A Case of Recurrent Sleep Paralysis: Beyond Narcolepsy

Case Report

Austin J Clin Neurol 2014;1(3): 1015.

A Case of Recurrent Sleep Paralysis: Beyond Narcolepsy

Vijaya Yelisetty and Kanika Bagai*

Department of Neurology, Vanderbilt University School of Medicine, Tennessee, USA

*Corresponding author: Kanika Bagai, Department of Neurology, Vanderbilt Sleep Disorders Center, Vanderbilt University School of Medicine, A- 0118 Medical Center North, Nashville, TN 37232, Tennessee, USA

Received: June 20, 2014; Accepted: August 20, 2014; Published: August 22, 2014


Isolated episodes of sleep paralysis can occur in healthy people at least once in their lifetime; however recurrent isolated sleep paralysis (RISP) events are less common and often worrisome. Recurrent episodes of sleep paralysis are often seen in patients with narcolepsy. Here, we present a unique case of a middle-aged woman who presents with symptoms of RISP in her fifth decade that was not associated with narcolepsy.


We describe a case of a 52-year-old woman who presents with initial symptoms of recurrent isolated sleep paralysis.

Case Presentation

A 52 year-old woman presented to the sleep clinic with complaints of sleep difficulties and symptoms of “unable to move her body while in bed”. These episodes of isolated sleep paralysis (ISP) occurred randomly either at sleep onset, or upon awakening in the morning. These events lasted for a few minutes, were often frightening and resolved spontaneously. These were not associated with vivid dreams and occurred randomly with a frequency of twice per month over the last year. She had experienced similar symptoms of sleep paralysis on rare occasions in the remote past, but reported worsening in the frequency recently. Furthermore, she reported similar episodes of inability to move her body after awakening from occasional daytime naps on weekends.

Upon further questioning on the details of sleep history, she noted symptoms of multiple nighttime awakenings, loud snoring and daytime fatigue. She reported an irregular sleep schedule with varying bedtimes on weekdays and weekends and was getting only 4-5 hours of sleep. She was fatigued all day and took naps during the day occasionally on weekends. Her Epworth sleepiness scale (ESS) was 6/24. She denied symptoms of cataplexy, hypnic hallucinations or automatic behaviors. She exhibited mild restless leg symptoms but they did not disrupt her sleep.

Past medical history was significant for diabetes, hypertension, hyperlipidemia, generalized anxiety disorder, and asthma. There was no family history of narcolepsy or similar symptoms of sleep paralysis.

Social history was negative for smoking, alcohol use or any illicit drug use.

Medications included albuterol, fluticasone-salmeterol inhaler, olmesartan, montelukast, metformin, sitagliptin, glyburide, omeprazole and cetirizine.

On physical exam, vital signs were stable. She had a crowded oropharynx (Friedman palate position 3); otherwise remainder of the physical exam was within normal limits.

Laboratory data including complete blood count, complete metabolic panel, TSH, Vit B12, Vit D levels were within normal limits as below:

Complete blood count: WBC: 5.7k/ul; Hemoglobin 12.6 gm/dl, hematocrit 37%, platelets count 258k/ul.

Chemistries: Sodium 141 mmol/l, potassium 4.1 mmol/l, chloride 107 mmol/l, bicarbonate 25 mmol/l, glucose 213 mg/dl, BUN 19 mg/ dl, creatinine 0.9 mg/dl, Calcium 9.3 mg/dl, total protein 7.4 gm/dl, albumin 4.1 gm/dl, total bilirubin 0.6 mg/dl, alkaline phosphatase 68 intU/l, ALT 23 intU/l, AST 26 intU/l.

Endocrine data: TSH: 1.03 mcU/ml, Free T4: 0.87 ng/dl, 25-hydroxy Vit D: 27 ng/ml, Vitamin B 12: 249 pg/ml.

We counseled patient on sleep hygiene, including not varying bedtime on weekends and weekdays and getting at least 7-8 hours of sleep at night. Her symptoms of recurrent isolated sleep paralysis (RISP) persisted despite improvement in her sleep hygiene and increasing the total sleep time. We ordered an overnight polysomnogram (PSG) followed by next day multiple sleep latency test (MSLT) to evaluate her symptoms. The PSG results are summarized in Table 1.

Citation: Yelisetty V and Bagai K. A Case of Recurrent Sleep Paralysis: Beyond Narcolepsy. Austin J Clin Neurol 2014;1(3): 1015. ISSN : 2381-9154