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Sleep Disorders

Hypnogogic Episodes with Paralysis

02/16/2010

Question:

Since my early teens, I had been experiencing what I called "night terror" Before falling asleep, I sometimes hear a loud "boom" in my head, followed by scary visions (hallucinations?) and feeling of sheer terror. The "visions" are always threatening, and although I know I`m not asleep, my body becomes paralyzed. Sometimes the "hallucinations are auditory (loud music, yelling, etc.) Although, these episodes are not as frequent as they used to be (as a  young woman, they were nightly) when I do have these "terrors", they seem to last longer!!!! I finally spoke to a doctor about it, and he told me it was called hypnogogia, but offered me no help. I`ve read that it`s a sleep disorder, related to narcolepsy, but is there any help for it? There are many nights that I am even afraid to go to sleep at all!! I am a 55 year old woman, and I would really appreciate any help!!!!!

Answer:

Hello - thank you for using NetWellness.

While distressing to you, sleep paralysis is certainly normal in a certain percentage of adults. It is a common condition with a prevalence of 5-62%. Although most affected people have single or infrequent episodes, sleep paralysis may be recurrent. It is also occurs in association with the narcoleptic syndrome as you have eluded to. Narcolepsy is comprised of: cataplexy - loss of muscle tone after an emotional stir; sleep paralysis; hallucinations either at the onset of sleep or at awakening and excessive daytime sleepiness. Sleep paralysis, however, can occur in the setting of sleep deprivation. Studies have also found the following factors that are also associated with sleep paralysis:

- anxiolytic medication (e.g. ativan, valium)

- various psychiatric disorders (e.g. automatic behavior, bipolar disorders)

- physical disease

Sleep paralysis is usually described as the inability to perform voluntary movements either at sleep onset or upon awakening. Individuals often report an inability to speak or move the limbs, trunk or head.

Most individuals will recall the events. The episodes usually only last for seconds up to a few minutes and tend to resolve on their own. Occasionally, the episode will end if the person is touched or spoken to.

Episodes of sleep paralysis can be very anxiety producing as you have described. In addition to the sensation of an inability to breathe as noted above, hallucinations, whether hearing or seeing things that are not present, can accompany the event. All-in-all, the experience can be somewhat frightening.

You used the term "night terrors" - I would like to clarify that when we refer to night terrors we usually speak of a disorder that is seen in children

These are are characterized by a sudden, often dramatic arousal with facial expression, vocalization, and other behaviors that express agitation and fear. patients usually describe a fast heart rate and profuse sweating. The pupils (black parts of the eyes) usually become larger. Patients are difficult to arouse and will fall back to sleep spontaneously after a few to several minutes. These episodes can first manifest at a young age, around 18 months, have a peak prevalence at age five to seven years, and typically resolve prior to adolescence. Triggers include acute stress and sleep deprivation, as well as certain medications including stimulants, neuroleptics, sedatives, and antihistamines.

So from what you describe it does not appear that you have night terrors.

You may wish to consult with a Sleep Physician so as to ascertain if you have an associated condition that can be treated. It is imperative to obtain a full history and physical examination so as to establish the exact reason as to why you have such events. There are medications that can provide effective treatment for narcolepsy. If this is related to poor sleep hygiene and insufficient sleep you will need to address tghe problem by adopting regular sleep hours and engaging in good sleep practices.

Once again thank you for using NetWellness

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Response by:

Steven  Kadiev, MBBCh Steven Kadiev, MBBCh
Formerly:
Assistant Professor
College of Medicine
The Ohio State University