I recently had a patient describe a troubling event. At first, she was afraid to discuss the incident for fear that people would think she was insane. She described awaking from sleep recently with the sense that someone was in the room with her. The patient was unable to move her body for several minutes but could open her eyes. Although she was terrified, the patient said she was unable to call for help.
The patient explained that she had difficulty breathing during the episode and felt like there was something sitting on her chest. At the conclusion of the event, she reported gasping for breath, sweating and feeling her heart race. What is your diagnosis?
This patient described an attack of sleep paralysis. Sleep paralysis is one of the lesser known parasomnias. It was first described in 1876, by American neurologist Silas Weir Mitchell. It is a cardinal symptom of narcolepsy but can also occur among healthy individuals. The primary or idiopathic form is called isolated sleep paralysis (ISP).
ISP may occur anywhere from once in a lifetime to as frequently as daily. Patients are often afraid to discuss it and historical accounts from many cultures mistakenly equate sleep paralysis events with visits from paranormal entities.
All of us experience atonia during REM sleep. It is a normal physiological event to keep us from acting out our dreams. However, it is not normal to wake in a state of paralysis.
ISP is more likely to occur when a patient is sleep deprived, stressed, sleeping supine, doing shift work or has an irregular sleep schedule. The condition often first occurs in the late teen years. If your patients describe experiencing sleep paralysis, you should refer them to a sleep professional for evaluation to rule out narcolepsy or other sleep abnormalities.
Did you know that there are over 80 defined sleep disorders in the American Academy of Sleep Medicine/s International Classification of Sleep Disorders? The most commonly discussed in primary care are insomnia and obstructive sleep apnea. In my next blog, I will talk about how advising patients to change one habit can help them improve initiating and maintaining sleep.
Sharon M. O’Brien, MPAS, PA-C, works with Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.