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Narcolepsy (and Cataplexy)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
Sleep paralysis occurs when a person can't move or speak at the transition between sleeping and waking up. The person is awake but can't move any voluntary muscles except for the eyes, the diaphragm (to allow breathing), and some small muscles in the ears (Stefani et al., 2019). It may come as a surprise, but this muscle paralysis, scary as it may be, is actually a completely normal thing that your body does when you are sleeping. Seriously, paralysis is normal during a type of sleep called Rapid Eye Movement (REM) sleep. That's typically the part of your sleep cycle where you have dreams. It is believed that your brain paralyzes your muscles in order to prevent you from acting your dreams out in real life and falling out of bed or otherwise injuring yourself. One part of your body that does continue to move during REM sleep is the eyeballs—just like in sleep paralysis. In sleep paralysis, however, this inability to move muscles happens at the wrong time, while you are awake instead of during REM sleep.
Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
This event occurs at sleep onset or on awakening and is also thought to be due to an intrusion of REM sleep atonia into wakefulness. It is characterized by a terrifying feeling of being unable to move or speak despite being awake, and there is often a feeling of suffocation. Sleep paralysis rarely lasts more than a few seconds or minutes. About 40–80% of narcoleptic patients experience sleep paralysis, but in order to be considered a significant symptom, it must occur repeatedly, as it is also commonly reported as a rare event in the general population. Hypnagogic or hypnopompic hallucinations may occur along with the episode of sleep paralysis, thereby enhancing the frightening aspect of these spells.
Extraordinary dreams
Published in Josie Malinowski, The Psychology of Dreaming, 2020
We don’t know for sure exactly what causes sleep paralysis in the people who experience it, but we have identified lots of risk factors – things that make an episode of sleep paralysis more likely. These include having a variable sleep schedule; sleeping on your back rather than your side or front; consuming alcohol before bed or caffeine late in the day; anxiety and depression; stress and trauma, especially post-traumatic stress disorder (PTSD); being overly tired or sleep deprived; and having jet lag. However, you may have experienced all of these risk factors and still never have had a sleep paralysis experience, so how can we account for that?
Sleep paralysis in college students
Published in Journal of American College Health, 2022
Note from Researcher about Sleep Paralysis: Sleep paralysis is understood to be a disruption of the normal biological process that occurs during the transition between wake and sleep. When we are in a stage of sleep called REM (Rapid Eye Movement), our body is partially paralyzed. Sometimes this gets turned on too soon (as you're falling asleep) and sometimes it doesn't shut off quickly enough (as you're waking up). The hallucinations and altered body sensations are understood to be an instance where dreamlike experiences are melded with waking awareness (i.e., internal inputs are mixed with external inputs). This can obviously be a frightening experience for those who don't understand what is happening. This is a common experience for people who have a condition called narcolepsy-with-cataplexy, but it is not uncommon for people without that condition: approximately 28% of college students have experienced sleep paralysis at some point in their life.
Emerging therapeutic targets for narcolepsy
Published in Expert Opinion on Therapeutic Targets, 2021
Marieke Vringer, Birgitte Rahbek Kornum
Narcolepsy has two subtypes: Patients with Narcolepsy type 1 (NT1) have cataplexy and hypocretin (Hcrt, also known as orexin) deficiency, while Narcolepsy type 2 (NT2) patients have neither cataplexy nor Hcrt deficiency [4,9,18]. Cataplexy attacks are brief episodes of muscle atonia during wake typically triggered by strong, mainly positive emotions. Other symptoms are sleep paralysis, hypnagogic, and hypnopompic hallucinations, and disturbed nocturnal sleep. These symptoms can be experienced by both NT1 and NT2 patients, but not every patient experience all the symptoms. Diagnosis requires nighttime and day-time polysomnography to rule out other sleep-wake disorders, objectify a short latency to fall asleep, and document at least two sleep onset REM (SOREM) periods [18]. Diagnosing NT2 can be challenging. This requires the presence of EDS and two SOREM periods but cataplexy and Hcrt deficiency should be absent. Due to the lack of clear biomarkers, diagnosis is mainly based on the exclusion of other sleep disorders [3,18,19].
Update on nonpharmacological interventions in parasomnias
Published in Postgraduate Medicine, 2020
Maria Ntafouli, Andrea Galbiati, Mary Gazea, Claudio L.A. Bassetti, Panagiotis Bargiotas
Sharpless et al. presented the first psychotherapeutic manual for ISP [89]. The manual “Cognitive–Behavioral Therapy for Isolated Sleep Paralysisˮ is based on earlier experiences of the authors with the treatment of ISP, validated insomnia treatments and an empirical investigation into the ways how ISP sufferers attempt to both prevent and disrupt episodes. This treatment includes specific sleep hygiene, relaxation techniques to be used during RISP episodes, in vivo episode disruption techniques, several strategies to cope with frightening hallucinations, cognitive techniques to cope with thoughts and imaginary rehearsal to deal with RISP episodes. A CBT for isolated sleep paralysis manual now exists as a promising therapy; however systematic evidence for its magnitude of effectiveness is still missing from literature [85].