Sleep paralysis in narcolepsy: more than just a motor dissociative phenomenon?
Michele Terzaghi, Pietro Luca Ratti, Francesco Manni, Raffaele Manni
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology February 2012 DOI: 10.1007/s10072-011-0644-y (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 59-year-old man with narcolepsy experiencing sleep paralysis |
| Key findings | The patient failed to distinguish real from dream mentation during sleep paralysis, and EEG analyses indicated an intermediate state between wake and REM sleep. The authors propose that local REM-related impairment in cortical circuits for self-awareness, conflicting with wake-like activation elsewhere, underlies this disrupted boundary perception. |
Abstract
Sleep paralyses are viewed as pure motor phenomena featured by a dissociated state in which REM-related muscle atonia coexists with a wakefulness state of full consciousness. We present a 59-year-old man diagnosed with narcolepsy experiencing sleep paralysis, who failed to establish the boundaries between real experience and dream mentation during the paralysis: the patient's recall was indeed featured by uncertainty between real/unreal and awaken/dreaming. Hereby, we suggest that sleep paralysis may represent a more complex condition encompassing a dissociated state of mind together with the dissociative motor component. Neurophysiological data (spectral EEG analysis corroborated by cross-correlation analysis) reinforce the idea that the patient was in an intermediate state of mind between wake and REM sleep during the paralysis. The persistence of local impaired activity proper of REM sleep in cortical circuits necessary for self-reflective awareness and insight, in conflict with wakefulness-related activation of the remaining brain areas, could account for disrupted processing of afferent inputs in our patient, representing the underlying pathophysiologic substrate for patient's failure to establish the boundaries between real experience and dream mentation.