Pathogenesis of Hallucinations in Sleep Paralysis

Abstract

Sleep paralysis is a state of involuntary immobility that occurs during REM sleep, which is accompanied by “ghostly” hallucinations and strong reactions of fear and anxiety. This article presents the neuropharmacological mechanisms of these hallucinatory experiences. Attention is drawn to the role of the serotonin 5HT 2A R receptor in their implementation Studies have shown that activation of 5‑HT2AR can cause visual hallucinations, mystical, subjective states and out-of-body experiences. Hallucinatory experiences caused by serotonin tend to be “dreamlike” when the experiencer has an understanding that he is hallucinating. Presumably, there is a mechanism by which serotonin can be functionally involved in the creation of hallucinations of sleep paralysis and fear reactions through the activation of 5‑HT2AR. In addition, this article discusses the influence of the orbitofrontal cortex, rich in 5‑HT2A receptors, on the visual pathways during sleep paralysis, in fact, on the formation of hallucinations. Also information is provided on how this process can become a vicious circle, through the formation of feedback “fear — serotonergic system”.