The Connection Between REM Sleep and Periodic Paralysis

Understanding the Connection Between REM Sleep and Periodic Paralysis

Periodic Paralysis (PP) is a rare genetic disorder characterized by episodes of muscle weakness or paralysis. Recent discoveries have highlighted a potential connection between the REM (Rapid Eye Movement) phase of sleep and the episodes experienced by those with PP. This new insight could help explain why individuals with PP often wake up paralyzed or experience muscle weakness in the morning.

The Role of REM Sleep in Muscle Paralysis

During REM sleep, our bodies undergo a process called atonia, where most muscles become temporarily paralyzed. This natural mechanism prevents us from acting out our dreams and potentially injuring ourselves. However, for individuals with PP, this temporary paralysis can be problematic.

Key Points About REM Sleep:

1. Muscle Atonia: During REM sleep, signals are sent to the spinal cord to inhibit movement, causing temporary paralysis in the arms and legs​ (Neurology live)​​ (Paving My Path)​​ (Oxford Academic)​.
2. Brain Activity: The brain's cerebral cortex remains active, facilitating learning, thinking, and organizing information during REM sleep​ (Paving My Path)​​ (Oxford Academic)​.
3. Sleep Cycles: A typical night involves four to five sleep cycles, with increasing amounts of time spent in REM sleep as the night progresses​ (Oxford Academic)​.

The Connection to Periodic Paralysis

Individuals with PP may experience difficulty transitioning out of the natural muscle paralysis of REM sleep. While most people wake up without issue, those with PP may wake up paralyzed or experience residual muscle weakness. This phenomenon can occur multiple times throughout the night, potentially contributing to the development of Permanent Muscle Weakness (PMW).

Hypothesis:

• Nightly Episodes: For individuals with PP, the temporary paralysis during REM sleep may not fully resolve upon waking. This could lead to unnoticed nightly episodes of muscle weakness or paralysis.
• Cumulative Damage: Each episode of paralysis can cause damage to muscles and connective tissues, leading to PMW over time.

Managing Periodic Paralysis

Understanding the link between REM sleep and PP can help individuals better manage their condition. Here are some strategies:

1. Sleep Hygiene:
• Maintain a regular sleep schedule to ensure consistent sleep patterns.
• Create a relaxing bedtime routine to improve sleep quality.
2. Diet and Nutrition:
• For Hypokalemic PP: Ensure adequate intake of potassium-rich foods (e.g., bananas, oranges, potatoes).
• For Hyperkalemic PP: Avoid high-potassium foods and focus on a balanced diet that helps regulate potassium levels.
3. Hydration:
• Stay hydrated with water and homemade electrolyte solutions.
4. Monitoring:
• Keep a sleep journal to track episodes and identify patterns.
• Regularly consult with healthcare providers familiar with PP to adjust management plans as needed.

Conclusion

The discovery of the link between REM sleep paralysis and Periodic Paralysis provides valuable insight into why individuals with PP may wake up paralyzed or experience muscle weakness. By understanding and addressing this connection, individuals can better manage their symptoms and potentially reduce the risk of developing Permanent Muscle Weakness.

References

1. Sleep Foundation. How Sleep Works. Available at: Sleep Foundation
2. Sleep Foundation. Stages of Sleep: REM Sleep. Available at: Sleep Foundation
3. National Institute of Child Health and Human Development. What Happens During Sleep? Available at: NICHD
4. Johns Hopkins Medicine. The Science of Sleep: Understanding What Happens When You Sleep. Available at: Johns Hopkins Medicine
5. Neurology Live. Insider Tips on Periodic Paralysis: Issues in Developing a Comprehensive Treatment Plan. Available at: Neurology Live
   
   Image: A woman with PP in REM sleep

 
More information from a previous PPN article:

Hello All,

Last Monday our ‘Weekly Question' was related to going into paralysis at night as we sleep. I have written about this several times over the years, but my research never led me to something I discovered recently and need to pass along to you.

When all humans go into the REM (rapid eye movement) phase of sleep our muscles become paralyzed!! I found this amazing!! It also gave me a possible answer as to why those of us with PP wake up either paralyzed or coming out of paralysis each morning. Normal people are equipped to come out of it without an issue, but we who have muscle issues, do not seem to come out of it as others can. This happens 4 or 5 times a night.

It may also explain why many of us develop Permanent Muscle Weakness (PMW) even if we do not seem to have episodes during the day or very often. It is happening at night, every night, without our knowledge. Each episode of paralysis for us does an amount of damage to the muscles and connective tissues, thus setting us up for PMW.

“Muscles gradually relax during each stage of non-REM sleep, and the body’s total energy expenditure drops5. During the REM stage, most muscles are paralyzed in a condition known as atonia. This keeps the legs and arms from flailing in response to dream content. Respiratory and eye muscles stay active, though, and the darting of the eyes behind closed eyelids is the inspiration for the name rapid eye movement sleep.”

https://www.sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep#:

“During REM sleep, much of your body operates similarly to how it does when you’re awake, except your eyes are closed and you experience a temporary loss of muscle tone. Researchers have hypothesized that this is a protective measure, meant to stop you from acting out your dreams and injuring yourself. However, now that scientists know we can experience dreams during non-REM sleep stages when our bodies are not paralyzed, this hypothesis is losing steam”
.https://www.sleepfoundation.org/stages-of-sleep/rem-sleep#

“REM sleep begins in response to signals sent to and from different regions of the brain. Signals are sent to the brain’s cerebral cortex, which is responsible for learning, thinking, and organizing information. Signals are also sent to the spinal cord to shut off movement, creating a temporary inability to move the muscles (“paralysis”) in the arms and legs. If this temporary paralysis is disrupted, people might move while they are dreaming (“sleepwalking”). A person who sleepwalks is at risk for injury.5”
https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/what-happens

“As you cycle into REM sleep, the eyes move rapidly behind closed lids, and brain waves are similar to those during wakefulness. Breath rate increases and the body becomes temporarily paralyzed as we dream.

The cycle then repeats itself, but with each cycle you spend less time in the deeper stages three and four of sleep and more time in REM sleep. On a typical night, you’ll cycle through four or five times.”
https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-science-of-sleep-understanding-what-happens-when-you-sleep