Category: Sleep Paralysis

Posted in
Posted in

Sleep Paralysis… curse or blessing?

By

A first encounter with sleep paralysis (SP) is usually terrifying. But for those who experience it often and learn to stay calm, it can be entryway to lucid dreaming and extraordinary states.

Ryan Hurd, a sleep paralysis expert, has experienced hundreds of episodes himself and offers a road map for those who experience it. The following is a summary of his book, Sleep Paralysis, A Guide to Hynagogic Visions & Visitors of the Night.

In Hurd’s initial encounter with SP at age 14, all he wanted to do was wake up from the nightmare: first a ring, then a menacing voice that said, ‘Darkness rules!’ A pervasive felt sense of evil. The strong feeling of being pushed down forcibly into sleep. He was left feeling crazy, haunted and reticent to talk about his experience. It was classic a SP episode, and it deeply influenced the course of his life. He later became both a dream researcher, lecturer and lifelong lucid dreamer.

 

Symptoms of Sleep Paralysis

Hurd said the symptoms of SP are “near universal” and “noted throughout history and across cultures.” An episode might include one or more of the following:

Inability to move;
a feeling of great weight on your chest, abdomen and/or throat;
hearing buzzing or crackling sounds, or voices;
difficulty breathing;
heart racing;
extreme fear;
out-of-body experience;
electrical current or shock;
seeing lots of spiders or insects;
sensing, seeing and/or bring touched by an apparition or presence;
full awareness and a sense that what is happening is very real.

Isolated SP is common – about 40% of people experience it at least once in their lifetime (and a full 75% of post-secondary students). Alarming as it is, SP is a normal part of sleep, not pathological or a sign of psychosis.* It happens most often from sleep deprivation or disrupted sleep cycles (ie shift work, jet lag, late-night partying). It is an intrusion of REM/dreaming during the transition from wake-to-sleep or sleep-to-wake. In essence, your dreams are being superimposed onto the waking state. This is why the visions that arise can feel so real.

 

Ways to Manage Sleep Paralysis

Most people who experience SP occasionally simply want the hellish experience to stop. Hurd has found the following series of responses to be the most helpful:

  • Identify to yourself that you are having an eposide of SP
  • Surrender, don’t fight it (or it intensifies)
  • Wiggle your toes or clench a fist to break the paralysis
  • Focus on calm, steady breathing
  • Wait patiently for the episode to end, usually after a minute or two

Some people experience multiple episodes of sleep paralysis, or have a series of false awakenings. If you are worried about falling asleep and back into another episode, Hurd suggests you wake up more fully before going back to sleep:

  • Expose your eyes to bright light for a least a minute
  • Get up and do 10 minute of exercise
  • Write about the encouter in your journal

Then go back to sleep! Do not make things worse with even more sleep deprivation. To prevent SP, good sleep hygiene is essential… things like sleeping and waking at the same time every day, sleeping in a cool, dark, quiet place that you feel safe in, avoiding caffeine, alcohol and strenuous exercise too close to bedtime.

 

Get to Know the ‘Stranger’

For those who have learned to relax and go with the SP experience, and are brave and curious about the presence that appears to them, Hurd suggests turning toward the apparition with openness and trust (with the caveat that not all of the figures that appear are benign). However, if it feels available to you and safe enough, he suggests you relax, trust, be curious, ask what the stranger wants. These actions can transform the presence into something helpful and healing.

He notes that many tales of hauntings and magical creatures may in fact stem from sleep paralysis. A major clue is the timing of the visitation – if the presence appears at the edges of sleep, it is likely a hypnagogic hallucination. Vampires, the legend of the Sea Hag, ghosts, out-of-body experiences and even alien abductions may be attributed to sleep paralysis. It can also be a doorway to lucid dreaming and deeply spiritual encounters.

 

Sleep Paralysis as a Doorway to Extraordinary States

Despite his initially terrifying experiences with SP, Hurd now sees these as a “blessing in disguise.” If you recognize the state you are in as SP, you are already dreaming while awake, and can use this to co-create the kinds of dreams you would like to have. He suggest that once you have come to terms with your personal beliefs and have learned to relax into an SP state, you can “focus on the kinds of dreams you want to have and watch them materialize around you.”

He describes how you can use SP as an entrée into out-of-body experiences, lucid dreaming, creativity and spiritual growth.

Hurd even suggests ways to encourage SP (and of course do the opposite if you want to prevent it): Sleep on your back; take a nap when you are sleep-deprived or have jet-lag; or wake up 2 hours before your usual time, and nap later. When you nap while sleep-deprived, there is pressure to make up for a lack of REM sleep, and this intrusion of REM can induce the mixed state of SP.

The key message in all of this is that the valence of the visions which appear to us in a hynagogic state are dependent on the degree of safety we feel. The more frightened we are, the more terrifying the images that visit. It is an example of how we co-create dreams. If we stay calm, we can engage with the dream state while maintaining lucid awareness. Hurd notes that those new to lucid dreaming often treat it as a “virtual playground’ and invite fantasy experiences like flying or sex. But deepening into the experience can lead to truly extraordinary visions and “even a taste of enlightenment.”

 

Don’t miss our 1-hour seminar on critical information for therapists about nightmares and suicide, including current research and how to help. We are currently offering a 30% discount! Click here to avail the promo!

 

Reference:

Hurd, Ryan (2011). Sleep Paralysis, A Guide to Hynagogic Visions & Visitors of the Night. Los Altos, CA: Hyena Press.

*Symptoms of typical isolated sleep paralysis are not considered harmful – unless they include sleep apnea, narcolepsy or other parasomnias. If you have any concerns, consult a sleep medicine professional for diagnosis and treatment.

Posted in
Posted in

Night Moves: Understanding Dream Enactment and REM Behavior Disorder

By

By Dr. Leslie Ellis

Our scariest nocturnal experiences may not be the greatest cause for concern. Those who experience sleep paralysis wake up while still in a dream state, unable to move a muscle. This is often accompanied by the sense of a malevolent presence in the room, even right in bed! Believe it or not, the experience of paralysis is a normal part of our sleep cycle, our body’s way of protecting us from enacting our dreams. When our circadian rhythm is off, we can wake up before sleep paralysis has switched off which can be terrifying if you don’t understand it.

But this is not the worst thing.

What can be more ominous and dangerous is when sleep paralysis does NOT happen as it should, and instead, the dreamer enacts their dream scenarios. In rare cases, murders have been committed during such episodes. Comedian Mike Birbiglia suffers from this condition, called REM (rapid eye movement) Behavior Disorder, or RBD. His wild nocturnal experiences are a frequent subject of his highly popular shows, and the basis of an award-winning movie, Sleepwalk With Me.

In one sketch, Mike describes how he dreamt of being the target of a guided missile with coordinates set specifically on him. His dreamtime logic told him to jump out the window so the explosion would detonate outside, away from his platoon. He actually did this, despite the fact that he was on the second floor of a motel, and the window was closed. He landed, cut up, on the grass, got up and kept running… until he slowly realized, with relief at first, that he was in his underwear, bleeding, on a cold January night. He was dreaming, not actually being attacked! He was lucky his injuries were not worse. His doctor diagnosed him with RBD, and he now sleeps in a neck-high sleeping bag with mitts on to prevent him from unzipping it and potentially hurting himself.

 

About RBD

There are many ways to treat RBD, but one of the most important things to do is ensure the nocturnal safety of both the person who has it, and their bed partner, if they have one. Mike’s sleeping bag is not a bad idea. Sleep medicine experts suggest removing all sharp objects and weapons from the bedroom, padding the floor, lowering the mattress, placing a pillow between you and your bed partner, or even sleeping in separate beds.

Let’s back up a step though. Just what is RBD, what are its causes and what can you do?

RBD is now thought to be the initial symptom of neurodegenerative disease, and it most often affects older men. Up to 90% of those with idiopathic RBD (ie that is not a side effect of medication or other known causes) go on to develop neurodegenerative disease, usually Parkinson’s or dementia with Lewy bodies. Research suggests that RBD is the manifestation of an otherwise covert disease already present in the brain, rather than simply being associated with an increased risk of future development of disease. While treatments exist, there are no known therapies to slow the rate of degeneration – although the disease process itself can be very slow. Exercise has been shown to be neuroprotective, and a recent study shows it may help with RBD. Risk factors such as smoking, alcohol use and depression can be addressed. RBD is also associated with concussions, hyposomnia, arthritis, pesticide explosure, constipation and family history of neurodegeneration. It can be also brought on by use of anti-depressants, and in this case, stopping the medication can stop the RBD.

The American Academy of Sleep Medicine (AASM) suggests four medications that can be used to treat RBD: clonazepam, melatonin, pramipexole, and rivastigmine. Each has a different mechanism of action and each has its pros and cons. Of course, seek the advice of a sleep medicine professional about their use. (Howell’s 2023 AASM articles below also provide more detail.)

 

Options for Managing RBD

First, be sure to get a proper diagnosis. Sleepwalking and night terrors are also characterized by movement and intense vocalization during sleep. However, these happen during the first half of the night, during deep sleep versus REM, are not recalled by morning, and are more common in children. RBD episodes are dream enactments, most common in older people and can usually be remembered.

While RBD that is not associated with drug use or secondary to a medication condition may not be curable, it can be managed in various ways. Keeping safe is a priority because although those with RBD can go for long periods without an episode, dream enactments are always possible.

One partial solution, aimed at keeping those with RBD safe, is a bed alarm system (ie the Posey Sitter Select). Using pressure pads under the shoulders, and optional tether, the system detects when the user starts to get out of bed, and play a custom voice loop that tells something like: go back bed, you are dreaming. A small study found this device not only prevented injury but reduced overall dream enactments, possibly because it reduced the dreamer’s worries about hurting themselves or their partner.

In my practice, I have worked with the nightmares of those with RBD, reasoning that if one has fewer intense or violent dreams, enactments will be less frequent and dangerous as well. This has been the case with several patients, although like all RBD treatments, it is not a perfect solution, but rather can become part of an overall management strategy. Lifestyle changes, embracing the joys of life, befriending and potentially developing more control of one’s dream life are some positive responses to RBD. Or, like Mike, you can find and express some of the humor inherent in this otherwise potentially serious condition.

 

References:

Management:

Howell, M., Avidan, A. Y., Foldvary-Schaefer, N., Malkani, R. G., During, E. H., Roland, J. P., … & Ramar, K. (2023). Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 19(4), 769-810.

Howell, M., Avidan, A. Y., Foldvary-Schaefer, N., Malkani, R. G., During, E. H., Roland, J. P., … & Ramar, K. (2023). Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 19(4), 759-768.

Helpful adjunctive treatments:

McCarter, S. J., Boeve, B. F., Graff-Radford, N. R., Silber, M. H., & St. Louis, E. K. (2019). Neuroprotection in idiopathic REM sleep behavior disorder: a role for exercise? Sleep, 42(6), zsz064.

A device to protect from dream enactment behavior (DEB) and bed injury

Howell, M. J., Arneson, P. A., & Schenck, C. H. (2011). A novel therapy for REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine, 7(6), 639-644A.

Risk factors:

Xiang, Y., Zhou, X., Huang, X., Zhou, X., Zeng, Q., Zhou, Z., … & Guo, J. (2023). The risk factors for probable REM sleep behavior disorder: A case-control study. Sleep Medicine, 110, 99-105.

Posted in
Posted in

Befriending the old hag: A primer on sleep paralysis

By

Folklore, causes and approaches to treatment and prevention

In Newfoundland, they tell stories of her: a terrifying creature said to live in the ocean and torment those who dare to sleep near the shore. In a typical account, a fisherman returns home exhausted from a long day at sea, lays down to rest and starts to drift off to sleep. But as he does so, he feels a heavy weight and can’t move or speak. Sitting heavily on his chest, is the dreaded Sea Hag, a wild woman with ragged clothes, straggly hair and long, sharp nails. She returns night after night until he arms himself with a crucifix and gathers the strength to command her to leave him be, in the name of God.

Tales of the Sea Hag are legendary in Newfoundland, one of the stories now told on the St. John’s Haunted Hike tour. The legend of the Sea Hag emerged as a way to make sense of sleep paralysis, a temporary inability to move or speak during the sleep-wake transition. As legend had it, the only way to defeat the Sea Hag was by invoking the name of God.

The history and folklore surrounding sleep paralysis can be traced back to ancient civilizations, and not understanding it, many cultures attributed it to supernatural forces. The Sea Hag is a variant of the “old hag” dating back to medieval Europe, a demonic entity that would sit on a person’s chest, a way to explain the pressure and immobility of sleep paralysis.

 

What causes sleep paralysis?

An episode can occur while falling asleep (hypnagogia) or in the transition from sleep to waking (hypnopompia). Symptoms include an inability to move, often accompanied by pressure on the chest or back, hallucinations and the sense of doom or an evil presence. Sleep paralysis often occurs during sleep cycle disruptions (ie from shift work, jet lag, insomnia), but can also coincide with mental health issues. This fairly common, mostly benign condition affects about 8% of the general population at some point in their lives.

During REM sleep, to protect us from thrashing around and enacting our dreams, our body goes into a state of muscle atonia. The exact mechanism, which inhibits the motor neurons in the spinal cord, is not fully understood. It is thought to involve a combination of factors, including changes in brain chemistry and activation of inhibitory neurons.

The body naturally shifts out of paralysis upon waking, and external stimuli such as touching or speaking to the person can trigger the shift as well. In sleep paralysis, the shift to the natural ability to move simply happens in the wrong order; we are supposed to wake up after our movement is restored to normal, not before.

 

How to treat sleep paralysis

Lauren was plagued with nightmares as a child, and as she grew older this shifted to frequent, terrifying sleep paralysis. She tried some of the most common ways to treat the problem, including changing her sleeping position, taking melatonin, practicing good sleep hygiene. What finally helped most was to turn toward the experience and relax into it rather than resisting and struggling to move. She reminded herself that she was not in any danger, and that she could still breathe – so she focused on slow, relaxing breaths, and the calmer she got, the less intense the sensations became. Over a few weeks of practicing relaxing into the transition to sleep, she was able to break the cycle.

The way to treat sleep paralysis depends on what may be causing it. While sleep paralysis can affect anyone, those with psychiatric disorders, a history of trauma, sleep disorders and disrupted sleep patterns are more likely to experience it. Therefore, effectively treating trauma, anxiety and/or depression may help those with psychological causes.

Disrupted sleep can come from shift work, sleep apnea, or too much late-night partying. This is why sleep paralysis is not uncommon among post-secondary students who stay up way too late studying or socializing. Sleep apnea also causes disrupted sleep, and sometimes sleep paralysis.

Overall, what helps:

  • practice good sleep hygiene, a regular bedtime and ideally a cool, dark quiet bedroom
  • sleep on your stomach or side, not your back
  • reduce stress
  • medication, such as melatonin or antidepressants
  • treat underlying causes: ie therapy for a history of trauma, anxiety or depression, sleep medicine for apnea

 

What to do during an episode

Sometimes, despite one’s best efforts, sleep paralysis will occur. If this happens, following Lauren’s example of relaxing into the process can make a real difference. Once you understand what’s happening, you can tell yourself, it’s okay, I am safe in my bedroom and still in the dream state. If you want to wake up calmly, focus on slow, deep breaths and begin to wiggle your fingers and toes, waiting until the paralysis dissipates. Although it may feel like an eternity, the transition is usually just a minute or two.

If you want to go back to into sleep rather than waking, you might try lucid dreaming. In fact, during an episode, you are in a lucid dream – as defined by being both awake and in a dream state. You might want to experiment with relaxing back into sleep and creating a dream scenario that feels empowering rather than scary. You might imagine into flying away from the source of your fear and into a beautiful landscape. Or you could conjure the presence of an ally or friend.

To give one example, Marian tried many things to alleviate her sleep paralysis before turning to lucid dreaming. She was desperate at this point, and decided to set an intention before sleeping that if she experienced paralysis, she would recognize she was dreaming. It took a few weeks, but after an initial exhilarating experience of flying in her dream, she got more adept at becoming lucid. This coincided with a shift toward better, more refreshing sleep and a whole new relationship to her dreams.

#sleepparalysis #oldhag #seahag #sleepdisorders #nightmares #sleephealth #sleephygiene #sleepmedicine #sleeptherapy #mentalhealthawareness #stressrelief #mindfulness #luciddreaming #sleepresearch #sleepscience

 

In my complete course on nightmares for clinicians, I offer much more information about the origins, theories and treatment of nightmares. Click here to learn more.