Is this sleep paralysis?

Hi Chris, Welcome to the club! It's not a very exclusive club. Everyone experiences sleep paralysis (SP) once or twice in their life, around 5% of the population get it on a regular basis, and at least half of this group also experiences hallucinations or other strange sensations during SP. It's completely harmless and just a variation of normal sleep patterns. The reason you don't hear more about is that people who have it learn at an early stage to keep quiet about it. After all, one's hallucinations don't make a good topic for dinner party conversation, do they?

I'm sorry you drew a blank with your doctors, even at the sleep clinic, but not surprised. Doctors are amazingly ignorant of this relatively common condition. On the other hand, you might have dodged a bullet there. When doctors do accept that the condition exists, their solution is to prescribe antidepressants, usually of the older, tricyclic group. This isn't because SP is in any way related to depression or any other mental illness. It's just that suppression of the rapid eye movement (REM) phase of sleep - the phase from which SP arises - happens to be a spin-off of these drugs. They don't cure the condition, they only suppress it. As soon as you come off the antidepressants, which can in itself be a long, traumatic process, the SP returns.

I've had SP, with hallucinations, for 50 years now. I'm also a former neuro nurse, so reasonably well placed to see it from both sides.

You've probably googled the physiology but in case you haven't, here goes. We all go through several sleep cycles every night, lasting on average one-and-a-half hours each. Each cycle is made up of a dreamless and dreaming (REM) phase. Most of us spend more time in the REM phase in the later cycles of the night. Everyone dreams, by the way - unless they've had their REM sleep suppressed by antidepressants. It's just that most people don't recall their dreams.

In order to stop us jumping up and acting out our dreams, the brain secretes a hormone during the REM phase that paralyses all our voluntary movements. Our autonomic nervous system isn't affected, so we continue to breathe, our heart beats, we swallow our saliva, our intestines keep moving etc. etc.

Some of our brains have a minor glitch, which causes them to carry on secreting the hormone for a short time after we've woken up or - less commonly - to start secreting it before we've fallen asleep. Hence your total inability to move when you wake in this state. As you've noticed, your breathing feels very shallow. This is because in our waking state our breathing is controlled by two different mechanisms. The autonomic nervous system maintains automatic breathing via the diaphragm and abdominal muscles throughout our life, and when we're awake we can also voluntarily take an extra deep breath when we feel we need to by expanding our chest. This voluntary deep breathing is the bit we can't do when we're under the influence of the paralysing hormone. Some people who have SP interpret this (wrongly) as not being able to breathe at all and become panic-stricken.

I also experience the sensation of my body doing all kinds of things that it isn't in reality. This is quite common in SP. It's a kind of hallucination - the result of the mind not being able to cope with this temporary paralysis and doing its own thing. During my nursing career I looked after a lot of patients who were paralysed by severe spinal injuries. Many of them described to me how, in the immediate aftermath of the accident, they could feel their paralysed limbs flailing around wildly.

I don't think anyone knows why this minor brain glitch affects some people, but it's clearly genetic. I've now spoken to hundreds of people with SP, and more than half of them have reported a family member having the same condition. My father, his mother and at least one of his siblings also had it. However, it often tends not to be spoken about in families. I didn't find out about my father's family history until a few years before his death, 20 years after I'd started getting SP, even though I'd told my parents about it at the time. It eventually transpired that my mother had forbidden him ever to mention it, for fear it was a sign of insanity in the family!

If it's troubling you unduly, it's usually possible to identify and avoid your particular triggers. These vary widely between individuals. My own main trigger is overheating while sleeping. I sleep under very light bedclothes all year round. Another one of mine is oversleeping. I'm much more likely to get an SP episode when having a lie-in or an afternoon nap. However, some people find they get more attacks when they're overtired. Eating certain foods late in the evening can trigger attacks in others. Avoiding your triggers won't entirely stop the episodes, but it should reduce the frequency. And the good news is that the frequency declines with age. It never completely goes away though. I'm 73 and still have a few episodes, and a few years back I was talking to an 87-year-old man who still had it!

If you have any more questions, don't hesitate to post them here or contact me by private message via this site.