Recurrent isolated sleep paralysis

AbstractNightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them. Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. Nonmedication treatment, in particular imagery rehearsal therapy, is especially effective. Isolated sleep paralysis is experienced at least once by up to 40% of the general population, whereas recurrence is less frequent. Isolated sleep paralysis can be accompanied by very intense and vivid hallucinations. Sleep paralysis represents a dissociated state, with persistence of REM atonia into wakefulness. Variations in circadian rhythm genes might be involved in their pathogenesis. Predisposing factors include sleep deprivation, irregular sleep–wake schedules, and jetlag. The most effective therapy consists of avoiding those factors.

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Objective REM sleep characteristics of recurrent isolated sleep paralysis: a case-control study

SLEEP ◽

10.1093/sleep/zsab153 ◽

2021 ◽

Author(s):

Monika Kliková ◽

Marek Piorecký ◽

Eva Miletínová ◽

Karolina Janků ◽

Daniela Urbaczka Dudysová ◽

...

Keyword(s):

Spectral Analysis ◽

Rem Sleep ◽

Power Spectral Analysis ◽

Sleep Fragmentation ◽

Beta Activity ◽

Sleep Paralysis ◽

Arousal Index ◽

Power Spectral ◽

Significant Difference ◽

Isolated Sleep Paralysis

Abstract Study Objectives Recurrent isolated sleep paralysis (RISP) is a rapid eye movement (REM) parasomnia characterized by a dissociative state with characteristics of REM sleep and wakefulness. Pathophysiology has not yet been clarified and very little research has been performed using objective polysomnographic measures with inconsistent results. The main aim of our study was to find whether higher REM sleep fragmentation is consistent with the theory of state dissociation or whether signs of dissociation can be detected by spectral analysis. Methods Nineteen participants in the RISP group and 19 age- and gender-matched participants in the control group underwent two consecutive full-night video-polysomnography recordings with 19-channel electroencephalography. Apart from sleep macrostructure, other REM sleep characteristics such as REM arousal index, percentage of wakefulness and stage shifts within REM sleep period were analyzed, as well as power spectral analysis during REM sleep. Results No difference was found in the macrostructural parameters of REM sleep (percentage of REM sleep and REM latency). Similarly, no significant difference was detected in REM sleep fragmentation (assessed by REM sleep arousal index, percentage of wakefulness and stage shifts within REM sleep). Power spectral analysis showed higher bifrontal beta activity in the RISP group during REM sleep. Conclusions The results showed an underlying persistent trait of higher cortical activity that may predispose patients with SP to be more likely to experience recurrent episodes, without any apparent macrostructural features including higher REM sleep fragmentation.

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