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Sleep Paralysis: A Brief Overview of the Intersections of Neurophysiology and Culture

Cyle Johnson

American Journal of Psychiatry Residents Journal June 7, 2023 DOI: 10.1176/appi.ajp-rj.2023.180401 (opens in new tab)

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Key findings Sleep paralysis arises when rapid eye movement sleep muscle atonia extends into wakefulness, and its neurophysiology involves the gamma-aminobutyric acid, glycine, orexin, and serotonin systems. The authors argue that despite this universal basis, subjective experiences vary widely across cultures, and they advise clinicians to distinguish it from other neurological and psychiatric conditions and to weigh cultural factors in neuropsychiatric assessment.

Abstract

Sleep paralysis is a parasomnia that occurs when the muscle atonia of rapid eye movement sleep extends into wakefulness and can be accompanied by intense fear and hallucinations. The primary neurophysiological processes that lead to sleep paralysis are well known and include alterations in the gamma-aminobutyric acid, glycine, orexin, and serotonin systems. Despite a universal neurophysiological basis, there is large variability in subjective experiences across cultures. Clinicians should distinguish sleep paralysis from other neurological and psychiatric conditions and consider the implications of a condition when assessing cultural factors in neuropsychiatric conditions.

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