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Narcolepsy pp 81–93Cite as

Hypnagogic Hallucinations and Sleep Paralysis

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Abstract

Hypnagogic hallucinations and sleep paralysis are two associated features of narcolepsy that can also be found as isolated phenomena or within the context of other clinical conditions. Hypnagogic hallucinations are abnormal sensory perceptions experienced in the transition between wakefulness and sleep, whereas analogous hallucinations that occur upon awakening are called hypnopompic. Sleep paralysis is a transient paralysis of skeletal muscles associated with a clear waking mentation occurring in sleep/wake transitions. The two phenomena often occur together in narcoleptic subjects, provoking significant fear responses, especially when first experienced, because of the threatening and often terrifying content of the hallucinations and the impotence associated with the inability to move.

Though underlying neurobiological mechanisms are still partly unknown, hypnagogic hallucinations and sleep paralysis are usually considered dissociated manifestations of REM sleep, with the former described as dreamlike intrusions into waking cognition and the latter considered to be the persistence of typical REM muscle atonia into wakefulness. Experimental evidence seems to point to the sleep-onset REM period typically found in narcoleptic subjects as a neurophysiological substrate for these phenomena; sleep paralysis has also been found to occur upon awakening during offset REM, confirming the hypothesis of an underlying dissociation of the REM stage in the transition between wakefulness and sleep. Though adequately structured clinical trials evaluating the efficacy of medications for hypnagogic hallucinations and sleep paralysis are lacking, sodium oxybate and antidepressants such as clomipramine, venlafaxine or SSRIs are commonly used to alleviate the significant distress caused by these symptoms in narcoleptic subjects.

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Authors and Affiliations

  1. Department of Health Sciences, Università degli Studi di Milano, Milan, Italy

    Armando D’Agostino MD

  2. Department of Mental Health, San Paolo Hospital, Milan, Italy

    Ivan Limosani MD

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  1. Armando D’Agostino MD
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  2. Ivan Limosani MD
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Correspondence to Armando D’Agostino MD .

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Editors and Affiliations

  1. Montefiore Medical Center Narcolepsy Institute, Bronx, New York, USA

    Meeta Goswami

  2. Montefiore Hospital Sleep-Wake Disorders Center, Bronx, New York, USA

    Michael J. Thorpy

  3. Somnogen Canada Inc, President and Chief Executive Officer, Toronto, Ontario, Canada

    S.R. Pandi-Perumal

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D’Agostino, A., Limosani, I. (2016). Hypnagogic Hallucinations and Sleep Paralysis. In: Goswami, M., Thorpy, M., Pandi-Perumal, S. (eds) Narcolepsy. Springer, Cham. https://doi.org/10.1007/978-3-319-23739-8_8

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