Sleep Paralysis and Sleep Walking

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SLEEP PARALYSIS AND

SLEEP WALKING
Sleep paralysis and sleep walking are both
totally different phenomena which are
categorized under sleeping disorders.

WHAT ARE SLEEPING DISORDERS?


Changes in sleeping patterns or habits that
can adversely affect health are termed as
sleeping disorders.
Most common sleeping disorders are are
Insomnia, Jet Lag, Night terror,
Sleepwalking etc.

WHAT CAUSES SLEEPING DISORDERS?


Mental illness, caffeine, alcohol, aging,
nerve disorders, unhealthy lifestyle and
genetics are some common causes of sleeping
disorders.
TYPES OF DISORDERS:
Usually sleeping disorders are classified
into four types: Dyssomnia, Parasomnia,
Medical Psychiatric sleep disorders and
proposed sleep disorders.
Both sleepwalking and sleep paralysis
reside under parasomnia.

PARASOMNIA: Parasomnia is a sleep disorder


that involves unusual and undesirable
physical events or experiences that can
disrupt your sleep. They often run in
families hence, they are mostly genetic.
Nightmares,sleepwalking are often a part of
parasomnia.

SLEEP CYCLE:
In order to understand sleepwalking and
sleep paralysis, the sleep cycle must be
introduced because sleeping disorders are
dependent on their occurrence and time of
occurrence.
When you sleep, your brain goes through
natural cycles of activity. There are four
total stages of sleep, divided into two
phases:

●Non-REM sleep happens first and


includes three stages. The last two
stage of non-REM sleep is when you
sleep deeply. It’s hard to wake up from
this stage of sleep.
●REM sleep happens about an hour to an
hour and a half after falling asleep.
REM sleep is when you tend to have
vivid dreams.
As you sleep, your body cycles through non-
REM and REM sleep. You usually start the
sleep cycle with stage 1 of non-REM sleep.
You pass through the other stages of non-
REM sleep, followed by a short period of
REM sleep. Then the cycle begins again at
stage 1.
A full sleep cycle takes about 90 to 110
minutes. Your first REM period is short. As
the night goes on, you’ll have longer REM
sleep and less deep sleep.
REM stands for rapid eye movement. During
REM sleep, your eyes move around rapidly in
a range of directions, but don't send any
visual information to your brain.That
doesn't happen during non-REM sleep.

Dreams typically happen during REM sleep.


NON-REM-There are three phases of non-REM
sleep. Each stage can last from 5 to 15
minutes. You go through all three phases
before reaching REM sleep.

Stage 1: Your eyes are closed, but it's

easy to wake you up. This phase may last

for 5 to 10 minutes.

Stage 2: You are in light sleep. Your heart


rate slows and your body temperature drops.
Your body is getting ready for deep sleep.
This can last for 10-25 minutes.

Stages 3: This is the deep sleep stage.


It's harder to rouse you during this stage,
and if someone woke you up, you would feel
disoriented for a few minutes.
During the deep stages of NREM sleep, the
body repairs and regrows tissues, builds
bone and muscle, and strengthens the immune
system.

As you get older, you sleep more lightly


and get less deep sleep. Aging is also
linked to shorter time spans of sleep,
although studies show you still need as
much sleep as when you were younger.

SLEEPWALKING
Sleep walking is an act of getting up and
waking around while asleep.It is also
known as somnambulism.It is a sleeping
disturbance that occurs in the deepest
part of NON-REM phase of sleep.It most
often occurs within 1 to 2 hours of
falling asleep. During an episode of
sleepwalking one might sit up,walk around
and even perform ordinary activities-all
while sleeping.

Somnabullism is more prevalent in


children, though somnambulism that
results in violence usually occurs in a
slightly older age group. The episodes
typically last from a few minutes to an
hour and can occur from once a month to
multiple nights per week. Attempts to
wake individuals usually remain fruitless
and sometimes even elicit violent
responses, such as aggressive and spastic
limb movements . During the episode, the
individual appears awake but is
unresponsive. Sensory perceptions are
virtually switched off, so while the
person can often navigate around objects
due to habit and simple stumbling, he
does not fully perceive any sight, smell,
sound, or even pain The individual’s eyes
are usually directed upward and inward,
resulting in a vacant expression . In
addition, memories of the incident do not
carry into the waking state . If awakened
during a sleepwalking episode, the
individual usually remains confused and
disoriented for a period of time .
Alpha motor neurons control skeletal
muscle fibers, which are responsible for
the majority of body movements. During
sleep, the input signals to these neurons
change. Excitatory impulses, which
depolarize these neurons, decrease.
Inhibitory signals, which hyperpolarize
the alpha motor neurons, increase. To
reach the threshold potential in a
hyperpolarized cell requires a
significantly greater net depolarization,
i.e., a much larger excitatory impulse,
than achieving the threshold from resting
potential. Therefore, transmitting an
action potential to skeletal muscle is
much less likely. During REM sleep, the
alpha motor neuron membranes are
significantly more hyperpolarized, making
it even more difficult for impulses to
fire and cause movement.
Scientists believe that sleepwalking
occurs when the brain’s limbic region
remains awake. This emits alpha waves
while the cortex and hippocampus regions
of the brain are in a sleep state (where
delta waves are emitted). The result is
that the brain becomes activated into a
fight or flight type of response. This is
associated with what occurs when our
basic survival response is triggered.
Hence, motor neurons activate and indulge
into movement of body.

CAUSES OF SLEEP WALKING:


Many factors can contribute to
sleepwalking, including:

●Hereditary (the condition may run in


families).
●Lack of sleep or extreme fatigue.
●Interrupted sleep or unproductive
sleep, from disorders like sleep
apnea (brief pauses in the child's
breathing pattern during sleep).

●Illness or fever.
●Certain medications, such as sleeping
pills.
●Stress, anxiety.
●Going to bed with full bladder.
●Noises or touches.
●Changes in sleep environment or
different sleep setting (example: a
hotel).
●Migraines.
●Head injuries.

DIAGNOSIS:
Sleep walking is generally self
diagnosable and noticeable by fellow
family members or partners, in order to
check it’s severity following tests might
be taken:
●Physical exam. Your doctor may do a
physical exam to identify any
conditions that may be confused
with sleepwalking, such as
nighttime seizures, other sleep
disorders or panic attacks.
●Discussion of your symptoms. Unless
you live alone and are unaware of
your sleepwalking, you'll likely
be told by others that you
sleepwalk. If your sleep partner
comes with you to the appointment,
your doctor may ask him or her
whether you appear to sleepwalk.
Your doctor may also ask you and
your partner to fill out a
questionnaire about your sleep
behaviors. Tell your doctor if you
have a family history of
sleepwalking.
●Nocturnal sleep study
(polysomnography). In some cases,
your doctor may recommend an
overnight study in a sleep lab.
Sensors placed on your body will
record and monitor your brain
waves, the oxygen level in your
blood, heart rate and breathing,
as well as eye and leg movements
while you sleep. You may be
videotaped to document your
behavior during sleep cycles.

TREATMENT:
Treatment for occasional sleepwalking
usually isn't necessary. In children who
sleepwalk, it typically goes away by the
teen years.
If sleepwalking leads to the potential
for injury, is disruptive to family
members, or results in embarrassment or
sleep disruption for the person who
sleepwalks, treatment may be needed.
Treatment generally focuses on promoting
safety and eliminating causes or
triggers.

Treatment may include:

●Treating any underlying condition,


if the sleepwalking is associated
with sleep deprivation or an
underlying sleep disorder or
medical condition
●Adjusting medication, if it's
thought that the sleepwalking
results from a drug
●Anticipatory awakenings — waking
the person who is sleepwalking
about 15 minutes before he or she
usually sleepwalks, then staying
awake for a few minutes before
falling asleep again
●Medication — such as
benzodiazepines or certain
antidepressants
●Learning self-hypnosis — when done
by a trained professional who is
familiar with parasomnias, people
who are receptive to suggestions
during hypnosis may benefit by
achieving a deep state of
relaxation through which a change
in unwanted activities during
sleep is promoted
●Therapy or counseling — a mental
health professional can help with
suggestions for improving sleep,
stress-reduction techniques, self-
hypnosis and relaxation.
SLEEP PARALYSIS
A temporary inability to move or speak
while falling asleep or upon waking.
Sleep paralysis most often occurs in
people who have narcolepsy or sleep
apnoea, but it can affect anyone.

Episodes involve not being able to speak


or move while falling asleep or upon
waking. This usually lasts one or two
minutes and is often frightening

More than 10 million cases per year


(India)
Patient generally experiences paralysis,
anxiety, or hallucination. During the
rapid eye movement (REM) sleep stage,
you’re likely to have dreams. The brain
prevents muscles in your limbs from
moving to protect yourself from acting
out of dreams and hurting yourself. Sleep
paralysis happens when you regain
awareness going into or coming out of
REM. Because narcolepsy is characterized
by unstable wakefulness and unstable
sleep, people with narcolepsy have
frequent night awakenings that can be
associated with sleep paralysis. Sleep
paralysis is highly associated with
consciousness while asleep. The physical
body is asleep whereas the brain is still
working.
Many patients experience hallucinations
and night terrors which can utterly
disturb someone

The hallucinations associated with


Sleeping Period do not have factual
reasoning behind them. They are commonly
believed to reflect dream imagery
intruding into waking consciousness.
Hallucinations can be accompanied by
voices, visual apparitions, and less-
frequently sensations of floating or out-
of-body experiences. Hallucinatory
experiences fall into three major
categories; based on frequency and
perceived vividness or intensity. The
three categories are intruder, incubus,
and vestibular-motor (VM) experiences.
DEMONIC HALLUCINATION DURING SLEEP
PARALYSIS(A ABNORMAL PERSPECTIVE):
Envision going to bed like any other
night; your room in dark and cold, just
how you like it. Wrapped up in your
blankets like a burrito, you start to
fall asleep. As you are sleeping you
suddenly wake up, or so you think. You
are laying there mind racing, but unable
to move. You feel like a brick of solid
cement stuck to your sheets. As the
terror of the immobility sets in, you can
feel your heart beating as fast as a
racehorse; lubb dubb lubb dubb is the
sound that fills your ears. Already
anxious and afraid from this unusual
paralysis, you realize you aren’t alone.
Unable to make out the figure in the
corner, you try with all your might to
get up and run. Yet, you are still lying
there. As the dark figure get closer and
closer, your heart beats faster and
faster, lubbdubblubbdubb. Unexpectedly
and abruptly, the figure is now on top of
you, grasping their fingers around your
throat. You can feel the touch of the
rough and jagged skin on your neck, and
you trachea collapsing. Struggling to
breathe, and unable to fight, you can
feel your body start to give up. You take
what feels like your last gasp of air. As
this air is struggling to get into your
lungsYou suddenly wake up. You are alone,
and able to move. Although it felt so
real, it was only a dream. This is a
common example of what a sleep paralysis
episode could consist of, and the
terrible terrors that come along with the
disorder. Sleep paralysis is a haunting
sleep disorder that feels like a reality.
There is considerable amounts of science
that consist of factual evidence of what
sleep paralysis is. Notwithstanding the
fact that there are many theories about
this disorder and the hallucinations
associated with it.

DIAGNOSIS:
Generally sleep paralysis is self-
diagnosable but to prescribe medication
and investigation of a severe problem
following tests might be conducted.

●Overnight sleep study


(polysomnogram): The test monitors
your breathing, heartbeat, and brain
activity while sleeping. It may
enable healthcare providers to
observe an episode of sleep
paralysis or detect issues like
sleep apnea.
●Multiple sleep latency test (MSLT):
This test measures how quickly you
fall asleep and what kind of sleep
you experience during a nap. The
test helps uncover issues such as
narcolepsy (unusual daytime
sleepiness), which is the most
common cause of sleep paralysis.

TREATMENT:
There are no proven therapies that can
stop a sleep paralysis episode, but most
people who experience it routinely report
that focusing on making small body
movements (such as moving one finger,
then another) helps them to recover more
quickly.

PREVENTION OF PARASOMNIA:
Many people who suffer from parasomnias
see an improvement in their symptoms

simply by improving their sleep habits.

Good sleep habits include keeping a

regular sleep schedule, managing stress,

having a relaxing bedtime routine and

getting enough sleep. There are also drug

therapies that are used to control

symptoms.
A person should seek treatment whenever

there is risk for injury to oneself or

another person from the parasomnia. It is

also important to seek treatment if the

parasomnia disrupts your own sleep or the

sleep of a bed partner or roommate, or if

there is distress about the symptoms

(e.g., nightmares), or if the frequency

is high or escalating. An overnight sleep


lab study may be needed.
The sleep medicine specialist will
recommend a treatment based on the
parasomnia diagnosis. Members of the
sleep team can help you manage your
parasomnia using medication, behavioral
therapy or lifestyle change.
If you sleepwalk or have a parasomnia
that causes you to get out of bed, there
are steps you can take to make your home
safer:
●Add locks or alarms on your windows
and doors

●Sleep on the ground floor


●Clear your bedroom of
things that
might cause you to trip
or fall

If you are diagnosed with obstructive


sleep apnea, treatment
using CPAP
(continuous positive
airway pressure) or
an alternative treatment
may improve the
symptoms of related
parasomnias. You may

also be instructed to follow these tips


to minimize your symptoms:

●Get a full night of sleep every night


●Keep a regular sleep/wake schedule
●If you use sleeping pills, use the
medication as directed
●Make adjustments to your work
schedule if you are a shift worker
●Avoid alcohol and drug use

BIBLIOGRAPHY
my.clevelandclinic.org
www.mayoclinic.org
www.simplypsychology.org
www.ncbi.nlm.nih.gov

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