Recurrent fearful isolated sleep paralysis - A distressing co-morbid condition of obstructive sleep apnea

We present a case of recurrent fearful isolated sleep paralysis in a 52-year-old male of Indo-Caribbean ethnicity with obstructive sleep apnea (OSA). Recurrent sleep paralysis is a widely under-reported yet worrisome symptom of various sleep disorders. Although a benign condition in most cases, sleep paralysis in a minority of patients causes great distress. Some patients exhibit bedroom avoidance behavior, whereas others experience bedtime anxiety, making it difficult to fall asleep. This leads to poor sleep quality and sleep deprivation, which can greatly impact a person's overall health. As in our case, this led to a vicious "lack of sleep" cycle where a patient who had bedtime anxiety and could not fall asleep, owing to his recurrent isolated sleep paralysis, also had poor quality sleep secondary to his OSA. This increases morbidity and has many potential consequences, which may include cardiovascular events, cognitive decline, and motor vehicular accidents. Sometimes, simply addressing the underlying medical condition cures the recurrent sleep paralysis as in this case where continuous positive airway pressure for OSA cured the recurrent sleep paralysis. One of our goals is to raise awareness of recurrent sleep paralysis so that patients can seek medical help and would not have to live with the anguish of the condition. Coming forward will also assist medical researchers in furthering their understanding of sleep paralysis.