Parasomnia: When sleep becomes the nightmare

Parasomnias are characterized by regularly occurring atypical behaviors, experiences and vocalizations. // Photo courtesy of Yuris Alhumaydy on Unsplash.

This story is part one in the Nightmare Series.

Most people expect to have a nightmare while they are asleep, but for some people, going to sleep is a nightmare.

We have all heard of dreaming, but there is a group of sleep disorders characterized by regularly occurring atypical behaviors, experiences and vocalizations, called parasomnias, which about 10% of Americans are affected by, according to Northwestern Medicine.

Brian A. Sharpless, a United States-based licensed clinical psychologist and visiting research fellow at Goldsmiths, University of London, has an interest in working with people who suffer from rare sleep disorders.

“Some of the things I study are not only interesting because they impact people, but also because they're connected with broader mythological beliefs, folklore and things like that,” Sharpless said.

Sleep Paralysis

Sharpless co-authored and published his first book in 2015 titled, “Sleep Paralysis: Historical Psychological and Medical Perspectives.” Sleep paralysis, according to Sharpless, is common as an experience, but not as a disorder, with about 8% of the general population experiencing it once or twice in their lifetimes. Students and psychiatric patients experience higher rates of sleep paralysis, with about 28% of students and 32% of psychiatric patients.

“The Nightmare” is an eighteenth century oil painting by Swiss artist Henry Fuseli. In the painting, a demonic incubus sits on a woman’s chest as she sleeps. // Photo courtesy of Henry Fuseli.

“Sleep paralysis is interesting because the core features of this phenomenon are invariant. You wake up and you can't move, but you have conscious awareness and your eyes can move. Most people experience hallucinations during it, and most of the time, these are very scary,” Sharpless said. “You're being attacked by something malevolent, so depending on the culture and the time and place you're at, you might see different things. In 21st century America, when you're dealing with college students, they're seeing shadow people or ghosts. If you go back to 14th century France, they might see an Incubus or Succubus.”

Sleep paralysis, as well as other sleep disorders grouped as parasomnias, may be caused in part by stress, but experts believe they are due to inconsistent sleep schedules, which explains why students and psychiatric patients experience them more often, according to Sharpless.

In 2015, Sharpless traveled to the U.S. after giving a talk on sleep paralysis at a university in England. He watched a documentary about sleep paralysis called “The Nightmare,” directed by Rodney Ascher. That night, various factors disrupted his sleep schedule. He was extremely jet lagged, he drank red wine before bed, ate a heavy meal and went to sleep earlier than usual.

“I woke up and everything was normal at first. It was very dark in my bedroom. Then all of a sudden, the door that was to the left of me slowly started opening and light started filtering in from the hallway to the point I could see the painting that was in front of my bed. Then I see a black figure that looks like someone wearing a full ninja mask with glowing red eyes,” Sharpless said. “I realized I couldn't move. Then this face starts inching closer and closer. I noticed that all I'm seeing is a neck and there's no body.”

The next morning, he told his girlfriend that he experienced sleep paralysis for the first time. Shockingly, she experienced it the same night as him; however, she didn’t have a hallucination.

“There have been people that have speculated going back to ancient Roman times that it's a contagious thing,” Sharpless said. “I haven't studied the contagious element empirically, but when I've shown films on sleep paralysis to students, inevitably, what will happen is a couple of them, at least, will come to me the next time I see them, and then tell me they had it that night. So I think there might be some element of that.”

Victoria Thompson, a licensed esthetician and makeup artist at Victoria Thompson Makeup Artistry, from Pennsylvania, experienced sleepwalking, sleep talking and sleep paralysis throughout her life. When Thompson was younger, her mother would find her in the morning sleeping under tables in the living room, dining room and other bizarre locations around the house. She outgrew that as a teenager, but she began experiencing an intense parasomnia that caused her immense fear.

As Thompson was on the precipice of sleep, she saw a dark figure with a head, arms, torso and red glowing eyes, whom she nicknamed Malikai, in the corner of her bedroom towards the ceiling.

“Malikai will kind of float or manifest to my bed either standing on me or my chest with extreme pressure on my chest. My mind will fight sometimes, but my body is not capable of moving at the time. He is essentially suffocating me,” Thompson said. “That fight or flight instinct kicks in, and you're just in survival mode, while you're in your room, in your bed, supposedly safe and trying to fall asleep, and it’s terrifying.”

Thompson does not consider herself to be a religious person; however, she is a spiritual person who believes there are powers and entities stronger than our human physical forms. The last time she saw Malikai was two years ago after having her house cleansed and blessed.

“My next sleep paralysis incident after that, Malikai did look very weak, disfigured and deformed,” Thompson said. “His eyes, though, were still red, but were very pinpoint minuscule, so I guess the cleansing and blessing kind of injured him. I haven’t seen him since.”

Exploding Head Syndrome

Over a year ago, Thompson encountered another parasomnia. She took to Facebook in July seeking advice after her exploding head syndrome episodes worsened.

Victoria Thompson, a licensed esthetician and makeup artist at Victoria Thompson Makeup Artistry, seeks advice for her parasomnias on Facebook. // Screenshot by Megan Naftali.

With exploding head syndrome, you hear a massively loud noise or feel a sense of explosion in your head while you're transitioning to or from sleep, according to Sharpless.

Thompson has heard a cacophony of construction sounds, car crashes, explosions and electrical sounds, among others. She began having episodes about five nights a week after starting an esthetics program at a beauty college, where she attends school for four and a half hours Monday through Thursday evenings and all day on Saturday.

“Sleep disturbances such as stress, anxiety and all those things, might make it more likely that you don't go through the neat processes that you normally go through, but you get this thing that can be a real problem,” Sharpless said. “I've personally worked with people who have that five times every night, where they're hearing explosions, and they essentially feel like there was a terrorist event right outside their bedroom.”

Sharpless claims there are about five different theories as to why exploding head syndrome occurs.

“The one that makes the most sense to me is that as your brain is going to sleep, it goes through a series of processes where you inhibit groups of neurons. Normally, you inhibit your motor neurons and your auditory neurons,” Sharpless said. “What we think happens here is there's a part of your brain called the reticular formation, which is part of your brainstem, and instead of shutting it down, for some reason, it makes them fire all at once, causing loud noises.”

REM Sleep Behavior Disorder (RBD)

Sleep paralysis and exploding head syndrome are benign, but some parasomnias can be detrimental to a person’s health.

During rapid eye movement (REM) sleep, the body is typically paralyzed while in a dream state. With REM sleep behavior disorder, the body does not enter a state of paralysis and instead, a person enacts their dreams while they are asleep.

RBD could have significant risks because dreams during an episode are typically violent, causing a person to aggressively punch, kick or move in their sleep, according to Sharpless.

“There are documented cases of people physically harming their bed partner while they're asleep, not intentionally, but because they think they're being attacked,” Sharpless said. “I believe there's even a case where somebody killed their bed partner while undergoing RBD.”

Larry Gifford, the president and co-founder of PD Avengers, an initiative dedicated to ending Parkinson’s disease, was diagnosed with PD when he was 45 years old. Around the same time, he began exhibiting symptoms of RBD.

In certain cases, RBD can serve as a precursor to a neurodegenerative condition later on in life, according to Sharpless, people who eventually get PD and MS later in life will sometimes have it as an early warning sign or symptom.

For Gifford, RBD started as mumbling and slight movement in his sleep. However, it has progressed to the point where he will act out his dreams violently enabling him to fall out of bed, scream at the top of his lungs, attack the nightstand or almost hurt his wife, Rebecca. To avoid harming her, they now sleep in separate bedrooms.

“It's hard, especially because our 14-year-old doesn't understand what's going on. ‘Why is dad yelling in the middle of the night?’ It’s so difficult,” Gifford said. “And of course, there's the intimacy with my wife, and just being in the same room would be nice.”

Larry Gifford, the president and co-founder of PD Avengers, shares a photo of his RBD inflicted wounds on Facebook. // Screenshot by Megan Naftali.

Over the summer Gifford and his wife were in Barcelona to attend the World Parkinson Congress, where he gave a speech. They had hoped to get a hotel room with two beds but were only given one. He slept on the far right side of the bed out of fear of hurting her, so he ended up attacking the nightstand in the middle of the night and developed cuts and bruises on his face before his speech.

“We try to keep soft things around and keep my bed low to the ground, but when you're in a hotel, you can't really control those things,” Gifford said. “I've rolled off into dressers and nightstands, we've woken up where my elbow is in my wife's back, and she's woken up with my fists hanging over her face. Luckily, I've never hurt her. I have not had a serious injury, but I know people who've broken bones because of that.”

Sharpless urges people not to fear having a rare sleep disorder.

Parasomnias “might seem strange or unusual, but there are folks out there who experience these things sometimes regularly,” Sharpless said. “If you're concerned about it, all of the things that I've talked about, there are treatment options available. You might have to do a little digging to find somebody, but don't give up hope.”