Night Terror

―You may be an undigested bit of beef, a blob of mustard, a crumb of cheese, a fragment of an underdone potato. There's more of gravy than of grave about you, whatever you are!" Charles Dickens, A Christmas Carol ―…how greatly night adds to our dread in all cases of danger, and how much the notions of ghosts and goblins (of which none can form clear ideas) affect minds, which give credit to the popular tales concerning such sorts of beings.‖ Edmund Burke, An Enquiry

The subject, a widowed 68-year old female, experienced her first episode of what is

commonly termed sleep paralysis in adolescence. The condition had not manifested again until recently, when Mrs. D—, concerned, I thought, about some deeper physiological or neuro-psychological problem, began consulting me. I assumed immediately that she suffered from migraines or narcolepsy, conditions with which sleep paralysis is usually associated, but this did not turn out to be the case. She appeared, for her advanced age, in generally good health, though gaunt and disheveled, maintained that she kept to a sensible diet, and reported no other concerns whatsoever with the quality or quantity of her sleep. While I tried to convince her that the condition’s prognosis is benign, with absolutely no serious health risks other than the heady dose of terror experienced during an episode, Mrs. D— desired not only to acquire a complete understanding of sleep paralysis’ patho-physiology, but to be prescribed such a treatment so as to completely eliminate the condition. The reason for this, she admitted, was that the recurring episodes were so terrifying that she, living now alone in an old house, was ready to believe, contrary to all reason, that she was being beset by some type of ghostly or demonic activity that would lead to her own death. My first order of business, therefore, after my diagnosis, was to reassure her of the purely physiological basis of the disorder; which, though extensively studied, I did not demur to admit, in the interest of full disclosure, was still imperfectly understood, as are so many neurological pathologies.

From what I could gather, she suffered from that type of sleep paralysis called hypnopompic, wherein the episodes occur in the postdormitum, along with a bit of thanatophobia, or the dear of death. Her custom was to take some herbal tea around ten in the evening, and, while curled up with a book, drift into sleep. Sleep paralysis came always at a set hour in the middle of the night. Given the commonality of this disorder, I was prepared for Mrs. D—’s narration of her nocturnal experiences, though not entirely of their sinister progression. Common to each occurrence, of course, is suddenly awakening in a completely paralyzed state, not dissimilar to cataplexy. This however, is not exactly true, since she could, as most sufferers, move her eyes. Though gripped with unaccountable fright, she at first sees nothing out of the ordinary. But as her eyes scan the familiar contents of her room, she is overcome with the feeling of an evil presence nearby. As she struggles to move, which appears impossible, the dread not only lingers, but multiplies. From these initial conditions, subsequent experiences involved the sensation of being poked, or having her bedclothes pulled from her. She also has frequently felt a weight upon her chest, and the uncomfortable sensation of suffocation, or at least an inability to draw an adequate breath. Another night, unable to move, she can only peer into the dark doorway leading to her closet and sees, or thinks she sees a black form stir therein. The form grows palpable and, detaching from the shadows, darts unnaturally to the foot of her bed. Though she cannot—and does not dare nor want—to delineate the face, the apparition possesses somewhat of a human form, but gaunt and hung with spindly limbs, writhing like that of loathsome insects, by which it accomplishes its grotesque ambulation. As the nights progress, this incubus grows bolder, and comes to the side of the bed to stare down at her; while at another time it enters into bed beside her ear, whispering her name, or else vile and

unmentionable things. She of course, terror-struck, strains with all her might to flee, but succeeds only in averting her eyes. She tries to cry out, but is unable even to speak.

The horrid experiences, so she told me, can last from minutes to an hour, although she is not always certain of its duration. Eventually she finds she can utter some words, and then move a finger or toe, until she is released from the grip of the nightmare and properly awakens tremulous and clammy. She believes that repeating the name of Jesus, mentally or verbally as the case may be, has a beneficial effect in loosening the bond of the nightmare.

Before explaining the science behind the phenomenon, I recounted to Mrs. D—, if only as an attempt to ease her nerves, the preponderance of similar experiences, sometimes wrapped in fable and folklore in the form of supernatural attack traditions, found in practically all cultures worldwide, going back even into antiquity. She was familiar with the myth of the ―Old Hag‖ common to English–speaking countries. In Turkey, it is a djinn that comes in the night, and only a prayer to Allah will bring relief. Among the Chinese it is a ghostly apparition, as in Mexico it is the spirit of a recently deceased. In Greece, the disturbance is characteristic of demonic activity. But in practically all cases, the principal work of the malign entity is to press down on the victim, sometimes by sitting on his chest, in order to asphyxiate him. One cannot help, in this regard, but to recall Fuseli’s famous and troubling painting.

The common elements of this phenomena, rather than convince her of its mundane nature, served only to reinforce in her mind its supernatural genesis; for how could so many cultures report the very same type of experiences, universally attributing them, without exception, to the work of ghosts or demons? It was not my place to judge or contradict her beliefs; indeed the majority of people believe just that. It is an entirely understandable position, given the abundance of superstitions acquired since childhood and the frightful conditions in which victims find themselves when undergoing sleep paralysis. To some, there is no other explanation because, unlike traditional nightmares, the victim is verifiably awake; and though awake, hallucinations occur in frightful detail, projected by the brain dimensionally into reality. One opens his eyes and can see his room. Indeed, all is as he had left it when he went to bed. But now there are intruders in the room, shadows, ghosts, voices—always evil things, never good—bringing with them the threat of bodily or psychical injury. Contrary to popular notion, the body during sleep is not at rest, but in an active state, repairing and regenerating tissue. An hour or so after retiring to bed, the body goes into REM sleep. Dreams occur then, and to prevent the acting out of dreams, the body undergoes almost complete paralysis due to motor neuron inhibition. It is believed that sleep paralysis likely occurs when the person awakes before the REM cycle is complete, or when he remains aware while the body is entering REM sleep. But why is this transition always accompanied by a deep sense of terror and disturbing hallucinations? During mankind’s long evolution, when life was nasty, brutish and short, no respite existed from the threats of wild beasts, weather, or fellow-man. Especially at night, that odd footstep heard within the encampment, that wicked flash of light through the trees or that threatening shadow passing over the cave wall, forebode evil and catastrophe. The brain’s evolution thus struggled with the need for vigilance even during periods of rest. The hallucinations experienced during sleep paralysis are perhaps neural vestiges of that long and terrible struggle for survival. I had not seen Mrs. D— in some time when she rang my office in a terrible state of agitation. She was, or course, afraid to go to sleep after such a long series of night terrors and began to develop an acute insomnia, which no doubt exacerbated her condition. I prescribed a concentrated dose of melatonin, urged a change of sleeping position from supine to prone and advised that she relieve her loneliness by the company of friends and family. But without children, lacking friends and bereft of parents or other relatives as is common in the twilight of life, there was

no one she could turn to. Against my professional judgment I agreed, after much pleading on her part, to an unusual request. She wished me to spend a night in her home. I cannot help but admit that part of me was eager to examine firsthand the very act of sleep paralysis in a patient who, it seemed, suffered from it chronically. In preparation for our consultations, I had reviewed all the available literature on the subject; which, though enlightening, abounded in many more theories than conclusions from direct observation. While a limited form of the condition can certainly be induced chemically or behaviorally, naturally recurrent isolated sleep paralysis, with all its customary symptoms, is difficult to reproduce in situ. Mrs. D— lived in a large, rambling old house in a part of town I, for good reason, did not frequent. She received me with all courtesy one afternoon, and over tea we felt freer to become better acquainted personally. She was reticent about her husband, however, and I found it odd that from among all the pictures on her mantle he was conspicuously absent. I casually mentioned this, and she divulged that the nightmares began after her husband had died, and she had felt it necessary to remove his likeness from her sight. After an early dinner, I returned later in the evening with a video camera, which I intended not only for scientific monitoring, but to safeguard me against any shadow of impropriety under the circumstances. I then set my watch alarm, ensconced myself in her comfortable sofa with a book from her small library, and read until I fell asleep. I awoke shortly after midnight, and by prearrangement, made my way to her bedroom on the second floor. I entered, switched on the video camera which I had set up earlier, and sat in an armchair in a corner of the room. With writing pad in hand, as well as a small flashlight, I waited. The room had a single window, without curtain or shutter, by which a tenuous moonlight scumbled a gloom. There she lay, quite still, with only what seemed to my eyes the faint rising and setting of her gauzy nightgown as evidence of life. Dimness can often play tricks on perspective, and at one instance I thought that Mrs. D— had popped open her eyes and fixed upon me a baleful stare, but my flashlight proved this illusion false. She had, however, in sleep such a ghastly appearance that she appeared to me like a different person altogether. Like some ancient medusa she laid there with her tarnished silver hair all strewn, her bloodless lips gaping, her cheeks sunken, and her pasty countenance, denuded of maquillage, blotched and crenellated. I could not help suppress a shudder, as I returned to my seat, at the ravages of old age.

As I sat there in the darkness, minute after minute, hour after hour, thoughts of all the frightful folklore attached to sleep paralysis began to affect me psychosomatically. Although I was neither religious nor superstitious and fully recognized the deceptive power of suggestion, I still felt a shiver with the old house’s every transient creak. My neck hairs stood erect at the quivering shadows upon the wall. My throat constricted with every rattle of the window-pane. At one point I must have certainly dozed off and had a sort of lucid dream, because I saw the bedroom door ajar, as if someone had entered, when I was certain I had closed it behind me.

Then it happened. The illusion of Mrs. D—’s fixed stare through the gloom became, under the beam of my flashlight, the reality of sleep paralysis. Her unblinking eyes appeared wide and wild, her eyeballs quivering but directed with dilated pupils at something before her. I rose from my seat and came close. A very disagreeable odor assailed me. Her body had lost the suppleness of the sleeper, and had become rigid, as if descending into rigor mortis. Her gnarled, livid hands had curled around folds of her nightgown. Her breathing grew stertorous. Her lips trembled as if robbed of speech. Her face, ghastly before, now reflected in an enhanced way whatever horror she hallucinated. I followed the direction of her affrighted gaze. There was something in her closet, which had evidently emerged, moved slowly to the foot of her bed; and then, in an instant, presented itself beside her, crawling into bed with her. Unlike her, however, I could see no prowling demons. I was certain that she was not aware of my presence, nor could even see me, although I stood directly over her, and that all her concentration rested in the terrible and mysterious drama

conjured in her brain and manifested by some hardly understood mechanism before her very eyes. I noted the time, precisely three o’clock in the morning, and returned to my seat to await the conclusion. It came within minutes. Mrs. D— took a loud and deep breath, settled back into quiet sleep and stirred no longer. I returned downstairs and sat at the dining-room table to compose some preliminary notes, to be supplemented later by review of the video footage, until weariness overtook me. To the couch I repaired and soon fell asleep.

My eyes burst open. All was dark, uncertain, confused. I could not move. I was inexplicably petrified. By intellection I soon recognized the irony that I was experiencing the very event I was investigating, and, with a striving after clinical detachment, closed my eyes to wait with patience for the episode to pass, concentrating by long practice on the hurried palpitations of my heart in order to remain grounded in reality. But my dread, rather than diminish, grew, and with it came a laboring for breath. I suddenly felt oppressed by some heavy weight. I opened again my eyes and saw, impossible though it seemed, Mrs. D—, upon her haunches like some horrific sphinx, perched upon my breast! Her haggard, moribund face descended toward me until her disgusting pallor filled my visage and that same stench—of putrescence, I now recognized—overwhelmed me. All I could do was tightly shut my eyes and mentally scream for help, for my throat and lips could not work together to utter a single syllable. I heard her hiss my name and certain foul things, thrusting me into the greatest agony of fear and loneliness and panic imaginable, like that of a drowning man feeling the ebb of his life, though at least can flail his limbs against inevitable dissolution. At some level, deep in my conscious brain, I understood that she was just a hallucination, that the feeling of suffocation was nothing more than a species of apnea; but even that condition, I knew, if repeated or prolonged, could lead to cardiac arrest and death, which only compounded my dread. I must have relapsed into unconsciousness, for the dawn greeted me. I rose with a start, relieved to be freed of the frightful paralysis. Still shaken by the night’s disturbing experience, I looked carefully around the room for oddities or anything in violation of the laws of physics to ensure I was not in the midst of a false awakening. Confident of being fully conscious, I gathered my things, and hurried from the house without notifying Mrs. D—. Reaching my car, I was arrested by an old woman sitting on her porch. She asked me brusquely what I was doing, since she had also witnessed my arrival the day before. I responded that I was a doctor, and that Mrs. D— was in my care. At my statement, the old woman turned a shade paler, and rising from her seat, ambled to her front gate. Grasping my arm, she pulled me close hoping for some news of her neighbor, whom she said she had not seen leave her house since the death of her husband a fortnight ago; he had expired upon their bed in the middle of the night. Overcome by a cold, foreboding feeling I excused myself and rushed back to the house. I ran up the stairs, burst into Mrs. D—’s bedroom, switched on the light and recognized instantly the nature of the malodor, for—horror!—before me lay a moldering corpse writhing with maggots and beetles in its putridity, its eyeless sockets fixed upon me.

Fear death, O rational man, fear it!