96018921 journal-analysis-print

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Journal Analysis

“Sleep Paralysis”

Submitted for the fulfillment English II Subject

Instructor:



http://www.homeworkping.com/





By:

Perkasa Pradipta P 22020110120003

Nurul Hidayati 22020110120061

Pilot Project of International Class (A.10.3)

SCHOOL OF NURSING

FACULTY OF MEDICINE

DIPONEGORO UNIVERSITY

2012

1. Title

Sleep paralysis in narcolepsy: more than just a motor dissociative phenomenon?

2. Researcher

Michele Terzaghi • Pietro Luca Ratti • Francesco Manni • Raffaele Manni

3. Publication

Received: 6 May 2011 / Accepted: 23 May 2011 / Published online: 7 June 2011_ Springer-

Verlag 2011

4. Abstract

Initially, Sleep Paralysis (SP) is only considered a pure motor phenomenon is shown by

the current state of REM held in conjunction with muscle atonia. Presented a 59-year-old man

diagnosed with narcolepsy who experience SP, where he cannot even be difficult to establish

the boundary between he was dreaming or not. Patients can clearly remember what happened

except that he is difficult to distinguish what is real or not. Based on these explanations, the

SP in patients with narcolepsy are more complex conditions of the separation of mind and

dissociative motor components. Neurophysiological data (EEG spectral analysis is reinforced

with cross correction) reinforces the idea that the patient is in a state between waking and

REM phases during SP. The persistence of local disturbances in REM in cortical circuits

required for the reflection of consciousness, waking-related activity contrary to the remaining

regions of the brain, may explain the presence of afferent disorders in these patients. It

represents the underlying pathophysiology difficult patients to distinguish between thoughts

and dreams of real experience.

5. Preliminary/Background

Sleep paralyses is a conscious state where mobility is not functioning due to a sudden

waking from REM sleep time (1, 2). A dysfunctional that occurs when REM and

consciousness (awake) is considered to cause damage to the limit in both regions. With the

persistence of REM, he can not perform movements such as the brain awake while enabling.

(3)

In the journal report about the case of SP in patients with narcolepsy. A clinical and

electrophysiological finding suggests a separation of mind and matter in motor.

6. Methode

Researchers using qualitative research methods where the researcher is the one who collecting

all the data. Researchers used a 59-year-old male client with narcolepsy. During the research,

clients were asked to use the EEG to record brain activity during the research period, the

client also asked to respond to what was happening to him and answer questions which asked

by researcher.

7. Result

No symptoms of depression or psychiatric disorders emerge during the clinical interview,

neurological examination and brain, NMR is unremarkable. Results are shown when the

patients had SP, the patient is able to provide pertinent information about himself. He could

not move his limbs and bilateral myosis presented, and the slow and slurred speech with an

inability protrude the tongue. After recovery (17 minutes later), the patient reported his

experience that he can not move and speak fluently as he experienced during SP. Although

the patient to remember the details of conversations that he had had with the neurologist, he

was not sure if the dialogue is actually happening or not. He simply concluded that, if the

neurologist said that the conversation never happened, he would conclude that he was only

dreaming and conversation did not really happen.

EEG-polysomnographic findings

Visual analysis for SOREMP before sleep paralysis showed a typical pattern of REM sleep.

During sleep paralysis is the pattern displayed by the mixed alpha frequency and irregularly

alternating with low voltage fast activity of EEG. Bursts of continuous REMS and submental

EMG pattern characterized by muscle atonia together with the incidence of losing the atonia.

(Figure 1)

Fig. 1 Paralysis episode: 30-s EEG epoch. EOGL left electro-oculogram, EOGR right electro-

oculogram, MILO ? MILO - chin EMG

8. Discussion

Sleep paralysis considered a pure motor phenomenon is shown by the separation of

REM-related muscle atonia that coexists with a state of full wakefulness and awareness.

Patients generally showed an awareness of the environment during these circumstances and

more patients are able to give a sincere statement about events that occurred during these

circumstances.

The advice from researchers is the paralysis represents a more complex condition.

Although the patient can remember clearly the details of the events that occurred in the

surrounding (eg, talk to your doctor, answering specific questions) do not seem fully able to

distinguish whether the event is happening is real or not real. Memory indicated by the

uncertainty about the patient's dream or a real incident, reminiscent of the contradiction

between the real and unreal, waking and dream, the same as patients who exhibit delirium,

suggesting the existence, during the separation of mind and sleep paralysis.

EEG frequency analysis results are consistent with clinical findings confirmed by

analysis of neurophysiological data cross-correlation, reinforcing the idea that patients in the

middle of the brain between waking and REM sleep during paralysis. The hypothesis the

authors is consistent with the theory of separation of the brain by a stop snoring and Schenk.

According to this theory the subdivision is awake, REM sleep and non-REM sleep are not

mutually exclusive division and under certain circumstances that do not overlap the right

leads at the center of experiencing a variety of clinical phenomena (arousal disorder,

parasomnia, overlap syndrome, conduct disorder REM, narcolepsy, cataplexy, and delirium).

In particular the possibility of waking and sleep together as a local brain fenomenea that

the neurophysiological documented in the confusion of arousal (5)

9. Conclussion

SP for people with narcolepsy is a complex problem, related to the narcolepsy which

make sleep in a sudden, and they are experiencing SP. The first problem is the SP, it is motor

problem when the patient woke up immediately during the REM phase, and that motor

problem makes the sufferer could not move his limbs. The second prolem is narcolepsy, it

make that people often to fall asleep and automatically more often to enter the REM phase

and it makes more experiencing SP. That event which do oftenly makes the patient became

difficult to distinguish the reality and dreams. Continuous state of disorder proper activity of

REM sleep (6, 7) in the prefrontal and parietal cortex required for consciousness and self-

reflective knowledge. (8). Contrary to wake associated with activation of the remaining brain

regions may explain the impairment of the afferent input, representing the pathophysiologic

basis of the failure of patients to establish the boundaries between reality and dream thoughts.

10. Bibliography/references

1. American Academy of Sleep Medicine (2005) International classification of sleep

disorders, 2nd edn. Diagnostic and coding manual. American Academy of Sleep

Medicine, Westchester

2. Girard TA, Cheyne JA (2006) Timing of spontaneous sleep paralysis episodes. J Sleep

Res 5:222–229

3. Mahowald MW, Schenck CH (2005) Insights from studying human sleep disorders.

Nature 437:1279–1285

4. Duppils GS, Wikblad K (2007) Patients’ experiences of being delirious. J Clin Nurs

16:810–818

5. Terzaghi M, Sartori I, Tassi L, Didato G, Rustioni V, LoRusso G, Manni R, Nobili L

(2009) Evidence of dissociated arousal states during NREM parasomnia from an

intracerebral neurophysiological study. Sleep 32:409–412

6. Maquet P, Ruby P, Maudoux A, Albouy G, Sterpenich V, Dang-Vu T, Desseilles M, Boly

M, Perrin F, Peigneux P, Laureys S (2005) Human cognition during REM sleep and the

activity profile within frontal and parietal cortices: a reappraisal of functional

neuroimaging data. In: Laureys S (ed) Progress in brain research, vol 50. Elsevier,

Amsterdam, pp 219–227

7. Braun AR, Balkin TJ, Wesenten NJ, Carson RE, Varga M, Baldwin P, Selbie S, Belenky

G, Herscovitch P (1997) Regionalcerebral blood flow throughout the sleep–wake cycle.

An H2(15)OPET study. Brain 120:1173–1197

8. Voss U, Holzmann R, Tuin I, Hobson JA (2009) Lucid dreaming: a state of consciousness

with features of both waking and non-lucid dreaming. Sleep 32(9):1191–1200

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