Sleep paralysis and folklore

Abstract

Sleep paralysis is a relatively new term to describe what for hundreds of years many believed to be a visitation by a malevolent creature which attacked its victims as they slept. The first clinical description of sleep paralysis was published in 1664 in a Dutch physician’s case histories, where it was referred to as, ‘Incubus or the Night-Mare [sic]’. In 1977, it was discovered more than 100 previously healthy people from various South East Asian communities had died mysteriously in their sleep. The individuals affected were dying at a rate of 92/100,000 from Sudden Unexplained Nocturnal Death Syndrome. No underlying cause was ever found, only that subsequent studies revealed a high rate of sleep paralysis and belief in the dab tsog (nightmare spirit) amongst members of the community. The nightmare/succubus is descended from Lilith. The earliest reference to Lilith is found in the Sumerian King list of 2400 BC known as Lilitu or she-demon, she bore children from her nocturnal unions with men. In other derivations, she was Adam’s first wife who rather than ‘obey’ became a demon that preyed on women during childbirth. In modern Middle Eastern maternity wards, some women still wear amulets for protection. Today, clinical cause of these disturbances is sleep paralysis due to the unsuitable timing of REM sleep. During the ‘Nightmare’ episode, the sleeper becomes partially conscious during REM cycle, leaving the individual in a state between dream and wakefulness. For some, culture and the tradition of the nightmare is explanation enough.

Introduction

… in the night time, when she was composing her self [sic] to sleep, sometimes she believed the devil lay upon her and held her down, sometimes that she was choaked [sic] by a great dog or thief lying upon her breast, so that she could hardly speak or breath, and when she endeavoured to throw off the burthen, she was not able to stir her members. And while she was in that strife, sometimes with great difficulty she awoke of her self [sic], sometimes her husband hearing her make a doleful inarticular [sic] voice … ¹

The quote above, from a 1664 Dutch physician’s collection of case histories, is perhaps the earliest clinical description of sleep paralysis, or as the doctor diagnosed the malady, ‘Incubus or the Night-Mare [sic]’.¹ Not only is the description of the event classic in the depiction of what occurs during an episode of sleep paralysis but also what is quite astounding is the doctor’s diagnosis of a folklore as the patient’s illness. Over 300 years later, in an article published in 1991, the modern variant of the nightmare was investigated in the form of Sudden Unexplained Nocturnal Death Syndrome (SUNDS). Since 1977, more than 100 people from various South East Asian ethnic groups have died mysteriously in their sleep. The community most severely affected was immigrant Laotian Hmong men.² These men, in relatively good health with a median age of 33, were dying at a rate of 92/100,000 from SUNDS.³ Since the discovery of the high prevalence of SUNDS among this group, one study has observed a link between sleep paralysis (at two to four times higher occurrence in this community), a belief in the dab tsog (a crushing nightmare spirit which sits on the chest and ‘took their breath’), and stress as possible catalysts for SUNDS, and resulting deaths.⁴ In the 35 years since SUNDS was first identified among the Hmong, the Center for Disease Control’s initial statement on the cause still holds, a definitive ‘cause [of death] remains unknown’.^2,3

One intriguing and fanciful explanation attributed the deaths to the ‘Nightmare’. It was postulated that the nightmare ‘is not a bad dream, but rather, in traditional terms, the nocturnal visit of an evil being that threatens to press the very life out of its terrified victim’.² Generally, those who have experienced such incidents reported feeling paralysed, unable to speak, helpless, and overtaken by intense fear and terror.² Modern victims have described the incidents as ‘I imagined that somebody was laying in bed with me, but I couldn’t see them because I was struggling to turn over but couldn’t move’.⁵ These episodes usually ended when individuals were able to move some part of their body, roll off the bed, or were awakened when someone entered their room.

The most famous representation of the phenomenon was the 1781 painting, The Nightmare, by the Swiss artist Henry Fuseli. In a swoon, a young woman lies limply sprawled across her bed, as the incubus squats grotesquely on her stomach staring out at the viewer, as if to draw them in to her nightmare. The painting is literally the clinical presentation of sleep paralysis. The nightmare and the succubus (the physical embodiment of frightening dreams) appear to have been two distinct terms referring to two different sleep manifestations which explained occurrences of frightening disturbances in sleep. Formally, the nightmare referred primarily to episodes of terror with no sexual content, while the succubus involved sexual content. At some point, both terms became synonymous and are presently used interchangeably.⁶

The creatures span both cultures and time. In the Canadian province of Newfoundland, the nightmare is referred to as the ‘Old Hag’, while on the Caribbean Island of St Lucia, the creature is called Kokma. In this respect, the creature is very much the traditional description of the succubus; it is the spirit of a dead, unbaptised baby which attacks people in their beds and cuts off their respiration by jumping on their chest and grasping their throats.⁷ Other forms of the succubus/nightmare include lamia, strix, and Lilith. In some respects, these creatures were the personification of eroticism:

The succuba. I don’t know what it is. It comes like a love. It creeps up on me. It came here, but no longer. I swore to myself and in different ways. It never bothered me after that.⁸

Methods

A literature search was conducted on MEDLINE (PubMed), Social Sciences Citation Index, Arts & Humanities Citation Index, and Google Scholar. Relevant papers and books from the resultant search were retrieved and reviewed by the author to write the current paper.

Folklore origins

The succubus is descended from the ancient figure of Lilith. The earliest reference to Lilith is found in the Sumerian King list of 2400 BC. This list refers to the father of the Sumerian hero-king, Gilgamesh (immortalised in the poem The Epic of Gilgamesh), the child of a Lillu demon, one of four succubi or vampire-like demons (creatures which preyed on men while they slept), the other three being demons known as Lilitu (Lilith) or she-demons, which bore children from their nocturnal unions with men. In these Sumerian texts, Lilith was considered a vampire and a harlot, ‘the Beautiful Maiden; once she chose a lover, he was hers forever.⁹

From Mesopotamian to Hebraic representations of her, portrayed usually with the body of a serpent, a scorpion, or a dragon, Lilith was usually associated with the devil in both proximity and depiction.^10,11 One of the few references to Lilith in the bible is Isaiah 34:14. Here, she is referred to as a ‘screech owl’, i.e. a creature of the night, and more aptly referred to as ‘the night monster’ in the Good News Bible.^12,13 She was the creature which haunted good women during childbirth (in ancient Greece, pitch was smeared on houses to keep at bay the demons which preyed on women during childbirth and newborn children). Even today in Israel’s maternity wards, Jewish women of Middle Eastern extraction can be found wearing amulets to protect themselves from her power.^14,15

In the Talmud, Lilith was believed to have been the first woman and Adam’s first wife. There are various narratives of Lilith’s relationship with Adam, the most popular related her refusal to ‘lie beneath’ him, believing as they were created together, both from ‘dust’, she should be his equal. Uttering God’s secret name, Lilith transformed into a dragon and flew to the Red Sea where she was pursued by three angels sent by God. When the angels gave Lilith God’s ultimatum to either return to Adam or be drowned in the sea, she replied,

[l]et me be for I was created in order to weaken the babes: if it is a male, I have power over him from the moment of his birth until the eighth day of his life [when he is circumcised and thereby protected], and if a girl, until the twentieth day.⁹

She further swore: ‘[w]henever I shall see you or your names or your images on an amulet, I shall do no harm to a child’.⁹ Having reached a bargain, of sorts, the

Holy One … brought her out from the depth of the sea and gave her power over all those children, the ‘little faces’ of the sons of men, who are liable to punishment for the sins of their fathers … she fled and wandered about the world and, finding children liable to punishment, she maltreated and killed them.¹⁶

Following Adam and Eve’s encounter with the Tree and the Serpent, Adam refrained from, among other things, sexual intercourse for 130 years as a form of penance. During this time, Lilith, as one of ‘two female spirits … [had] intercourse with [Adam], and he bore from them spirits and demons that flit about the world’.¹⁶ So begins Lilith’s reign, in the Talmud, and in later tradition as the succubus and nightmare:

[w]herever these spirits find people sleeping alone in a house, they hover over them, lay hold of them and cleave to them, inspire desire in them and beget from them. They further inflict disease on them without their being aware …¹⁶

And so, not only is Lilith blamed for diseases ‘inflicted’ on men but also for ‘wandering about at night time, vexing the sons of men, and causing them to defile themselves’.¹⁶

The Science

The primary presentation of the succubus and nightmare and their ilk, instances of awakening and unable to move, the sensation of pressure on the chest, fear, visual hallucination, and perceiving some creature, or person in your immediate surroundings, or directly on your body, is known as sleep paralysis. The term sleep paralysis, as such, was first used in the medical literature in 1928.¹⁷ Sleep paralysis, which has been estimated to affect from as little as 1.7% to as much as 40% of the general population, with the majority of incidents affecting students, generally peaks by age 30 and appear to be associated with posttraumatic stress disorder, narcolepsy, and panic attacks.^17–22 In one study, an increased rate (65%), intensity, and duration of sleep paralysis was observed in a group of Cambodian refugees suffering posttraumatic stress disorder.²⁰ Other factors which can contribute to episodes of sleep paralysis include fatigue, sleep deprivation, and stress.¹⁷ There is also some evidence that a relationship exists between sleep paralysis and schizophrenia and bipolar disorder.⁵

During the REM sleep cycle, the state when most dreaming occurs, the body is paralysed to protect it from acting out those dreams. It is believed that during the ‘Nightmare’ episode, the sleeper becomes partially conscious during the REM cycle, leaving them in a state somewhere between dream and wakefulness, as such the sleeper can experience both auditory and visual hallucinations.^2,23 Overall, as sleep paralysis usually occurs at sleep onset or on awakening, its cause is likely due to the unsuitable timing of REM sleep paralysis (or atonia).^18,24

Conclusion

As long as people have imagined what ‘goes bump in the night’, the nightmare has existed. With the advent of a scientific explanation in the term of sleep paralysis, we now know today that sleep paralysis is often recognised for what it is, in many an aberration, and for a few, a symptom of more serious illnesses. But, for some, like the Hmong, sleep paralysis or more aptly, the nightmare, will always be the manifestation of evil in the twilight of slumber.

Declarations

Competing interests

None declared

Funding

None declared

Guarantor

AMC

Ethical approval

Not applicable

Contributorship

AMC contributed to the writing of the complete paper including, literature search, review of papers, drafting the manuscript, and major revision.

Acknowledgements

None

Provenance

Not commissioned; peer-reviewed by Mohammed Rashed