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Sleep Paralysis: Its Genesis and Qualitative Analysis of Case Histories

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DOI: 10.1166/asl.2018.11373

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 RESEARCH ARTICLE
Copyright © 2017 American Scientific Publishers Advanced Science Letters
All rights reserved Adv. Sci. Lett. 24, 3347–3351
(2018)Printed in United States of America

Sleep Paralysis: Its Genesis and Qualitative

Analysis of Case Histories
Nandita Chaubea* and S.S. Nathawatb
a Gujarat Forensic Sciences University, Gandhinagar, Gujarat, INDIA
b Amity University Rajasthan, Jaipur, Rajasthan, INDIA

Sleep paralysis is a state of sleep disturbance in which people experience hypnogogic or

hypnopompic hallucinations marked by an inability to move their bodies or speak out while
reporting the consciousness about their surroundings. Philosophical explanation of sleep paralysis
has been quoted in the ancient texts in terms of incubus and succubus. However, pathologically, it
has been linked to several disorders including narcolepsy, migraines, anxiety disorders, and
obstructive sleep apnea but it can also occur in isolation. Some other significant factors may include
perceived stress, spiritual and paranormal beliefs, etc. Hence, a qualitative analysis of five such
cases reporting symptoms of sleep disturbances with the criterion of sleep paralysis has been
reported here. The study considered various psychological factors like stressful life events, feelings
of inadequacy, spirituality, and paranormal beliefs. Results disclosed that four of the five cases were
inclined towards the paranormal beliefs and the entire sample indicated a noticeably augmented
level of spirituality and feelings of inadequacy. Furthermore, three cases reported experiencing
greater stress following life events. Among other factors, all the cases were characterized with
sleeping in the supine position, sleeping alone, an experience of fear, a sense of pressure on their
chest, a presence of someone in the room and increased level of feelings of inadequacy.

Keywords: Genesis, Inadequacy, Paranormal, Sleep-Paralysis, Spiritual, Stress

with some sleeping habits and positions such as sleeping alone

1. INTRODUCTION and in supine position. It is less likely to occur in the unusual
Sleep paralysis is often misinterpreted as narcolepsy which is and uncomfortable sleeping position such as sitting or lying on
an entirely different phenomenon that may suddenly occur one’s either side.1,5-6 Evidences report the duration of such
anytime in the day irrespective of any kind of mental of attacks from few seconds to 10 minutes which gets over out of
physiological involvements such as eating food, talking to the strong efforts put by the sleeper.7 Research indicates a wide
someone, driving or working etc. These are the uncontrolled prevalence (20%-60%) of sleep paralysis,8-13 often with
sleep attacks lasting for 10 to 20 minutes after which the hallucinations, giving rise to supernatural and paranormal
person feels very energized and refreshed. However, the beliefs14 among the non-narcoleptic world’s population.
comorbidity of sleep paralysis is usually found with narcolepsy This state of sleep paralysis without other symptoms of
1,16
(approximately 40%-60%) but not necessarily in all patients of narcolepsy is also called isolated sleep paralysis. On the
narcolepsy. On the other hand, sleep paralysis may be present other hand, recurrent sleep paralysis (RISP) is a sleep state
as an independent state in many.1 It is a dissociative wakeful which may last for a longer period such as an hour or more.
state of sleep during which sleep atonia occurs while individual Historically, the original definition of sleep paralysis was
is conscious.2 These findings were also supported by Sharpless3 codified by Samuel Johnson in his A Dictionary of the English
explaining sleep paralysis in terms of REM sleep atonia Language as nightmare. In the initial religious writings sleep
coexisting with conscious awareness. paralysis can be traced as a demonic activity of sitting of the
Sleep paralysis is a period of transient, consciously chests of sleeping people. As Carl Sagan17 also recounts in his
experienced paralysis either when going to sleep (hypnogogic) book, The Demon Haunted World, "with this Bull, Innocent
or waking up (hypnopompic). During the attack, individuals initiated the systematic accusation, torture, and execution of
are fully aware of their surroundings and able to open their countless 'witches' all over Europe." This would lead to the
eyes sometimes feel unable to move their bodies. They may publication of the infamous Malleus Maleficarum (the
also feel troubled breathing and extreme anxiety.4 Varying "Hammer of Witches"), one of the vilest, irrational, fearsome
person to person these attacks may be characterized by the and cruel documents in all of human history.
unpleasant feelings like excessive fear, demonic attacks, sensed
presence, irritation, anxiety, etc. and very rarely the pleasant 1.1 PARAPSYCHOLOGICAL AND PHILOSOPHICAL
feelings like joy, bliss etc. Sleep paralysis is also associated INTERPRETATIONS OF SLEEP PARALYSIS
Succubus and Incubus.
* [email protected] Religious explanations of sleep paralysis in diverse cultures
1 Adv.Sci. Lett. y, xxxx-xxxx, 2017 xxxx-xxxx-/2017/x/xxxx/xxx doi: xx.xxxx/asl.2017.xxxx
Adv.Sci. Lett. y, xxxx-xxxx, 2017 RESEARCH ARTICLE
Explanations of sleep paralysis can be more widely seen in 1.3 PSYCHOGENESIS OF SLEEP PARALYSIS
various cultures. Cross cultural psychiatry has got many Psychodynamics of sleep paralysis are not well traced in the
explanations of the same. Jalal et al18 in their study explored previous studies, some studies, however, have explained it
explanations of sleep paralysis in Egypt and Denmark. They differently. The associated variables of sleep paralysis have
also studied the population in terms of educational status. They been identified by Denis et al. 27 such as substance use, stress,28
found that the general population of Egypt was more likely to genetic factors, other physical illness, sleep disorders,
explain sleep paralysis in terms of supernatural happenings as anomalous beliefs, personality, and sleep disorders etc.
compared to the general population of Denmark. Further they Schneck29 in his study interprets it as a latent homosexuality in
marked difference in the opinions of undergraduate students as symptom-formation and probably this is the reason people
compared to the general population of Egypt in which they report of experiencing sexual assaults during these attacks.
found less significant views endorsing supernatural factors of Rushton,30 in his findings reporting normal EEG patterns
sleep paralysis. They also explained a difference in terms of during the sleep paralysis attacks, supported this view of
cultural variations in both countries. Schneck. Out of all the explanations stress, nightmares and
Philip Kapleau, a teacher of Zen Buddhism, in his book ‘The psychiatric disorders etc. emerge out as its possible
Three Pillars of Zen19 explains about a phenomenon called precipitators but as a matter of fact neurophysiological
makyo (similar to sleep paralysis; ma means devil and kyo explanations are more prominently found over the
means objective world). He favors this phenomenon by saying psychological ones. Despite the several attempts to explain the
that “These phenomena are not inherently bad. They become a root cause of sleep paralysis, modern research, in many ways,
serious obstacle to practice only if one is ignorant of their true fails to explain its actual causes and therefore the paranormal
nature and is ensnared by them” (p.38). He, in a way also explanations take place to fill this gap.31
considers all humans, until attached to this world, are makyo The genesis, patterns and determinants of sleep paralysis have
but while talking specifically about the nature of makyo, he been covered at a greater length since its inception to
says that it may vary depending upon the personality and contemporary period, as not infrequently the concept is
temperament of the devil. unfamiliar. Some qualitative preliminary observations have
As per the Hindu mythology such experiences (extreme heat been made with respect to few cases of sleep paralysis with
sensations), called Siddhi, and are experienced by meditators respect to selected psychological aspects. More specifically,
(Patanjali Yoga Sutra 3.40) which sometimes create sleep this study was to carried out to fulfill the following objectives-
paralysis and out-of-body experience (tapas). A similar To examine the association of spiritual beliefs in a group of
interpretation is also given by a Namibian San tribe that a heat sufferers with sleep paralysis.
in the spine which is generated during the trance dance results To identify the linkage of paranormal beliefs in these subjects.
in an out-of-body experience. Patanjali also explains tapas not To evaluate the role of stressful life events following the
only as a symptom of sleep paralysis but as a cause as well disorder of sleep paralysis.
(Yoga Sutra 4.1). On the contrary, looking at the Jewish To explore the relationship of feelings of inadequacy and sleep
literature it can be seen that Judaism explains this phenomenon paralysis.
in terms of divine revelation in which Gods terrify and speak in It was broadly hypothesized that the sufferers of sleep paralysis
the ears of sleeping men as experienced by Prophet Daniel. are more prone to develop greater intensity of spiritual and
Somewhat similar explanations can be traced in the Christian paranormal beliefs, stress and feelings of inadequacy.
and Islamic mythologies.
2. METHOD
1.2 NEUROCHEMISTRY OF SLEEP PARALYSIS
The latest research on sleep paralysis covers a range of 2.1 SAMPLE:
explanation supporting the scientific views. Role of mirror Keeping in view the greater prevalence of sleep paralysis
neurons has been identified by Jalal and Ramachandran20 in among students,32 the sample comprised of three college
their recent study on sleep paralysis. Rose,21 in her article on students and two persons who were employed, in the age range
sleep paralysis, explains the chemistry of sleep paralysis of 19 years to 29 years. Of these, four were males and one
claiming that it occurs due to stress which disturbs the normal female. Furthermore, four of them were unmarried and
chemical flow in brain which stops us to be awake during remaining one was married. The entire sample belongs to the
sleep. During the sleep paralysis attack this flow becomes nuclear family background.
unusual in a partial awakening state. May be this is the reason
of hallucinations of such states when partial brain wants to 2.2 CRITERION OF SAMPLE SELECTION:
dream and the rest wants to wake up due to the restless The sample of the study was explored from the students and
stressful state. Cheyne et al.9 explains this phenomenon with the employees of university setup where the investigators are
the help of a three-factor structural model which consists of working. All the subjects participated on the voluntary basis,
incubus (a hyper vigilant state of mid brain), intruder, a state of screened through Waterloo Sleep Paralysis Questionnaire.33
hyperpolarization of motoneurons on perceptions of Only 5 cases who qualified the criterion of sleep paralysis were
respiration22 and unusual bodily experiences (generated by included. The study attempts to focus on people who have
conflicts of endogenous and exogenous activation related to experienced sleep paralysis at least once in the life time. These
body position or movement). This view has been confirmed in cases have experienced sleep paralysis at least once in their
the further research.23 Moreover, further explanations of these life.
visual hallucinations are also present in the literature attributing
the cause to the stimulation in the visual areas of the occipital 2.3 MEASURES:
cortex during the PGO spike, in which case the rapid eye
Waterloo Unusual Sleep Experiences Questionnaire –VIIIa:33
movements may reflect attempts to scan the images,24-25 or
The primary purpose in the development of this instrument has
conversely, the mages may be produced by the oculomotor
been to assess the frequency and intensity of the SP experience
impulses in response to direct stimulation from the
and of the qualitative features of the hallucinatory experiences
gigantocellular pontine reticular field.26
2
RESEARCH ARTICLE Adv.Sci. Lett. y, xxxx-xxxx, 2017
that frequently accompany SP. The standard (retrospective) scored slightly higher on spirituality and significantly higher on
version of the questionnaire is being validated against this inadequacy. He also reported reasonably higher number of
more recent concurrent questionnaire. stressful life events. The case significantly scored lower on
Paranormal belief scale:34 It consisted of eight questionsasking paranormal beliefs. By enlarge clinical presentation of this case
for the existence of paranormal phenomena. Each question was is in harmony with psychopathology of emotional disorders of
based on a semantic differential ranging from 1 (total sleep paralysis.
disagreement) to 6 (total agreement). The internal consistency
was found to be .81 was on the upper limit of the values CASE 2:
reported for similar scales in the literature. Semantic A 20-year-old unmarried Hindu male student belongs to a
differential ranging from 1 (total disagreement) to 6 (total nuclear family goes through terrifying sleep experiences when
agreement). falling asleep or when waking from sleep during which he
Spirituaity questionnaire:35 The scale comprises of four sub finds himself unable to move even though he is aware of his
scales consisting 20 items. These sub tests are belief in God, surroundings. In this duration he feels unable to speak or yell
search for meaning, mindfulness, and feeling of security. It is a out while his eyes are open and he feels a sense of fear. It was
5 point rating scale ranging from not true at all to absolutely reported by the respondent that he finds his body lying on the
true. The alpha level for all statistical tests was set to .01. back. He also reported that he normally lies on his back before
Inadequecy/self esteem from scale:36 The scale consists of 36 falling asleep. This terrifying experience was last experienced
items. The responses are obtained on a five point rating scale by him in the last week before the interview. The case
ranging from very often to particularly never/ very confident to experiences such sleep disturbances 3-4 times in a month
not at all confident. Davis-Zinner37 found median test-restest lasting for few seconds that always occurs at night. The case
reliabilities of .69. did not have a significant persistent stressor. He stays and
The Social Readjustment Rating Scale:38 It is a 43-item scale sleeps alone. He attributed psychological (emotional) factors
based upon the life events experienced the individual in the behind these sleep disturbances. However, surprisingly
past one year. A study was carried out in 1970 by Rahe et al39 enough, he scored very low on stressful life events (being
testing the reliability of the stress scale as a predictor of defensive). Furthermore, he was found to be average on
illness. There was a +0.118 correlation between stress scale feelings of inadequacy. As regards to the measure of
scores and illness, which was sufficient to support the spirituality he scored comparatively high but low on
hypothesis of a link between life events and illness. paranormal beliefs. He too partially fits in psychopathology of
sleep paralysis.
2.4 PROCEDURE:
As stated earlier screening measure for the diagnosis of sleep CASE 3:
paralysis was employed for a group of 200 students from A 22-year-old unmarried Hindu male student belonging to a
different schools of the university. The five qualified cases nuclear family goes through terrifying sleep experiences when
were included and were individually administered four tests falling asleep in which he is unable to move, open his eyes,
including Waterloo Unusual Sleep Experiences Questionnaire speak out though he is well acquainted of his surroundings. He
–VIIIa, Paranormal belief scale, Spirituaity questionnaire, feels that someone is present in his room that is touching him
Inadequecy/self esteem from scale and the Social Readjustment and applying pressure on his chest and other body parts.
Rating Scale. The 5 subjects chosen for the study were During these experiences he feels vibrating and tingling
characterized as four males and one female; age range 19-29 sensations. He also reports a sense of fear and anger. When
years; all were undergraduate students by their qualification; all asked about the sleeping position he reported that he finds him
of them were residing in university hostels; they belong to lying on his back though he could not remember the position
upper middle socio-economic status with nuclear family set up he normally lie before falling asleep and the frequency and
and hailing from urban domicile. All were Hindus except one duration as well. He had his last such experience one year
Muslim by their religion. before the interview. He reported that he stays and sleeps alone
and this experience particularly occurs at night. He denied
3. RESULTS having any persistent stressor and attributed spiritual factors
Some meaningful trends have emerged with respect to sleep behind such experiences. The case reported significantly lower
paralysis. Keeping in mind qualitative research, each case was level of stress due to life events and scored slightly higher on
analyzed individually. To get a clear picture of results, a case feelings of inadequacy. However, he had significantly very
wise description is demonstrated below: high scores on spirituality and reasonably high scores on
paranormal beliefs.
CASE 1:
CASE 4:
A 19-year-old unmarried Muslim male student belongs to a
nuclear family goes through sleep disturbances in which he A 28-year-old Hindu unmarried male entrepreneur belongs to a
finds himself unable to speak, open his eyes or yell out and nuclear family goes through terrifying sleep experiences when
feels a presence of someone in his room. During this state he falling asleep during which he is unable to move, open his
feels a pressure on his chest and other body parts also. He also eyes, speak or call out even though he is conscious of his
reported a feeling of depersonalization in which he fells out of surroundings. During this experience he feels as if he is
his own body in which he feels a sense of fear and sadness. The floating in the air and his body is moving up and down and
sleeping position reported by the case was face down before right and left when someone is touching him and applying
falling asleep. He experienced the last episode one week before pressure on his chest and other body parts. During this
the day of interview. He reported the frequency of this experience he feels a sense of fear, pain, sadness, heat and
experience once or twice a month that particularly occurs at anger. He experiences a sense of shaking and trembling and a
night since the past one year. The case sleeps alone and sense of erotic feeling. He reported that during this experience
attributes psychological factors to such sleep disturbances. He he finds his body lying on the back that is normally the same
before falling asleep. The last terrifying experience occurred
3
Adv.Sci. Lett. y, xxxx-xxxx, 2017 RESEARCH ARTICLE
one year before the interview. He reported to have such they support its occurrence mainly to be characterized by
experiences 4-5 times in a month which always occurs at night. sensed presence, due to the distress which is related to
He reported some significant persistent stressors that were dysfunctional social imagery. Many others researchers further
more prominent in the past year. He stays and sleeps on a support the role of repressed memories of childhood sexual
sharing basis and attributes spiritual factors behind such abuse in the occurrence of sleep paralysis41-42 disagreeing with
experiences. He scored considerably very high on stress due to the views of others who strongly support the role of mental
life events and high on the feelings of inadequacy as well. His disorders such as, anxiolytic medication, automatic behavior,
score was also reasonably higher on spirituality but bipolar disorders, physical disease, hypnopompic
significantly low on paranormal beliefs. hallucinations, nonrestorative sleep, and nocturnal leg cramps
in predicting sleep paralysis.12
CASE5:
Finally, a 28-year-old unmarried Hindu working woman who 5. CONCLUSION
belongs to a nuclear family sometimes goes through traumatic To sum up, it is inferred that people who suffer from sleep
sleep experiences while falling asleep during which she is paralysis usually sleep alone in supine position with a
unable to move, open her eyes, speak or call out even though predominant symptom of sensing fear. Expectedly, they also
she is aware of her surroundings. She feels that somebody is experience pressure on their chest and other body parts during
present in her room who is applying pressure on her chest. She the episode of sleep paralysis due to the various factors such as
feels a sense of fear during this experience. She also reported intruder and incubus etc. Usually the episode occurs at night
that she finds her body lying on her back that is the same leaving no signs of neurological deviations. Sufferers of sleep
before she falls asleep. She had her last such experience 24 paralysis experience greater level of inadequacy in them and
hours before she was interviewed. The frequency of such probably this leaves them with the perception of greater level
experiences was reported 3-4 times in a month that occurs for of stress due to life events. They also have enhanced levels of
few seconds. She reported to have significant persistent spiritual and paranormal beliefs but they consider
stressor in her life. She admitted to experience these sensations psychological disturbances as causative factors of sleep
at night but sometimes in the day also. She stays and sleeps paralysis. This creates a dogma that probably they show higher
alone and attributed supernatural factors behind these resistance to publicly accept their spiritual and paranormal
experiences. She scored moderately higher on stress due to life believes.
events and reasonably higher on inadequacy, spirituality and
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Fig. 1. Incubas. Retrived July 10, 2016 from http://www.memegenerator.eu/meme/6yq52k

Fig. 2. Succubus. Reteived July 10, 2016 from http://www.learning-mind.com/phenomenon-of-sleep-paralysis/

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