The 20-year-old electronic arts student and handsome hipster had the pale, flawless complexion of someone who spent most of his time indoors.
Mason Smith (not his real name) was here for an interview about his sleep issues. His girlfriend sat beside him and clutched his hand. They both seemed frightened and concerned.
Mason had been having disturbing episodes — three in the past month alone. Each time he awakened after what seemed to be a good, long sleep, he would open his eyes but discover he could not move any other muscle.
Neither his legs nor his arms, or even his neck, would respond to his panicked, silent pleadings to bend or stretch.
The episode wouldn’t last long, but it seemed an eternity before he could reclaim control of his body.
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The last time it happened had been the weekend before. His girlfriend awoke at the same time. She saw his wide-eyed stare and, startled, called his name and shook his shoulder. This broke the spell, and he could move again. His heart pounding with fear, he told her what he had experienced and said it hadn’t been the first time.
I have told patients in the past to just concentrate on moving one tiny muscle, like an eyelid or pinky finger.
Mason was afraid he was losing his mind or that he had some bizarre life-threatening brain tumor. His girlfriend insisted he call someone — so here they were at the sleep disorders center where I worked.
Mason was neither losing his grip on reality, nor hovering near death, I reassured the charming couple. He was merely experiencing “sleep paralysis.”
The Explanation
Sleep paralysis may be one of the most frightening, least dangerous things one can experience in sleep.
It usually happens just as someone is just falling asleep or right upon awakening, and it’s the distinct sensation that one cannot move or speak. There can be hallucinations and perceptions of an intruder that accompany the locked-up sensation, but the inability to move can be alarming enough on its own.
The feeling is caused by a slight mismatch in the brain and body; one is awake while the other is still “asleep.” It usually only remains for a few seconds but can also last minutes.
For the uninformed, it can be terrifying. The episode is usually ended by a sound or movement that “breaks the spell.”
I have told patients in the past to just concentrate on moving one tiny muscle, like an eyelid or pinky finger. This usually allows full movement to return quickly.
When sleep paralysis occurs at the onset of sleep, it is called hypnopompic sleep paralysis. In this situation, the body is relaxing more while the mind is surfing between wake and sleep. If the mind wakes up and finds the body far more relaxed than when it last checked, it can lead to a startling feeling of being unable to move.
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When it happens upon waking in the night or morning, it is referred to as hypnagogic paralysis. This is more likely when waking out of REM, or dreaming sleep. During REM sleep, it is natural and normal that our big muscles should be completely limp or paralyzed. This keeps us from acting out our dreams. However, if we again have that mismatch and the brain wakes up from REM before the muscles wake up, we will “catch ourselves” in that paralyzed state.
Sleep paralysis happens more often if we’re not getting enough sleep, or if our schedules are irregular. A change in time zones can be a trigger, as can medications that alter sleep cycles or timing. It may occur only once in a lifetime, or recur. It is usually harmless, and once one knows what is happening it can be kind of entertaining. It’s the only time we get to watch ourselves sleeping.
This can be such a dreadful experience, however, that it’s become the foundation of many mythical tales, old and new. Stories of sleep paralysis appear in all cultures and history. Hallucinations associated with sleep paralysis often include the presence of another being. This has been called The Old Hag, Demon, Succubus and Incubus, among others.
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The phenomenon has been explained in Norse mythology as being shot by the poisonous arrows of the black elves who then sit on the chest of the sleeper whispering horrifying things into his ears. Other folklore attributes the feelings to being drugged and abducted by fairies.
A new movie, premiered this year at the Sundance Festival, capitalizes on the disturbing nature of sleep paralysis by profiling the episodes of eight modern people from different walks of life. “The Nightmare” is advertised as a documentary about the “scariest place in the world.”
Despite legends and fables, sleep paralysis is not perilous. If it happens frequently enough to interfere with refreshing sleep, it can be addressed by improving sleep habits, catching up on sleep and working on stress relief.
Some antidepressant medications can change sleep stages in such a way that sleep paralysis would be less likely, though this would be reserved for a fairly severe case.
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It can be associated with narcolepsy, migraines and obstructive sleep apnea, though, so if sleep paralysis is common and there is significant daytime sleepiness, an evaluation by a sleep specialist is best.
As for Mason, he had been going to school and working a part-time job during the day. His active social schedule and homework took up evenings and weekends. He treasured the quiet middle-of-the-night hours for his creative work, often spending all night at the computer or his sketchbook working out new story boards and characters.
When “in the zone,” he could work all night and still get to class on time after a shower and a double espresso. He would catch a quick nap or fuel his next night with monstrous energy drinks. His days and nights were becoming blurred, his sleep cycles severely confused.
His sleep paralysis was only his body doing normal things, like being limp when asleep and alert when awake. The problem was they were happening at the same time!
Mason readjusted his schedule and made full and regular sleep nights a priority. While recalibrating, he did have another episode, but knowing he was perfectly safe made it a curious experience rather than a frightening one. After a few weeks, the sleep paralysis ceased, and Mason felt more rested and creative than he had in a long time.
Patty Tucker, a medical practitioner for more than two decades, has specialized in sleep medicine since 2001.
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