A case of incubus phenomenon

The incubus phenomenon is a sleep-related disorder combining sleep paralysis with compound hallucinations, including sensed presence, fear, visual and auditory hallucinations, unusual body experiences, chest pressure, breathing difficulty, and pain. A 29-year-old man with intellectual disability, psychotic disorder, and cannabis use disorder was diagnosed with narcolepsy and cataplexy; his hallucinations included sexual themes, breathing difficulty, moving sensations, and chest pressure. Literature review indicates a lifetime prevalence of 0.11% in the general population versus 0.41% in psychiatric patients, suggesting the phenomenon is four times more common in those with psychiatric history and should not be mistaken for psychotic disorder. Recognizing it is important for proper treatment with anxiolytics, antidepressants, anticholinergics, or anti-epileptics, along with sleep hygiene.

Study at a glance

Abstract

Introduction The incubus phenomenon is a paroxysmal sleep-related disorder in which patients experience sleep paralysis and compound hallucinations. The symptoms of this phenomenon contain: sensed presence, fear, visual and auditory hallucinations, unusual body experiences such as out-of-body experience and feelings of floating/paralysis, experiencing a pressure on the thorax, difficulties breathing and a feeling of pain(1). This phenomenon appears to be universal, but has different cultural explanations(2). Objectives We present a case of possible incubus phenomenon to raise awareness about this specific condition. Methods A literature search in English was performed using PubMed with the following mesh term: ‘incubus phenomenon’. Results We present a 29-year old man, known with an intellectual disability (IQ=74), psychotic disorder and a cannabis use disorder. After neurological examination, he was diagnosed with narcolepsy and cataplexy. Over the past weeks there had been an increase of hallucinations that appear before, during or after sleep. The patient’s thoughts included sexual approaches by caregivers, difficulties in breathing and a moving sensation while laying down in bed and experiencing pressure on the thorax assuming a woman was sitting on his chest. Literature search shows a lifetime prevalence of 0.11 % in general population versus 0.41 % in psychiatric patients(2.) Conclusions Literature review shows only a few cases describing the incubus phenomenon. The prevalence is four times higher in patients with a psychiatric history(2) and should not be confused with psychotic disorder. Recognizing is important for proper treatment, as reoccurring attacks can be treated with anxiolytics, antidepressants, anticholinergics or anti-epileptics, and sleep hygiene methods(1.) Disclosure No significant relationships.