Sleep paralysis is a phenomenon known by all cultures throughout the world, in which people, either when falling asleep or wakening, temporarily experience an inability to move in the middle of the night, often you are woken suddenly with a feeling of evil surrounding you, you can’t breathe and your chest is heavy, like someone pressing down on you, trying to suffocate you or holding you down, you can’t move! You think you can hear voices and see a dark shadowy figure swooping around your bed and you wonder why? If you’ve had this experience, you’re not alone, it’s is a classic example of what has become known as the “old hag” syndrome that comes from the superstitious belief that you may be hunted by the devil or a witch.

In African culture, it’s commonly referred to as “the witch riding your back.” Ogun Oru is a traditional explanation for nocturnal disturbances among the Yoruba of Southwest Nigeria; ogun oru (nocturnal warfare) involves an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming. Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer’s earthly spouse and a ‘spiritual’ spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements.

In Zimbabwean Shona culture the word Madzikirira is used to refer something really pressing one down. This mostly refers to the spiritual world in which some spirit—especially an evil one—tries to use its victim for some evil purpose. The people believe that witches can only be people of close relations to be effective, and hence a witches often try to use one’s spirit to bewitch one’s relatives.

In Ethiopian culture the word ‘dukak’ (ዱካክ – Amharic) is used, which is believed to be an evil spirit that possesses people during their sleep. Some people believe this experience is linked to use of Khat ( ጫት ‘Chat’ – Amharic). Khat users experience sleep paralysis when suddenly quitting chewing Khat after use for a long time. In Amharic, the official language of Ethiopia, the word ‘dukak’ taken out of the context of Khat withdrawal related sleep paralysis, means depression.

The evil spirit ‘dukak’ is an anthropomorphism (anthropomorphic personification) of the depression that often results from the act of quitting chewing Khat. ‘Dukak‘ often appears in hallucinations of the quitters and metes out punishments to its victims for offending him by quitting. The punishments are often in the form of implausible physical punishments (e.g., the ‘dukak’ puts the victim in a bottle and shakes the bottle vigorously) or outrageous tasks the victim must perform (e.g., swallow a bag of gravel).

In Swahili speaking East Africa, it is known as jinamizi, which refers to a creature sitting on one’s chest making it difficult for him/her to breathe. It is attributed to result from a person sleeping on his back. Most people also recall being strangled by this ‘creature’. People generally survive these ‘attacks’

What is SP?

Research shows that SP is linked with REM (rapid eye movement) sleep. When in REM sleep you are usually dreaming, your body does not act out your dreams as you will hurt either yourself, or someone else, so evolution has worked its merry little way of getting your brain to switch off your muscles (so to speak) and relax you while dreaming, essentially paralyzing you to a degree.

The cause for a state of SP is when your mind wakes up, usually still in a semi-REM state, but your body is still relaxed and semi paralyzed, bringing sometimes a horrifying sensation of being paralyzed while still in a semi-dream state yet awake. The consequences of this state are usually nothing short of terrifying to individuals with their dreams suddenly becoming reality as they are trapped in an in between sate of consciousness. The usual result is panic to try to release oneself while sleep creeps around your brain like a slow fog trying to drag you back down to it’s depths again.

More formally, it is a transition state between wakefulness and rest characterized by complete muscle atonia (muscle weakness). It can occur at sleep onset or upon awakening, and it is often associated with terrifying visions (e.g., an intruder in the room), to which one is unable to react due to paralysis. It is believed a result of disrupted REM sleep, which is normally characterized by complete muscle atonia that prevents individuals from acting out their dreams. Sleep paralysis has been linked to disorders such as narcolepsy, migraines, anxiety disorders, and obstructive sleep apnea; however, it can also occur in isolation. When linked to another disorder, sleep paralysis commonly occurs in association with the neuromuscular disorder narcolepsy.

Of a recent survey it is suggested that between 25-30% of the general population has suffered some form of SP with 95% of these experiencing a perceived horrifying event. It is now considered to be a common disorder among the population, but not many people admit to suffering SP. Yes, it does run in the family, if you have suffered an episode, chances are there’s a member within your close family who has also experienced this. People often feel they are experiencing something paranormal with SP due to the bizarre symptoms and don’t realize that they are in fact suffering from something many others have experienced with a perfectly reasonable explanation.

I S T H I S C O N D I T I O N H A R M F U L ?

General medical research shows SP is not generally harmful and will only ever last from a few seconds, to maybe a few minutes. Of course reality is severely altered in this state and sufferers can have a feeling of being trapped in a state of SP for what seems like hours, when in fact it is merely minutes. Further research does indicate that a predisposition to something more traumatic, such as social problems due to lack of sleep and a disruption to normal daily life, may be a result of many episodes of SP.  If you feel you need more help or more information about any health issue including SP seek out further medical help with a licensed practitioner.

C A U S E S

The most commonly reported cause of SP episodes is in fact stress. It’s believed that stress can seriously alter sleep patterns, causing episodes of sleep paralysis. Another cause can be your sleeping position. Reports and research by Dr. J. A. Cheyne show that sufferers sleeping in the face up position are five times more likely to suffer an episode of sleep paralysis than others who attempt to sleep in a different position during normal sleep. Avoidance of sleeping on your back and attempting to not roll over into this position during the night is strongly advised. The use of a small squash or tennis ball placed behind your back can sometimes help with this.

P R E V E N T I O N & R E S C U E

Prevention is all about sleeping in the correct position (not face up), not eating large amounts of food, drinking caffeine or excessive smoking before sleep. Reducing stress levels in your life is also another key factor to preventing SP as mentioned before, stress can severely alter sleep patterns inducing SP episodes, insomnia, sleep deprivation, and an erratic sleep schedule.

A good way of trying to release yourself when caught in a state of SP is attempting to concentrate on moving a body part, whether it be your finger, toe or even blinking your eyes, this works quite well and is a common remedy for most SP sufferers as the instant a body part moves, the SP episode should cease. You can also do this in your mind if you cannot move any body part, merely trying to imagine shaking your head or moving a body part can keep your mind active enough for your body to catch up and be able to move for real, essentially fully waking yourself up and again ending the SP episode.

Treatment

Treatment starts with patient education about sleep stages and muscle atonia associated with REM sleep. Patients should be evaluated for narcolepsy if symptoms persist. The safest treatment for sleep paralysis is for people to adopt healthier sleeping habits. However, in serious cases more clinical treatments are available. The most commonly used drugs are tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). Despite the fact that these treatments are prescribed for serious cases of RISP, it is important to note that these drugs are not effective for everyone. There is currently no drug that has been found to completely interrupt episodes of sleep paralysis a majority of the time.

Prognosis

Sleep paralysis poses no serious health risk to those that experience it, despite the fact that it can be an intensely terrifying experience. SUNDS is a deadly disorder believed to be related to sleep paralysis; however, they are still considered completely separate disorders, so sleep paralysis sufferers should not be alarmed.

Conclusion

Several circumstances have been identified that are associated with an increased risk of sleep paralysis, stress, overuse of stimulants, physical fatigue, as well as certain medications that are used to treat ADHD. It is also believed that there may be a genetic component in the development of RISP due to a high concurrent incidence of sleep paralysis in mono zygotic twins.

Also, sleeping in the supine position is believed to make the sleeper more vulnerable to episodes of sleep paralysis because in this sleeping position it is possible for the soft palate to collapse and obstruct the airway. This is a possibility regardless of whether the individual has been diagnosed with sleep apnea or not. There may also be a greater rate of microarousals while sleeping in the supine position, because gravity exerts a greater amount of pressure on the lungs.

While many factors can increase risk for ISP or RISP, they can be avoided with minor lifestyle changes. By maintaining a regular sleep schedule and observing good sleep hygiene, one can reduce chances of sleep paralysis. It helps subjects to reduce the intake of stimulants and stress in daily life by taking up a hobby or seeing a trained psychologist who can suggest coping mechanisms for stress. However, some cases of ISP and RISP involve a genetic factor—which means some people may find sleep paralysis unavoidable.