On a recent episode of "," sister/model Kendall Jenner, 20, discussed her battle with anxiety, panic attacks, and sleep paralysis. She says it's gotten so bad that she's afraid to fall asleep: "I'm freaking out because recently I woke up in the middle of the night and I couldn't move."
Her mother, Kris Jenner, tells Kendall that she thinks Kendall has "incredible anxiety about traveling" which is a big problem as her work requires that she frequently travel overseas. Kendall replies: "But it's not ... no I'm done arguing with people because everyone says I'm fine, but I don't feel fine. And I promise you one day when I'm rushed to the hospital then you guys are gonna wake up."
Kendall decides to see a therapist to help her work through her anxiety about flying and sleeping paralysis. However, when the therapist suggests she mimics her symptoms, Kendall insists that this would be too scary and shuts down the visit. Instead, sister Kim Kardashian-West sets up a meditation session for Kendall with a couple of instructors. Kendall felt better after the session which made her feel "able to relax." She plans to continue to use meditation to help her deal with her anxiety.
A Short Primer on Sleep
Sleep is a naturally-occurring, reversible, periodic, and recurring state in which consciousness and muscular activity is temporarily suspended or diminished, and responsiveness to outside stimuli is reduced. It is different from hibernation, coma, or unconsciousness due to anesthesia because it is easily reversible.
Sleep is divided into two broad types: rapid eye movement (REM sleep) and non-rapid eye movement (NREM or non-REM sleep). Each type has a distinct set of physiological and neurological features associated with it.
REM Sleep
REM stands for "rapid eye movement" but involves many other aspects including virtual paralysis of the body. It is associated with dreaming, unsynchronized and faster brain waves, and loss of muscle tone. During non-REM sleep, the brain uses significantly less energy. In areas with reduced activity, the brain restores its supply of adenosine triphosphate (ATP), the molecule used for short-term storage and transport of energy.
REM sleep occurs in cycles of about 90-120 minutes throughout the night, and it accounts for up to 20%-25% of total sleep time in adult humans. As the name suggests, it is associated with rapid, random side-to-side movements of the closed eyes. This may relate to the internal visual images of the dreams that occur during REM sleep.
Breathing is more rapid and irregular during REM sleep than during non-REM sleep, and the heart rate and blood pressure also increase to near waking levels.
Although the muscles are more relaxed during non-REM sleep, they become completely paralyzed and unresponsive during REM sleep. This virtual absence of muscle tone and skeletal muscle activity is known as atonia. It occurs because the brain impulses that control muscle movement are completely shut down. The exceptions to this include muscles that control the eye movements and muscles with essential functions, such as the heart and diaphragm muscles.
Non-REM Sleep
Non-REM sleep is defined as any sleep which is not REM sleep. It consists of three separate stages (stage 1, stage 2, and stage 3). These are followed in order up and down as the sleep cycles progress.
Stages of Non-REM Sleep
Stage 1 (NREM1 or N1), a stage between wakefulness and sleep, sometimes referred to as somnolence or drowsy sleep:
- Muscles are still quite active
- Eyes roll around slowly and may open and close from time to time
- Breathing gradually becomes more regular
- Heart rate begins to slow
- Sudden twitches or hypnic (hypnagogic) jerks (sudden short micro-awakenings often accompanied by a falling sensation) are quite common
Stage 2 (NREM2 or N2):
- Muscle activity decreases further
- Conscious awareness of outside world fades completely
- Brain waves: Characterized as sleep spindles and K-complexes present, they serve to protect sleep and aid in sleep-based memory
- Sleepers pass through this stage several times a night
- 45%-50% of total sleep time for adults
Stage 3 (NREM3 or N3), also known as deep or delta or slow-wave sleep:
- Sleeper even less responsive to outside world
- Occurs in longer periods in the first half of the night (especially in first two sleep cycles)
- 15%-20% total sleep time for adults
- Brain temperature, breathing and heart rates, and blood pressure at lowest levels
- Dreaming possible and more common than in other non-REM stages (but not as common or vivid as in REM sleep)
- Parasomnias, such as night terrors, sleep-walking, sleep-talking, and bedwetting can occur
- Information process and memory consolidation takes place
What is Sleep Paralysis?
Sleep paralysis is a phenomenon in which an individual, either during falling asleep or awakening, briefly experiences an inability to move, speak, or react. This is a transitional state between wakefulness and sleep, characterized by an inability to move the muscles. Sleep paralysis is closely related to REM atonia, the paralysis that occurs as a natural part of REM (rapid eye movement) sleep. Sleep paralysis occurs either when falling asleep, or when awakening from sleep. When it occurs upon falling asleep, the person remains aware while the body shuts down for REM sleep, a condition called hypnagogic sleep paralysis. Hypnopompic sleep paralysis is when it occurs upon awakening. In this case, the person becomes aware before the REM cycle is complete.
Sleep paralysis may be accompanied by terrifying hallucinations in which one is unable to react due to paralysis, and physical experiences (such as a strong current running through the upper body). These hallucinations often involve a person or supernatural creature suffocating or terrifying the individual, accompanied by a feeling of pressure on one's chest and difficulty breathing. Another common hallucination type involves intruders (human or supernatural) entering one's room or lurking outside one's window, accompanied by a feeling of dread.
What Causes Sleep Paralysis?
Genetics plays a big role in sleep paralysis -- it tends to run in families. Other linked factors include:
- Lack of sleep
- Sleep schedule that changes
- Mental conditions such as stress or bipolar disorder
- Sleeping on the back
- Other sleep problems such as narcolepsy or nighttime leg cramps
- Use of certain medications, such as those for ADHD
- Substance abuse
The underlying mechanism results from disrupted REM sleep, when there should be a general inability to move the muscles to prevent the sleeper from acting out their dreams. About 8% of people experience sleep paralysis at some point in their life.
What is the Treatment for Sleep Paralysis?
According to Peter Ostrow, MD, sleep medicine specialist at Beth Israel Hospital in Boston, most people need no treatment for sleep paralysis. Treating any underlying conditions such as narcolepsy may help if you are anxious or unable to sleep well. These treatments may include the following:
- Improving sleep habits -- such as making sure you get six to eight hours of sleep each night
- Antidepressant medication, prescribed to regulate sleep cycles
- Treating any mental health problems that may contribute to sleep paralysis
- Treating any other sleep disorders, such as narcolepsy or leg cramps
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Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.