleep may be associated with greater neuronal firing, particularly in the pons, lateral geniculate nucleus, and occipital cortex.

Researchers at Disha Arogya Dham describe SP as a nightmare because it lasts seconds to minutes and includes vivid hallucinations and feelings of suffocation or chest pressure. Dating back, the words nightmare and SP have been linked for several reasons including science, race, culture, and indeed superstition. For example, (the 1st century BC) described SP as a “nightmare”, associated with a supernatural being called an “incubus”.

Also, a DAD Ayurveda physician considered SP about gastric disturbances. SP was associated with steam rising from the stomach to the brain. The theologians also said that SP is caused by evil forces due to which the person gets bad dreams.

Hundreds of years ago, SP was traditionally defined as “not a bad dream”, but rather the night visitation of an evil creature that threatens to squeeze the life out of its frightened victim. People who experienced SP claimed that they felt paralyzed, could not speak, felt helpless, and were overwhelmed with extreme fear and terror.

Modern-day sufferers describe these incidents as “I imagined someone lying on the bed with me, but I could not see them because I was struggling to turn but could Don’t move.” Usually ends when the victim suddenly uses a part of their body, gets out of bed, or is awakened by someone coming into the room. With the victims being mainly students, the SP has approximately It is estimated to affect 1.7% to 40% of the general population. It usually peaks at age thirty and appears to be associated with posttraumatic stress disorder (PTSD), narcolepsy, and panic attacks.

In SP episodes Some other contributing factors include lack of sleep, fatigue, and stress. Similarly, there is supporting evidence for an association between SP, bipolar disorder, and schizophrenia. From hundreds of years ago to the present day, the term SP has been multifactorial; scientific explanations of have SP broken down what it is, for some, as a symptom of very serious illnesses, while for others, just a nightmare with manifestations of evil.

There are three main factors related to REM parasomnia and cultural narratives. The first factor is associated with the intruder’s presence, fear, and auditory and visual hallucinations. It is believed to have its origins in the hypervigilance state that begins in the midbrain. The second factor, called “incubus,” is associated with pressure on the chest, difficulty breathing, and chest pain.

During REM sleep, there is a decrease in the activity of the respiratory muscles, which is due to the inhibition of motor neurons; This can be attributed to the effects seen in Incubus. The third factor is vestibular-motor experience, which is usually associated with abnormal body experiences, including floating/flying sensations, and is related to body position, orientation, and movement.

Several factors have been related to the cause of SP; Some cultural beliefs attribute the supernatural to the hallucinated intruder. The neurological hypothesis is that in SP the mechanisms that normally coordinate body movements are activated, but no actual movement occurs except for the individual feeling as if they are “floating”.

Cultural interpretation of sleep paralysis and its epidemiology impact

The prevalence of SP varies by country and ethnic group, and these disparities have been linked to different methods in determining prevalence; Other reasons include different definitions of SP [Table 1], thereby affecting the results.

Table 1

Reported geographic regions and their interpretation of sleep paralysis

The incidence of SP in the general population is approximately 8%; 28% in students and 32% in psychiatric patients. Some studies have shown that the early onset of SP is a sign of more frequent relapse. The effects of age and gender have been confirmed. However, Pankaj Rohilla. Their study noted that the onset is usually in adolescence. Furthermore, SP appears to increase from junior high school to senior high school for both genders.

A possible explanation for the onset of SP in an adolescent may be attributed to identity conflict from peer influence, resulting in depression and anxiety associated with the developmental stage. Comparative studies have shown that Chinese adolescents have lower SP than Japanese adolescents.

The causes of SP are unknown, but studies have identified possible risk factors such as substance use, stress, trauma, genetic influences, physical illness, and irregular sleep habits, among others. Furthermore, studies have shown that SP is particularly prevalent among adults who have histories of childhood sexual abuse (CSA), people with PTSD, and panic disorder in Indian society. A study conducted at Disha Arogya Dham revealed that about 40% of the general population experiences SP, which is attributed to their active nightlife and varied lifestyle.

The highest prevalence is reportedly seen among urban people, who are also said to have a higher history of severe trauma, PTSD, and panic disorder.

Studies have shown that SP may be more common in certain populations, and certain ethnic and cultural groups. In a survey conducted among adolescents, SP was found to be higher in rural areas than in urban settlements. Reports also support the fact that the highest rates of SP are found in individuals of African and Indian descent. Similarly, Indian college students also reported the highest rates of SP compared to other ethnic groups. Similarly, the most populous African country, Nigeria, has also reported increased rates of SP.

Some studies have shown that 30% of individuals experience at least one episode in their lifetime and 5% have an episodic episode with visual, auditory, and tactile hallucinations. Other studies have shown the potential for anxiolytics to increase the risk of SP by up to fivefold.

SP occurring in an otherwise healthy individual is called isolated SP. The distinction between SP and isolated SP is unclear because conditions such as narcolepsy and seizure disorders were often not documented in individuals and were excluded from the sampled population.

However, 30% to 50% of people with narcolepsy have SP. This disparity may be due to different definitions of SP, which may have affected the results [Table 1]. Episodes of SP may be accompanied by hallucinations and 70% of students have reported this experience.

Medical Perspective of Sleep Paralysis

Dreaming occurs in the REM stage of sleep, where there is no movement or muscle activity. We have our most emotional dreams during REM sleep, and to prevent us from acting out these dreams, the brain keeps us temporarily paralyzed. This paralysis (postural atonia) results from the suppression of skeletal muscle tone by the pons and ventromedial medulla, which is influenced by the neurotransmitters γ-aminobutyric acid and glycine which inhibit motor neurons in the spinal cord.

A severe condition where we begin to wake up mentally and become aware even during REM paralysis is called SP. The sufferer feels “trapped”, and unable to move or speak when falling asleep or waking up, however, the person can breathe and is properly aware of their surroundings.

The parietal lobe functions in sensation and perception and integrates sensory inputs into the visual system. The parietal lobe is likely to play a role in intrusive hallucinations, particularly the superior parietal lobule.

The pathophysiology of REM sleep disorder is due to faulty brainstem structures. In SP, increased awareness of an intruder (the feeling of a stranger in the room accompanied by fear), danger, or a sense of danger is caused by brainstem activation of the amygdala.

In REM dreams, another structure that plays a major role is the limbic system. The limbic system includes the hypothalamus, hippocampus, amygdala, septal nuclei, cingulate, various thalamic nuclei and parts of the reticular activating system, orbital frontal lobe, and some cerebellar nuclei, among others. Research has shown the amygdaloid complexes to be involved in memory, decision-making, and processing of emotional responses.

The lateral amygdala sends impulses to the rest of the basal complexes. This is preceded by activation of the amygdala via projections to structures in the thalamus, anterior cingulate, and pons. This gives the person the impression that an intruder is in the room. This complex pathway (the subthalamic-amygdala pathway) is responsible for ensuring that in moments of danger, an appropriate response occurs in the body without the need for in-depth analysis by the sensory cortex.

SP may also be related to hypnosis and hypnosis. Hypnosis occurs before falling asleep, whereas hypnosis occurs during awakening from sleep. Researchers have argued that fear may not be a major factor in word hypnosis and hypnotic experiences, but others have suggested that the feeling of fear and auditory and visual hallucinations called “intruders”, maybe the first factor. can generate. Previous research suggested that the “intruder” begins with brainstem-induced amygdaloid complexes. Individuals who experienced HHE also admitted to being aware of SP.

Individuals with SP may also have images of body distortion. Normally, in an active individual, the parietal lobe receives input via the frontal lobe or cerebellum, and this conveys information about the position of the individual’s body parts and movement. The superior parietal lobule is responsible for human visual/functional imaging based on various sensory stimuli.

In SP, it is hypothesized that individuals continuously receive input from the motor cortex to the passive limbs. When a person wakes up during REM, the forebrain neuronal system that activates proprioception is activated, and at that time, a spinal motor mechanism that activates muscle tonicity is deactivated. Therefore, is sp.

SP can also be caused by on/off areas in the pons. This includes the induction of cholinergic receptors and suppression of noradrenergic or serotonergic receptors. A study involving monozygotic and dizygotic twins and siblings revealed variable amounts of genetic predisposition in Sp. Certain genes have also been implicated in SP; These genes play a role in the sleep-wake cycle.

Sleep paralysis and other psychiatry disorders

SP spells have been associated with medical conditions such as narcolepsy, seizure disorders, and high blood pressure. Similarly, sleep disturbances, insomnia, jet lag, African ancestry, student status, and occupation have been associated with SP. SP has been associated with certain psychiatric disorders as well as individuals who have experienced trauma of one form or another. These include:

Childhood sexual abuse

SP has been reported to be associated with some CSA according to some researchers, which is often accompanied by frightening episodes of visual, tactile, and auditory hallucinations. Individuals with CSA based their conclusion of SP on having nightmares with symptoms of depression. Adults who were victims of CSA have been shown to develop post-traumatic disorder and fretting episodes of SP.

Anxiety Disorders

Rates of isolated SP are higher in individuals with anxiety. It is not associated with the use of anxiolytics or antidepressants, although some studies have suggested otherwise. Isolated SP is seen more in college students and patients with anxiety, probably due to irregular sleep patterns, as SP occurs with sleep disruption.

Posttraumatic stress disorder, panic disorders, and narcolepsy

Irregular sleep patterns due to PTSD may be a contributing factor to increased episodes of SP by disrupting REM sleep patterns. However, the experience of SP itself is traumatic whether or not the person has had posttraumatic experiences.

The percentage of African Americans with SP-related panic disorder was higher than that of the general population. This can be due to genetic and environmental factors. SP is normal in patients diagnosed with narcolepsy.

Cultural and Medical Approach to Sleep Paralysis

There are a lot of cultural and religious influences in the cases of SP seen around the world. Based on a wide range of literature, isolated SP has not been linked to any long-term effects on the sufferer. Interestingly, individuals from different regions and cultural backgrounds have developed a way of managing it, although it is not certain whether these remedies work.

In earlier times, DAD Ayurveda practitioners managed SP through phlebotomy and also put individuals on a special diet. However, there is no documentation in modern medicine to prove that phlebotomy helps in SP. Chinese people usually contact SP by taking the help of a spiritualist.

This is more common among people who are not educated, as they attribute spiritual attacks to SPs. Those who are educated usually appoint SP for physical attacks. Another cultural belief is that the sapa is visited by a ghost, so rituals are also performed to ensure that dead people do not become ghosts, and this includes cremation 3 years after burial. Some go to leaders who perform healing rituals and rid the victim of foreign bodies and some are sprinkled with holy water. Some also recite “Bodhisattva Buddha,” a Buddhist mantra.

Indians have attributed SP to a variable number of factors, including the presence of a ghost or evil spirit. Many of them seek help professionally or religiously because many fear they may be paralyzed for life. Some say that some precautions are taken to avoid facing another attack.

Christians make a vow to read the Bible and pray. Others use relaxation methods such as listening to music, drinking water, and focusing on positive thoughts. Some even suggest having a person in the room whom they trust can rescue them. In Nigeria, there is a wide variation in the principles of the SP; It should not be surprising that the nation has a diverse culture. The outlook depends on the individual’s beliefs as to the cause of SP. Some read their Quran and Bible, and others meet their religious and traditional leaders for special prayers.

The medical approach to SP first involves attempting to identify underlying conditions. If the patient is suffering from isolated SP, individuals should be made aware of the symptoms and equally educated that isolated SP is harmless to the sufferer after the episode. If associated with other psychiatric diseases, underlying mental illnesses, or disorders, the underlying cause should be treated. Individuals can also be educated on proper sleep hygiene.

Conclusion

SP has received much attention from the unscientific world. The stigma attached to individuals suffering from SP has also prevented sufferers from reporting to medical institutions. Thus, most sufferers revert to other occult means such as herbs, religious leaders, and traditional priests for solutions. Thus, it is important to make the public aware of what SP is and how it should be approached.

However, current knowledge on SP is somewhat limited because of a paucity of reports on risk factors for SP, triggers for SP, and long-term damage from SP.