Read the Research: How to Make the Ghosts in My Bedroom Disappear
Review of - How to Make the Ghosts in my Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation for Sleep Paralysis
Welcome to Read the Research Fridays!
This week’s article review is a theory of sleep paralysis treatment from Baland Jalal of the Behavioural and Clinical Neuroscience Institute at the University of Cambridge. Jalal is an expert in sleep paralysis with an extensive publication history, and has been listed as one of the “15 Most Interesting People in Sleep.” A lot of his research uses a cultural approach to the understand and treatment of sleep paralysis, and the recommendations in this article also pull from that perspective.
Rather than a clinical study, this article presents a new concept for the direct treatment of sleep paralysis based on the author’s experience.
What is Direct Treatment, and Who is it For?
Sleep paralysis is a frightening parasomnia (sleep related disorder) in which people are mentally awake, but their body is still paralyzed in sleep. They often experience hallucinations that they can see, hear, and feel, with disturbing, sometimes violent content. A direct treatment, as defined in this article, is a treatment that’s meant to be used during the actual episode of sleep paralysis, rather than before or after as changes in sleep hygiene.
These recommendations are for people who experience Recurring Isolated Sleep Paralysis (RISP), defined as patients who meet the following criteria:
- It happens without a diagnosis of narcolepsy
- It happens 4 or more times per year
The article uses the panic-hallucination model of sleep paralysis, which assumes that RISP symptoms are caused by the brain misinterpreting the feelings of sleep as an outside force and overlaying hallucinations to justify what it feels. You can read more about the causes of sleep paralysis and why these specific themes appear in our article here.
What are Focused-Attention Meditation and Muscle Relaxation Therapy?
In this article, “focused attention mediation” is creating a positive image or mantra in the mind, then directing attention to it. Anytime the mind wanders, attention should be redirected back to this thought or image. Muscle relaxation therapy is allowing the muscles to be relaxed, with no attempts to move, flex or control breathing. These two techniques are to be used during an episode of sleep paralysis as follows:
Step 1: Reappraisal of the meaning of the attack – understand what sleep paralysis is and why it happens and think about the episode in those terms; it’s temporary, it’s harmless, it’s normal.
Step 2: Psychological and emotional distancing – fear and worry are unnecessary, there’s no real danger, and being worried will only make it worse
Step 3: Inward focused-attention meditation – focus on something positive (e.g. loved ones, or prayer if religious), engage with this positive thought emotionally, ignore the outside symptoms of sleep paralysis
Step 4: Muscle relaxation – avoid flexing muscles, trying to control breathing, and otherwise trying to fight the paralysis
It’s recommended that the person practice these steps when not in sleep paralysis to help the process become easy and automatic.
What Are the Possible Benefits of This Treatment?
The big focus here is to reduce the fear and anxiety associated with sleep paralysis. Rather than trying to fight with it, redirecting attention to a positive place and allowing the muscles to relax should lessen anxiety and reduce some of the feelings of pressure, letting the episode naturally pass. Since sleep paralysis isn’t inherently dangerous, alleviating the psychological distress should resolve most of the problem.
Study I: “Joe” is prone to sleep paralysis attacks, including visions of demons and a deceased friend. An initial use of meditation and muscle relaxation caused the visual hallucinations to abruptly disappear. After practice, Joe is no longer afraid of sleep paralysis because it feels like something harmless that he can control.
Study II: “Jonah,” who has PTSD, experiences RISP 3 to 5 times a week. Hallucinations include feelings of demonic possession, and his anxiety had become worse. Jonah initially struggled with using meditation and relaxation, but by the end of his 8-week course of treatment, his fear towards sleep paralysis had disappeared and he felt like a “white shield of energy” was protecting him during attacks. Knowing that other people experienced sleep paralysis made him feel connected and over treatment his symptoms of anxiety and PTSD became less pronounced.
Study Commentary and Criticism – CBT as an Alternative Treatment
One of the interesting consequences of this article actually comes from the authors of one of the cited books on sleep paralysis. In a commentary letter, Brian Sharpless and Karl Doghramji, authors of Sleep Paralysis: Historical, Psychological, and Medical Perspectives, argue that cognitive behavioral therapy (CBT) has also been successfully used, and MR isn’t the first direct treatment for sleep paralysis. Their book includes a manual on using CBT that outlines interrupting and preventing it, and Sharpless has published a study (that we’ll be covering next week) showing the benefits of disrupting sleep paralysis during an attack.
Jalal has responded to the commentary, arguing that muscle relaxation the first direct treatment because it’s a systematic guide that’s meant to be used during an episode of sleep paralysis, instead of improving thoughts and behavior around sleep. CBT, in his perspective, makes recommendations that can be used while asleep, but focuses on changing patterns while awake.
Whether or not you feel (or care) that MR or CBT is the first direct approach, this discussion highlights some important differences if you’re considering either of these treatments. Both have shown some success for sleep paralysis, but the delivery is different:
- Attention Mediation and MR – Used during an episode of sleep paralysis, with a focus on reframing the attack as safe and temporary, and changing emotions of fear to positive memories. The physical focus is on relaxing the muscles and avoiding the impulse to try and control breathing, struggle, or move.
- Cognitive Behavioral therapy – Used around episodes of sleep paralysis with a focus on prevention. It promotes changes in sleep hygiene, the person’s relationship to their feelings about sleep, self-monitoring (e.g. sleep diaries), and education about why the condition happens. When used during sleep paralysis, it encourages attempts to move and control breathing as a way to disrupt and distract from the episodes (there has been reported success in using this).
As of right now, there haven’t been any large-scale studies on which type of treatment works better, or why one might be better than the other for a specific person. There’s no reason they couldn’t both be used, and if one approach doesn’t work, the other is still a good alternative.
How to Make the Ghosts in my Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation (MR Therapy)—A Direct Treatment Intervention for Sleep Paralysis; Baland Jalal; Frontiers in Psychology; 29 January 2016 | https://doi.org/10.3389/fpsyg.2016.00028