In this episode, producer Alicia Leong discusses the scientific and social conditions of sleep paralysis with neuroscientist Brian Sharpless. While the biomedical explanations of and for sleep paralysis may bring some comfort to a disorienting experience, there may be more questions in the deeper subjectivities manifested as nightmares. As Billie Eilish puts it, "When we all fall asleep, where do we go?"
ALICIA LEONG: This is Metastasis. I'm your host, Alicia, Leong.
Over the course of 2020, amid all the Clorox-ing and quarantining, boredom and paranoia, I'd been spending more time in bed. One of my closest friends had booked a one-way trip home to Singapore and other friends had already left for spring break.
We thought there'd be a second goodbye, but I never came. I felt completely alone.
That's when it happened.
DANYAL: A demon or the devil or a djinn, or like the angel of death or something was trying to take my friend away. I was like, trying to get up. As hard as I tried, I couldn't move.
CHER: I think I was saying “help me” in my dream, trying to wake myself up, and I couldn't.
EDDIE: I saw like my roommate come towards me and like caress my face. And of course she didn't actually do that. Like when I actually woke up, like, “what the fuck are you doing?”
BILAL: So Noam Chomsky is talking about foreign policy and I had like a vision of a scroll in front of me. There was this crazy pattern around it. I just heard a bunch of voices saying like, “help us, help us”. But you know, you're stuck.
AL: I saw a floating dark figure by my bed. No face, no hands. I remember the experience most distinctly as this weird mixture of panic and fascination. There's this shadow pressing down on my body and throat. I can't move, scream, get up or run away.
A few minutes later, I realized that what I was experiencing was most likely sleep paralysis. I was able to put a name to this terrifying seemingly supernatural experience. I derived a sense of comfort from this. What was fear turned into wonder. Why was I experiencing this? What's causing it?
BRIAN SHARPLESS: If you read the accounts, they call it from different names. But the core features seem to be there, which is either waking up or going to sleep, find yourself completely unable to move.
AL: That's Dr. Brian Sharpless, a clinical psychologist.
Brian Sharpless: But you know you're not asleep. You have conscious awareness. The only thing you can really move is your eyes. And sometimes people have them open. Sometimes they have them closed and they're just looking in with their lids closed. And you have some control over your respiration, but you cannot move. So it's not like you're just, have heavy limbs and you're tired. And if you look at a lot of the stories and the myths about these phenomena, there's usually a sense of pressure on the chest. And in fact, that's one of the most common symptoms.
AL: In our conversation, Dr. Sharpless shared his own personal experiences with sleep paralysis. This cluster of similar experiences is also called popobawa or kanashibari or nightmares or something else, depending on who you are, and where you are.
BRIAN SHARPLESS: And there wasn't much popular recognition of it as a disorder. So when I'd interview people, I was shocked at how many people said, oh my God, you mean, I'm not the only one that has this, other people get this too. That's why I think getting public attention through things like this are good for folks that might be struggling to understand what this is. Cause it's a very scary experience.
AL: You can even find sleep paralysis in pop culture today. There is a sleep demon in Chilling Adventures of Sabrina that feeds on the nightmares of her victims and ends up driving them to insanity.
I shall plunder their minds and orchestrate a symphony of nightmares.
And then … I will slaughter them!
BRIAN SHARPLESS: The good news is I think there've been like six horror movies that have come out the past five years on sleep paralysis. So it is getting out there and Billie Eilish and Kendall Jenner have both talked about having sleep paralysis.
AL: It turns out that Billie Eilish's “bury a friend” was inspired by her own experience of sleep paralysis and nightmare. Studies seem to show now that sleep paralysis is common, but not usually a detriment to people's lives.
BRIAN SHARPLESS: There's a diagnosis called recurrent isolated sleep paralysis. So this is where you actually have it to the extent that it causes you problems in your life. So either due to the frequency, the amount of distress it causes you, or maybe interfering with your life in other ways. But the majority of people that have sleep paralysis don't have it to that extent.
And for psychiatric patients more generally, about 32% of people have it at least once, but depending on the study, somewhere between 15 and 45% of those people have it to the extent that it's a problem.
AL: According to Dr. Sharpless, sleep paralysis is a predictable phenomenon with usual triggers like increased stress, sleep deprivation and irregular sleeping patterns. Other factors may include alcohol consumption before bed and sleeping on your back.
BRIAN SHARPLESS: Really, if you wanted to have sleep paralysis, I'll tell you what you should do. You should really screw with your sleep cycle. So don't go to bed the same time every night. Get a lot of bad insomnia, drink alcohol before bed, that’s another thing.
AL: Coincidentally, these night terrors occur most frequently among college students and individuals with mental health disorders. While 8% of the general population experiences sleep paralysis, it's much higher among students at 28%.
To study this, Sharpless has even induced some aspect of sleep paralysis in the lab.
BRIAN SHARPLESS: So if you hook someone up to a polysomnography, so that's a electroencephalogram, things like that. And you look for, when they're entering into REM sleep, then you poke them. You sort of nudge them awake. And what you might end up doing is creating one of these dissociated sleep states where you've got REM activity going on while the person is awake.
AL: This gets to the heart of the biomedical definition. We're using biomedical tools, such as EEG to explain a scary individualized experience. In my case, a blurry hooded figure squashing down on my throat. With these tools and techniques, we're trying to reduce my experience to the activation of certain neurons in my brain. Within this biomedical framework, you could interpret these nocturnal attacks as a dysfunction in sleep regulation. And I think in that moment, that biomedical understanding helped comfort me.
I could identify my cloaked intruder as a quote unquote sleep paralysis episode, which our professor Dr. Fischer-Baum had defined as a harmless neurological disturbance.
Initially, I truly believed that there was an unknown figure in my room trying to suffocate me. It all felt very real. But as I understood my subjective nocturnal attack experience according to this framework of sleep paralysis, I was able to just marvel over the whole situation, like an intrigued detached observer. The intruder wouldn't be able to touch me that way.
BRIAN SHARPLESS: So I think a lot of people had had this. They would be very reluctant to say it because they didn't want to be judged as crazy or weird. Because they weren't aware of what sleep paralysis was, they really didn't have a category to understand, well, what is this? How do I make sense of this?
AL: According to Dr. Sharpless, these nocturnal attacks are characterized by certain stereotyped features. People may interpret the encounters differently depending on the time and space they’re in. But the underlying neurophysiological causes of these night terrors seem universal.
BRIAN SHARPLESS: Some people that have it fear they're going crazy. Some people think that the paralysis might be permanent, that they might die. So there's a lot of, sort of different appraisals of the same phenomenon.
And there seems to be a trend to experience an attack of some sort. So, if you look at a lot of the mythology in Zanzibar, they would talk about being attacked by the popobawa, this giant black bat in the jungle that would attack you. In China, they call it ghost depression. So there's ghosts that gets on top of you.
If you look at um, southern Black culture in the US, they'll talk about the witch riding you, feeling like a witch is on top of you, oftentimes engaging in sexual activities with you. So I think the core features seem to be invariant. I haven't seen a culture that doesn't sort of describe them in that way, but different cultures interpret them and experience them and give different appraisals to these, these phenomena.
So if you live in say, 15th-century France, you might be more inclined to experience the hallucination as an incubus or a succubus.
AL: Dr. Sharpless also told me that there are possible ways to potentially treat or even prevent these encounters using cognitive behavioral therapy and selective serotonin re-uptake inhibitors.
BRIAN SHARPLESS: So you can actually prescribe people with sleep paralysis, low doses of SSRIs. GHB, which is also called sodium oxyb ate, has been used for years to treat narcolepsy. So sleep paralysis can occur in the context of narcolepsy quite a bit.
So I developed a treatment. Very brief, like five sessions, cognitive behavioral treatment for isolated sleep paralysis that I published in that book as a manual. Anytime you have a sleep disturbance, it makes other sleep disturbances more likely to occur.
And then there are some specific things that, um, in interviewing lots of sufferers, I asked them, well, are there things you do to prevent it? And there are things you do when you're having it to get out of it? And so I was able to calculate which were the most effective strategies, which were the most common strategies and things like that. And I use those pieces of information in developing the treatment.
AL: In my own experience with sleep paralysis, I'd found temporary comfort in the notion that my perception of the world was all in my brain. That the hooded figure was nothing more than the result of my busy neurons. I could tie my confrontation with the unexpected intruder to a straightforward explanation from biomedicine: that something was probably wrong with my sleep.
When I'd first started working with psychiatric patients, I drew from my neuroscience training and readily accepted the reductionist paradigm that mental suffering begins and ends in the materialist brain. In another episode, we see how nightmares, dreams and hallucinations offer alternative forms of reality that extend beyond our individual bodies seeping into our everyday lives to refashion our current worldviews.
AL: As Billie Eilish puts it, when we all fall asleep, where do we go?