Sleep paralysis

Sleep paralysis and/or hallucinations when waking or falling asleep... 

Review patients sleep diaries to track the number of cataplexy, sleep paralysis, and hallucinatory events and when they occur. 

Sleep paralysis Moderate (50) High (80) Induced easily in normal controls with sleep deprivation Diagnosed clinically or electrophysiologically... 

Hishikawa, Y. Shimizu, T. (1995). Physiology of REM sleep, cataplexy, and sleep paralysis. Adv. Neurol. 67, 245-71. 

The essential features are sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis. Individuals with narcolepsy complain of excessive daytime sleepiness, sleep attacks that last up to 30 minutes, fatigue, impaired performance, and disturbed nighttime sleep. They have multiple arousals during the night. 

Sodium oxybate (yhydroxybutyrate a potent sedative-hypnotic) improves excessive daytime sleepiness and decreases episodes of sleep paralysis, cataplexy, and hypnagogic hallucinations. It is taken at bedtime and repeated 2.5 to 4 hours later. Side effects include nausea, somnolence, confusion, dizziness, and incontinence. 

A third symptom of narcolepsy is sleep paralysis. Sleep paralysis is an inability to move while falling asleep or shortly after waking. Normal people may occasionally and briefly experience sleep paralysis when waking, but sleep paralysis at the beginning of sleep is unique to narcolepsy. 

Einally, patients with narcolepsy may experience very vivid visual or auditory hallucinations, called hypnagogic hallucinations, while falling asleep. Similar to sleep paralysis, hypnagogic hallucinations occasionally occur in the absence of narcolepsy, but the patient with narcolepsy may experience them several times a week. 

Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes... 

Narcolepsy can usually be distinguished from insomnia by the presence of one of the auxiliary symptoms (cataplexy, sleep paralysis, hypnagogic hallucinations). When the diagnosis remains unclear, then a sleep study is necessary. 

Antidepressants. In addition to increasing alertness, the psychostimulants also mildly suppress the REM phase of sleep. Because the auxiliary symptoms of narcolepsy (cataplexy, hypnagogic hallucinations, and sleep paralysis) are basically... 

Narcolepsy is another medically recognized indication for the use of the psychomotor stimulants. This disorder is characterized by sleep attacks, particularly during the day, sudden loss of muscle tone cataplexy), sleep paralysis, and vivid visual and auditory nightmares that may persist into the waking state. Drugs that influence the central action of adrenomimetic amines re-... 

Narcolepsy (ICD G47.4) and other types of hypersomnia are severe disturbances of vigilance expressed as a sudden and irresistible requirement for sleep during the day, so-called sleep attacks (Aldrich. 1990). Apart from sleep attacks, the classical tetrad of narcolepsy includes cataplexy (sudden loss of muscular tone), sleep paralysis (waking from sleep with the feeling of not being able to move) and hypnagogic hallucinations (linages or sequences of... 

Similar to cataplexy, people with narcolepsy often experience sleep paralysis, which is the inability to move or talk for a... 

Examples of dissociations of consciousness that often divide the waking mind into two compartments include microsleeps, attentional lapses, and fantasy states. At the edges of sleep are hypnagogic hallucinations and sleep paralysis. Within sleep are sleep walking, sleep talking, and lucid dreaming. In all of these conditions, consciousness has some features characteristic of one state mixed with features characteristic of another. 

In order for dreaming to be contained in sleep, the brain must sharply demarcate its states. But it often fails to do so, as anyone who has awakened from a nightmare unable to move knows at first hand. The terror that prompted the awakening in the first place is not only unabated by the arousal, but it may be augmented as the return of waking consciousness takes account of the persistent sleep paralysis. 

One of the oldest uses for dextroamphetamines is in the treatment of narcolepsy, a sleep disorder characterized by constant daytime fatigue and sleepiness, with a disturbance in nighttime REM sleep (the period of sleep when dreams occur). During the day or other periods of time when they would normaly be awake, people with narcolepsy often experience sudden episodes of REM sleep. They may also suffer from sleep paralysis and/or cataplexy, an abmpt, total loss of muscle control. Central nervous system stimulants like dextroamphetamine help to relieve these symptoms. 

Sleepiness is a primary symptom of narcolepsy, often preceding the onset of the other well-known symptoms of the disease, namely cataplexy, sleep paralysis, and hypnagogic hallucinations (44). Evaluation of the MSLT of narcoleptic patients has demonstrated a short sleep latency (<5 min) and multiple sleep-onset REM periods (SOREMPs). The more specific finding in the MSLT of narcoleptic patients is more than 2 SOREMPs, shown to reach a specificity of 99% by Amira et al. (45), which further increased to 99.2% if 3 SOREMPs were recorded (46). On the other hand, more than one SOREMP can occur in nonnarcoleptic patients, such as those with sleep apnea, sleep deprivation, depression, periodic limb movements, circadian rhythm disruption, or withdrawal from REM-suppressing medications (5,47). Thus, the findings of the MSLT, which is always performed for suspected narcoleptic patients, must be interpreted in view of the clinical history and nocturnal PSG. 

The word narcolepsy refers to a syndrome of unknown origin that is characterized by abnormal sleep tendencies, including excessive daytime sleepiness and often disturbed nocturnal sleep and pathological manifestations of REM sleep. The REM sleep abnormalities include sleep onset REM periods and the dissociated REM sleep inhibitory processes, cataplexy and sleep paralysis. Excessive daytime sleepiness, cataplexy, and less often sleep paralysis and hypnagogic hallucinations are the major symptoms of the disease [12]. 

Narcoleptic individuals experience EDS, usually associated with REM sleep phenomena, such as sleep paralysis, cataplexy (emotion-induced weakness), and hypnagogic hallucinations (visual, tactile, kinetic, and auditory phenomena occurring during sleep onset) [37], Dismpted nocturnal sleep occurs frequently. Sleepiness is usually the first symptom to appear, followed by cataplexy, sleep paralysis and hypnagogic hallucinations [6,37 40]. Cataplexy onset occurs within five years after the occurrence of daytime somnolence in approximately two thirds of the cases [38, 40], The mean age of onset of sleep paralysis and hypnagogic hallucinations is also 2-7 years later than that of sleepiness [39, 41], In most cases, EDS and irresistible sleep episodes persist throughout the lifetime. 

At the present time, there is no cure for narcolepsy, and treatment goals include control of EDS, cataplexy, hypnagogic hallucinations, and sleep paralysis improvement of nocturnal sleep and reduction of psychosocial problems. 

Narcolepsy genetic characteristics. Rare, disabling sleep disorder of unknown origin. Characterized by sudden attacks of flaccid paralysis (cataplexy), extensive daytime sleepiness, sleep paralysis, hypnagogic hallucinations and rapid onset of rapid eye movement (REM) phase of sleep. 

Monitoring parameters for pharmacotherapy of narcolepsy include reduction in daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis. Patients should be evaluated regularly during medication titration, then every 6 to 12 months to assess adverse drug events (e.g., mood changes, sleep disturbances, and cardiovascular abnormalities). If symptoms increase during therapy, PSG should be done. 

---