EpistemisSleep paralysis
Specialty: Neurology.
Why it occurs
- Narcolepsy type 1 and type 2 (hypocretin/orexin dysfunction in the lateral hypothalamus)
- Chronic sleep deprivation or irregular circadian rhythms (night workers, recurrent jet lag)
- Generalized anxiety disorder and post-traumatic stress disorder
- Recurrent isolated sleep paralysis (benign idiopathic form, often familial)
- Consumption or abrupt withdrawal of alcohol or sedative CNS depressant substances
Initial workup
Complete nocturnal polysomnography followed the next day by a Multiple Sleep Latency Test (TLMS) to demonstrate sleep latencies of less than 8 minutes and the presence of multiple periods of rapid eye movement sleep (SOREMPs); determination of hypocretin-1 levels in cerebrospinal fluid.
red flags
Frequent sleep paralysis associated with extreme uncontrollable daytime sleepiness that causes traffic or work accidents, or associated with sudden falls caused by emotions (cataplexy), confirming the diagnosis of narcolepsy.
Standard management
- Sodium oxybate — 4.5-9 g/night divided into two doses, excellent for consolidating sleep and reducing paralysis and cataplexy
- Antidepressants that inhibit serotonin and norepinephrine reuptake such as Venlafaxine — 75-150 mg/day) or tricyclics such as Clomipramine (25-75 mg/day, powerful suppressors of REM sleep
- Modafinil (100-400 mg/day) or Solriamfetol for daytime sleepiness.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3