The connection between sleep paralysis and PTSD
Common expressions used to describe medical terms can sometimes add to widespread misunderstanding and stigma. That’s certainly the case with ‘Old Hag’ syndrome, often depicted in art as a demon sitting on someone’s chest while they sleep!
This is, in fact, a relatively common condition called sleep paralysis. It can affect a broad range of people, including those with post-traumatic stress disorder.
Insomnia and night-time restlessness associated with PTSD are well known. Around 70-90% of people with a PTSD diagnosis have some form of sleep disturbance. Most commonly nightmares. Some of these individuals may be unaware that what they are experiencing is a form of sleep paralysis.
This article answers the question “What is sleep paralysis?” and explores its close connection to your physical, mental and emotional wellbeing, and your recovery from PTSD.
How common is sleep paralysis?
It’s believed that around 30% of the population experience an episode of sleep paralysis at least once. As mentioned in the introduction, in ancient times it was associated with witchcraft and demons in many global cultures. (This is why sleep paralysis is called Old Hag syndrome in the UK.)
As research into this issue advances, it’s becoming clear that people with PTSD are far more likely to experience sleep paralysis than people without PTSD.
What does sleep paralysis involve?
Like many other sleep-related symptoms of PTSD, this is a disruption in your Circadian rhythm.
Every 24 hours, humans pass through a cycle of physical, mental, and behavioural activities that maintain their health, including their immune response and mental wellbeing. This cycle should include at least seven hours of sleep, including periods of REM (rapid eye movement) sleep, which are especially important to your health.
During REM sleep, neurotransmitters (your brain’s messengers) signal parts of your musculoskeletal system to stay immobile for a while.
As we’ve mentioned before, the physical changes that occur as a result of trauma and PTSD include alterations to your brain and hormonal balance. The fact you are on constant alert, can make it difficult to go to sleep, or stay asleep.
This disruption can also cause your muscles to be out of step with the rest of your sleep-wake cycle. Though you become partially conscious, your limbs are still in rest mode, and unresponsive when you try to move. It can affect your neck and face too, making it temporarily impossible to speak or open your mouth to breathe fully.
Though sleep paralysis is not a serious medical problem – and can quickly pass – it is disorientating, unpleasant and at times terrifying. Particularly if you’re still experiencing residual dreams and nightmares as you become awake.
In this situation, not only do you have an inability to move as you wake, but you can also be hallucinating too.
PTSD, hallucinations and sleep paralysis
For some people with PTSD, sleep paralysis is not only a symptom but also a trigger for additional anxiety and general mental ill-health. That’s because temporary immobility from sleep paralysis can blur the boundaries between reality and nightmares.
When you’re falling asleep, your brain is processing information and can generate hypnogogic hallucinations, or visions. As you awake, these are called hypnopompic hallucinations.
The sensory impact of sleep paralysis could even be sounds or smells, or physical sensations such as feeling like something is pressing you down, or that you are being watched or touched.
All of this adds to the way this sleep-related PTSD symptom can be severely distressing. For example, if you have experienced sexual or physical abuse it is essential to feel in control of your own body and safe in your home. This can be seriously eroded by the sensations, immobility and hallucinations resulting from sleep paralysis.
Also, it’s believed that the time of day a traumatic experience occurs can alter the physiological and psychological response, and the person’s ability to maintain a healthy Circadian rhythm. For instance, if your trauma is associated with evening or night, then your state of alertness will increase just as your internal clock should be setting your rest mode.
Sleep paralysis and other problems with your circadian rhythm erode your body’s ability to carry out essential healing, repair and restoration tasks, storing up various physical health issues.
Sleep paralysis treatment
There are ways to treat sleep paralysis and other forms of sleep disturbance as a symptom of PTSD.
For example: “Cognitive-behavioural sleep management constitutes a widely acknowledge, acceptable and durably effective treatment option in PTSD”, according to one study.
There are also medications for sleep disorders associated with PTSD, which can help some people restore a healthy Circadian rhythm.
As disrupted and spasmodic sleep patterns increase the likelihood of episodes of sleep paralysis, it is important to take steps to improve your ability to rest properly each night. Including sticking to a night-time routine, avoiding alcohol, caffeine and rich food in the evening, and using your favourite calming techniques (ideally not your phone) to support improved slumber.
If you’re struggling with sleep paralysis, or other sleep disorders as a result of PTSD, please speak to your GP, or private practitioners are also available in the UK.
NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).
Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.
- Circadian Rhythms
- Disturbed Sleep in PTSD: Thinking Beyond Nightmares, Lancel Marike, van Marle Hein J. F., Van Veen Maaike M., van Schagen Annette M: Frontiers in Psychiatry, VOLUME=12, 2021, Page 2135. 10.3389/fpsyt.2021.767760
- Agorastos, A., & Olff, M. (2020). Traumatic stress and the circadian system: neurobiology, timing and treatment of posttraumatic chronodisruption. European journal of psychotraumatology, 11(1), 1833644. https://doi.org/10.1080/20008198.2020.1833644
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