DR Medhat MRCP

Sleep disorders
1. Sleep paralysis
- Sleep paralysis is a common condition characterized by transient paralysis of skeletal
muscles which occurs when awakening from sleep or less often while falling asleep.
- It is thought to be related to the paralysis that occurs as a natural part of REM (rapid
eye movement) sleep.
- Sleep paralysis is recognised in a wide variety of cultures
• Features
Paralysis : this occurs after waking up or shortly before falling asleep
Hallucinations : images or speaking that appear during the paralysis
• Management
Clonazepam may be used if troublesome .
2. Narcolepsy
- A disorder characterized by increased daytime sleepiness & abnormalities of REM
sleep for a period of > 3 months.
- REM sleep occurs in < 10 minutes & the patient feels refreshed upon awaking.
• Physical & psychiatric features :
Sleep attacks : most common symptom.
Cataplexy : pathognomonic sign , sudden loss of muscle tone precipitated by loud
noise or intense emotion ( e.g laughing) .
Hallucination when the patient is going to sleep (= hypnagogic) & when he is
waking from sleep (= hypnopompic).
Sleep paralysis : see before.
• Treatment :
Forced naps at regular times of day : TTT of choice.
Psychostimmulants.
Antidepressants : if cataplexy .
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