Benign Sleep Phenomena

Primer

Benign Sleep Phenomena includes sleep paralysis, hypnagogic hallucinations, hypnopompic hallucinations, and hypnagogic jerks. In isolation, these occurrences are benign and not pathological.

Hypnagogic and Hypnopompic Hallucinations

Hypnagogic hallucinations are vivid perceptual experiences occurring at sleep onset at night, while hypnopompic hallucinations are similar experiences that occur at awakening in the morning.[1] These experiences own their own are not symptoms of a pathologic illness. However, the presence of other signs and symptoms such as cataplexy and sleep paralysis may be suggestive of narcolepsy.[2] Hypnopompic hallucinations may be a better indicator of narcolepsy than hypnagogic hallucinations.

Mnemonic

  • Hypnagogic hallucinations occur when the individual goes to sleep
  • Hypnopompic hallucinations occur when the person wakes up and gets pomped in the morning!
Epidemiology

The prevalence of hypnagogic and hypnopompic hallucinations in the general population is uncertain. However, it occurs in up to 30% of patients with narcolepsy.[3]

Sleep Paralysis

Sleep paralysis is a temporary inability to move or speak while waking up or falling asleep. It occurs when normal atonia (muscle paralysis) during rapid eye movement (REM) sleep perseverates into wakefulness. Episodes usually last for a few seconds or minutes. Sleep paralysis itself is not harmful, but can be very frightening for patients. In patients with sleep paralysis, a screen for other symptoms of narcolepsy should be done.

Treatment

Tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors can be used, and are thought to work via suppression of REM sleep. Clomipramine is the first line TCA, followed by imipramine.

Hypnagogic (Hypnic) Jerks

Hypnagogic (Hypnic) jerks (also known as sleep starts) are a sensation of “falling,” “shock,” or “falling into a void” accompanied by non-periodic myoclonic movements that usually involves isolated body segments.[4] They are associated with autonomic activation with transient tachycardia, tachypnea, and motor activity. The causes of hypnagogic jerks are unknown. Theories for their origins include descending volleys within the pyramidal tracts at the transition from wakefulness to sleep. Sleep starts are common physiological phenomenon affecting up to 70% of the adult population and their course is benign, resolving without any neurological sequel.

Resources

For Patients

For Providers

References

1) Ohayon, M. M., Priest, R. G., Caulet, M., & Guilleminault, C. (1996). Hypnagogic and hypnopompic hallucinations: pathological phenomena?. The British Journal of Psychiatry, 169(4), 459-467.
2) Ohayon, M. M., Priest, R. G., Caulet, M., & Guilleminault, C. (1996). Hypnagogic and hypnopompic hallucinations: pathological phenomena?. The British Journal of Psychiatry, 169(4), 459-467.
3) Ohayon, M. M., Priest, R. G., Caulet, M., & Guilleminault, C. (1996). Hypnagogic and hypnopompic hallucinations: pathological phenomena?. The British Journal of Psychiatry, 169(4), 459-467.
4) Vetrugno, R., & Montagna, P. (2011). Sleep-to-wake transition movement disorders. Sleep medicine, 12, S11-S16.