Reconsidering "Sleep Paralysis" in Narcolepsy: Non-Identity of Hypnagogic REM Intrusion and Typical Isolated Sleep Paralysis
Zenodo (CERN European Organization for Nuclear Research) December 22, 2025 Orexin Knockout Human
The term "sleep paralysis" in narcolepsy may not refer to the same neurophysiological state as typical isolated sleep paralysis in healthy individuals. Typical isolated sleep paralysis occurs upon awakening and involves residual REM-related muscle atonia without emotional triggering. In contrast, narcolepsy-related experiences labeled as sleep paralysis more often occur at sleep onset and are closely associated with hypnagogic hallucinations and cataplexy-like muscle atonia. Many such reports may represent a composite experience of REM intrusion at sleep onset rather than a direct increase in typical isolated sleep paralysis. The paper argues that the term should be used with explicit distinction regarding timing and the mode of muscle atonia.