‘I’ve been abducted by aliens’

Ms. S reported no daytime sleep attacks, cataplexy, or rapid onset of dreaming. Because her reported AAEs were spread out and the last occurred approximately 5 years ago, I decided against conducting a sleep study because it likely would be low yield and costly. I reached a diagnosis of sleep paralysis-familial type, chronic based on:

• an absence of organic or psychiatric dysfunction
  
• a familial pattern of sleep disturbances
  
• the temporal pattern and description of her symptoms (Table 2).¹¹
  

All of Ms. S’s episodes occurred at night or times of quiet restfulness. She usually slept on her back, which may be a risk factor for sleep paralysis.¹²

Table 2

Diagnostic criteria for sleep paralysis

A. Patient complains of inability to move the trunk or limbs at sleep onset or upon awakening
B. Brief episodes of partial or complete skeletal muscle paralysis
C. Episodes can be associated with hypnagogic (preceding sleep) hallucinations or dreamlike mentation
D. Polysomnographic monitoring demonstrates at least 1 of the following: Suppression of skeletal muscle tone A sleep-onset REM period Dissociated REM sleep
E. Symptoms are not associated with other medical or mental disorders, such as hysteria or hypokalemic paralysis
Minimal criteria are A plus B plus E
Note: If symptoms are associated with a familial history, the diagnosis is sleep paralysis-familial type. If symptoms are not associated with a familial history, the diagnosis is sleep paralysis-isolated type
Severity criteria Mild: Moderate: >1 episode per month but Severe: ≥1 episode per week
Duration criteria Acute: ≤1 month Subacute: >1 month but Chronic: ≥6 months
REM: rapid eye movement
Source: Reference 11

TREATMENT: Reassurance, therapy

Effective treatment for Ms. S required helping her to understand that an organic condition was the foundation of her experiences. I began by conveying the sleep paralysis diagnosis and my understanding of the occupational and personal consequences that this condition had had for her. I explained the physiology of sleep paralysis and that memories or hallucinations (dreamlike mentation) are preserved in an extremely vivid fashion because her eyes are open. I acknowledged the realistic character of her experiences and the resulting symptoms of posttraumatic stress disorder (PTSD).

I refer Ms. S to a therapist for psychotherapy. The therapist begins by using trauma informed techniques to address Ms. S’s PTSD. As she improves, her therapy evolves into a combination of narrative and supportive psychotherapy, and then family systems therapy to address issues with her daughter and mother.

In a follow-up visit 1 year after beginning treatment, Ms. S cites multiple improvements, with no recurrence of sleep paralysis episodes. She continues to take sertraline, which relieves her depression and anxiety, and methylphenidate to improve her attention and concentration. She has taken on more responsibility at home, cleaning, preparing meals, helping her daughter choose a college, and attending to her mother’s health issues. Ms. S still has difficulties with her sleep patterns, and her new psychiatrist is exploring the possibility of a bipolar component to her mood disorder.

The authors’ observations

Like other traumas, AAE can induce symptoms of acute or chronic PTSD. The various psychoses, personality disorders, and dissociative disorders that could account for abduction experiences are characterized by delusions, so conduct ongoing assessment for these conditions in patients who report AAE. However, evidence suggests that serious psychopathology is no more common among “abductees” than among the general population.¹²

Persons reporting AAE exhibit physiologic reactivity as profound as that of survivors of combat or sexual assault.¹³ This reactivity confirms that the emotional power of the memory is as evocative and problematic as the physiologic reactions attributable to genuine (documented) traumatic events. Because patients have difficulty differentiating these hallucinations from actual events, they experience emotional pain and suffering. Fifty-seven percent of sleep paralysis patients who report AAE attempt suicide.¹⁴

Offer patients with AAE psychotherapy to deal with long-term effects of trauma and problems with mood, sleep, daily functioning, and/or relationships.

There are no FDA-approved medications for treating sleep paralysis. Pharmacotherapy can be used to address psychiatric symptoms such as the depression and anxiety Ms. S exhibited.

Related resources

• American Academy of Sleep Medicine. International classification of sleep disorders, revised: diagnostic and coding manual. Chicago, IL: American Academy of Sleep Medicine; 2001:166-9.
  
• Cheyne JA. Sleep paralysis and associated hypnagogic and hypnopompic experiences. https://watarts.uwaterloo.ca/~acheyne/S_P.html.
  

Drug brand names

• Methylphenidate • Ritalin
  
• Quetiapine • Seroquel
  
• Sertraline • Zoloft