Marta is a nineteen-year-old girl who has been suffering from panic attacks for 6 years. Between theage of 15 and 17 her emotional distress grows. She begins a heavy use of alcohol and cannabis. Suicidal thoughts appear occasionally. For the last few years, she reports “Sleep paralysis” 1 , which she describes as experiences where “the mind wakes up from sleep, but the body continues to sleep, she can’t open her eyes, she can’t move, she’s like paralyzed”. Fear and anguish accompany these episodes, perceived as interminable even if they last a few secondsor minutes.
Recently in one of these episodes she “heard her father’s voice, even though she knew she was aloneat home. Then she heard an ugly voice of a man and his footsteps approaching her, she felt as if shewas groped and raped”. Laura a 22-year-old girl has always been very good at studies and sport, but something over the lastyears has changed. She’s not able to concentrate and reports a growing early insomnia with suddennocturnal awakenings accompanied by chest oppression and difficulty in breathing. Over the yearssleep paralysis has returned. The first episodes in her past were between kindergarten and primaryschool. During nocturnal awakenings a terrible monster appeared to her, she was awake, but her bodycould not move. As soon as she was able to move, she called her mother who captured the monsterusing a hoover and who calmed her telling that maybe she had heard a bad story at school.There are various popular beliefs2 proposing explanations for the phenomenon of sleep paralysis.
This fact explains their diffusion and the associated anguish. Scientific literature states that sleep paralysis is a common phenomenon in general population, witha prevalence rate of 7.6% 3 during individual life for the recurrent isolated sleep paralysis and of 40% 4 for single episodes. Sleep paralysis are called hypnagogic if they occur at the wake-sleep transition, i.e. during fallingasleep process; conversely, they are defined hypnopompic when they occur at sleep-wake transition, i.e. during waking process5 Age and gender do not appear to be particularly influential risk factors. Sleep paralysis can occur atany age, but the first signs seem to happen more frequently in childhood, adolescence, and earlyadulthood6 .
Other variables associated with these experiences are7 : substance use, stress and trauma, genetic influences, physical illness, personality aspects, sleep problems and disorders8 , particular beliefs,psychiatric disorders as well as specific symptoms of psychiatric illness (particularly anxietysymptoms).Despite all these studies, the cause of sleep paralysis seems to remain unknown and consequently thepossibility of a specific treatment9 .
What is the meaning of an awaken mind in a body “still sleeping”?Are the terrifying images that accompany these experiences nightmares, illusions or hallucinations10 ? Is it correct to define them as paralysis of sleep or should we indicate them as paralysis of the waking?We were stimulated by clinical cases of adolescents, who spontaneously asked for psychological helpfor sleep disorders and anxiety in public health care units. Particularly, we questioned ourselves andwere led to formulate, along with the anamnestic data, a few etiopathogenetic hypothesis as well asconsequent ways of intervention which we are sharing with the aim of developing scientific researchon this phenomenon still very little researched in its causes and consequently in the possibility oftreatment with psychotherapy.Considering the psychiatrist Massimo Fagioli’s11 Birth Theory and the present knowledge in the fieldof neuroscience12 , we know that sleep is fundamental for the survival of human being.If we don’t sleep, we die13 . Why? According to Fagioli it’s fundamental for the human being “to fallasleep and dream14″.
The dream is a language by images15 : “Dreams are a transformation of consciousthought into unconscious thought. From the verbal thought to the thought through images. There areno words, there isn’t articulated language, the dream is a free thought. Articulated language is learnedwhile the dream isn’t, it expresses spontaneously something which comes from inside. Images are created” and more: “the oneiric image is never a conscious remembering reproducing exactly what happened during the waking hours, because it creates a new image stimulated by what was lived andthought during the waking hours16 .”We believe that to fully understand the symptomatic phenomenon of sleep paralysis in all itscomplexity and in its variety of expression of a pathological process of variable severeness from caseto case, it is essential to know the physiology of the dream and wake rhythm which doesn’t excludewhat has been mentioned above and which in no doubt doesn’t exclude the “physiology of dreaming”. Consequently, it will be essential, in case of a deviation from the physiological aspect as we have insleep paralysis in the strict sense, considering the relevance in the dynamics of the annulment pulsion, described for the first time by Fagioli in 1972 as well as that of the negation17. In this context of ourwork, we intend to underline the original (because even this one has never been done before)differentiation of the dynamics of falling asleep from that of the waking up done by Fagioli andoutline, for the research of the sleeping paralysis, the role and the possible differences between theoneiric images and the psychopathological phenomenon as illusions (which don’t always have apathological meaning), hallucinations, delusions.
Note
1 Denis, D., French, C. C., & Gregory, A. M. (2018). A systematic review of variables associated with sleep paralysis. Sleep medicine reviews, 38, 141–157. https://doi.org/10.1016/j.smrv.2017.05.005
2Jalal, B., Romanelli, A., & Hinton, D. E. (2021). Sleep paralysis in Italy: Frequency, hallucinatory experiences, andother features. Transcultural psychiatry, 58(3), 427–439. https://doi.org/10.1177/1363461520909609
3 Sharpless, B. A., & Barber, J. P. (2011). Lifetime prevalence rates of sleep paralysis: a systematic review. Sleep medicinereviews, 15(5), 311–315. https://doi.org/10.1016/j.smrv.2011.01.007
4 Stefani, A., & Högl, B. (2021). Nightmare Disorder and Isolated Sleep Paralysis. Neurotherapeutics: the journal of theAmerican Society for Experimental NeuroTherapeutics, 18(1), 100–106. https://doi.org/10.1007/s13311-020-00966-8
5 Cheyne, J. A., Newby-Clark, I. R., & Rueffer, S. D. (1999). Relations among hypnagogic and hypnopompic experiencesassociated with sleep paralysis. Journal of sleep research, 8(4), 313–317. https://doi.org/10.1046/j.1365-2869.1999.00165.x
6 Farooq M, Anjum F. Sleep Paralysis. 2021 Dec 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan–. PMID: 32965993.
7 Denis, D., French, C. C., & Gregory, A. M. (2018). A systematic review of variables associated with sleep paralysis. Sleep medicine reviews, 38, 141–157. https://doi.org/10.1016/j.smrv.2017.05.005
8 Denis D. (2018). Relationships between sleep paralysis and sleep quality: current insights. Nature and science of sleep,10, 355–367. https://doi.org/10.2147/NSS.S158600
9 Farooq M, Anjum F. Sleep Paralysis. 2021 Dec 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan–. PMID: 32965993.
10 Farooq M, Anjum F. Sleep Paralysis. 2021 Dec 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan–. PMID: 32965993; Kompanje EJ. ‘The devil lay upon her and held her down’. Hypnagogic hallucinations andsleep paralysis described by the Dutch physician Isbrand van Diemerbroeck (1609-1674) in 1664. J Sleep Res. 2008Dec;17(4):464-7. doi: 10.1111/j.1365-2869.2008.00672.x. Epub 2008 Aug 5. PMID: 18691361; Jalal B. Theneuropharmacology of sleep paralysis hallucinations: serotonin 2A activation and a novel therapeutic drug.Psychopharmacology (Berl). 2018 Nov;235(11):3083-3091. doi: 10.1007/s00213-018-5042-1. Epub 2018 Oct 5. PMID:30288594; PMCID: PMC6208952.
11 https://massimofagioli.com/teoria-della-nascita/
12 Nollet M, Wisden W, Franks NP. Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 2020 Jun6;10(3):20190092. doi: 10.1098/rsfs.2019.0092. Epub 2020 Apr 17. PMID: 32382403; PMCID: PMC7202382.
13 Ivi
14 Addormentarsi e sognare. Tempi dispari, 16 gennaio 2013, Intervista di Francesco Gatti, Il sogno della farfalla, 4, 2017,L’Asino d’oro edizioni, Roma, pp. 41-44.
15 Cfr. M Fagioli, La psichiatria come psicoterapia, L’Asino d’oro edizioni, 2021, Roma.
16 M. Fagioli, “La parola è realizzazione”, intervista di Ilaria Bonaccorsi a Massimo Fagioli comparsa nel N.41 di “Left” il 24.10.2015, pp. 74-75.
17 Cfr. M. Fagioli, Istinto di morte e conoscenza (1972), L’Asino d’oro edizioni, Roma, 2017. M. Fagioli, La psichiatria esiste? L’Asino d’oro edizioni, Roma, 2022, pp. 155-156; F. Fagioli, Avaunt, and quit my sight!… Hence, horribleshadow, Unreal mock’ry, hence” in La medicina abbandonata, Atti degli “Incontri di Ricerca Psichiatrica”, Aula Magna dell’Università di Roma “La Sapienza”, 10 maggio, 24 maggio, 7 giugno 1997, a cura di Marcella Fagioli, Nuove Edizioni Romane, Roma, 1998, pp. 135-158.
Bibliography
- Denis, D., French, C. C., & Gregory, A. M. (2017). A systematic review of variables associated withsleep paralysis. Sleep medicine reviews, 38, 141–157. https://doi.org/10.1016/j.smrv.2017.05.005
- Denis D. (2018). Relationships between sleep paralysis and sleep quality: current insights. Natureand science of sleep, 10, 355–367. https://doi.org/10.2147/NSS.S158600
- Cheyne, J. A., Newby-Clark, I. R., & Rueffer, S. D. (1999). Relations among hypnagogic andhypnopompic experiences associated with sleep paralysis. Journal of sleep research, 8(4), 313–317.https://doi.org/10.1046/j.1365-2869.1999.00165.x
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- Fagioli, M. Retrivied March 25, 2022 https://massimofagioli.com/teoria-della-nascita/
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- Jalal, B., Romanelli, A., & Hinton, D. E. (2021). Sleep paralysis in Italy: Frequency, hallucinatoryexperiences, and other features. Transcultural psychiatry, 58(3), 427–439. https://doi.org/10.1177/1363461520909609
- Kompanje E. J. (2008). ‘The devil lay upon her and held her down’. Hypnagogic hallucinations andsleep paralysis described by the Dutch physician Isbrand van Diemerbroeck (1609-1674) in 1664. Journal of sleep research, 17(4), 464–467. https://doi.org/10.1111/j.1365-2869.2008.00672.x
- Nollet M, Wisden W, Franks NP. Sleep deprivation and stress: a reciprocal relationship. InterfaceFocus. 2020 Jun 6;10(3):20190092. doi: 10.1098/rsfs.2019.0092. Epub 2020 Apr 17. PMID:32382403; PMCID: PMC7202382.
- Sharpless, B. A., & Barber, J. P. (2011). Lifetime prevalence rates of sleep paralysis: a systematicreview. Sleep medicine reviews, 15(5), 311–315. https://doi.org/10.1016/j.smrv.2011.01.007
- Stefani, A., & Högl, B. (2021). Nightmare Disorder and Isolated Sleep Paralysis. Neurotherapeutics:the journal of the American Society for Experimental NeuroTherapeutics, 18(1), 100–106.https://doi.org/10.1007/s13311-020-00966-8
