i think I'm having night terrors

Hi Rebecca,

I know just how scary this is, because I have it too - like about 5% of the population. (So we're not a very exclusive club!) I'm a former neuro nur se, so can talk about it from both sides. It's not actually called night terrors, though it happens in the night and can be terrifying. Night terrors are related to sleepwalking, and arise from the non-dreaming phase of sleep. What you have is sleep paralysis (SP) which arises from the REM (rapid eye movement) or dreaming phase of sleep. We all dream, btw, it's just that most people don't remember their dreams.

When we're in the dreaming phases of our sleep, the brain secretes a chemical that paralyses all our voluntary muscles, to stop us jumping up and acting out our dreams. However, this paralysis doesn't affect the muscles that control our vital functions like heartbeat, breathing, automatic swallowing etc. (I take your point that you feel as if you can't breathe during these attacks, and I'll get to that later.) In about 5% of the population, this process regularly gets out of sync, and the brain carries on secreting the paralysing chemical for a minute or two after we've woken up or, less commonly, it kicks in a minute or so before we fall asleep.

Everyone will have one or two attacks of this in their life, but it happens to some of us on a regular basis. No one knows quite why this happens, but it seems to be strongly hereditary. I got it from my father's side of the family. It typically starts between the mid-teens and mid-twenties.

Before we go any further - you actually can breathe during attacks. We have two types of breathing - autonomic and voluntary. The interaction between the two is very complicated, but I'll over-simplify it here. We carry on breathing all the time, even when we don't think about it, don't we? That's under the control of the autonomic nervous system, which stays on duty 24/7. However, when we want to take an extra deep breath, or even when we just focus our attention on our breathing, it becomes partly voluntary. We can hold our breath for a while if we want to, or take an extra-deep breath.

What happens when we wake up paralysed by our brain's natural chemicals is that we immediately panic and try to take a deep breath. But we can't, because the voluntary aspects of our breathing - mainly the intercostal muscles but all sorts of other muscles too - are paralysed. Our autonomic breathing, controlled mainly by our diaphragm, is actually still working, but we're so used to being able to override this and take an extra-deep breath at will, that we wrongly perceive this state as being unable to breathe.

During the few seconds of paralysis, we can get all kinds of "special effects", and the unpleasant sensation of vibration is one of them. Some of us also see, hear or feel things that aren't there. This is nothing to do with seizures and though it's upsetting, especially when it happens for the first time, it's not at all dangerous. You won't come to any harm during these periods.

The best way to manage attacks is to identify what triggers them. In my case, the main trigger is getting too warm in my sleep. I also get more attacks if I sleep in too late or take an afternoon nap. Anxiety is a major trigger for most people too - especially anxiety about having another attack, of course! Some people find that certain foods eaten too late in the evening can trigger an episode. The other thing to bear in mind is that the brain functions via electrical impulses, so the brains of susceptible individuals can be affected by getting too close to electronic devices during sleep. (This means turning off your phone or leaving it in another room while you sleep.) Everyone has their own triggers, and once we've learned to identify and avoid them, we can exert a lot of control over our SP episodes.

I note you say you've been depressed - which is quite understandable following a serious accident. I wonder whether you're on antidepressants. If you are, you could try asking your doctor to switch you to the older tricyclic kind (amitriptyline or Tryptizol is one of these). SP isn't a symptom of depression, but the tricyclic antidepressants have a spin-off effect of suppressing the dreaming phase of sleep, which is where SP arises. All antidepressants have this effect, but it's stronger in the tricyclics. The downside is that you have to keep taking them for life. Antidepressants don't actually cure SP, they just suppress it as long as you're taking them. It comes back again when you stop. Incidentally, I'm wondering if it's possible your SP started up after you stopped or reduced your antidepressants. That can happen.

The main thing is to try not to get too anxious about these attacks. I know just how scary they can be, but they are actually harmless - and they're not a sign of mental illness. I've had this minor brain glitch for 50 years now and it hasn't done me any harm!