Ogun Oru: a traditional explanation for nocturnal neuropsychiatric disturbances among the Yoruba of Southwest Nigeria

Experiences and beliefs related to sleep paralysis among the general population of the twin cities: A cross-sectional study

BACKGROUND

Sleep paralysis (SP) is a rapid eye movement (REM) parasomnia that occurs during the transition between wakefulness and sleep. During this brief state, a person is conscious but unable to move or speak, often experiencing hallucinations. It is 'isolated' when it occurs without other symptoms of narcolepsy or sleep disorders. Despite its prevalence, much remains unknown about its clinical features and associated beliefs.

OBJECTIVES

This study examines the frequency of self-reported SP experiences and its associated demographic characteristics, along with participants' beliefs about the condition.

METHODS

A cross-sectional survey was conducted among visitors at a shopping mall, using the Unusual Sleep Experiences Questionnaire (USEQ) to assess the features of SP episodes and the common beliefs surrounding them.

RESULTS

A total of 350 participants were surveyed (mean age = 25.5 ± 9.30 years; 55.4 % females). Participants who experienced SP at least once in their life time (39.1 %) reported feeling pressure on their chest (67.2 %), an inability to open their eyes (71.5 %), and difficulty speaking (81.0 %) during the episode. The majority of the individuals reported having their first episode at a young age (16-20 years). Most people (24.5 %) were unaware that this condition was known as sleep paralysis, and many (23.5 %) thought that it was just 'a dream'.

CONCLUSION

Isolated sleep paralysis episodes are fairly prevalent, with many people experiencing their first episode at a young age. A typical episode entails a sense of pressure on the chest and difficulty in vocalizing. Misconceptions about the condition are common and wage further exploration.

Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites

BACKGROUND

We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria.

METHODS

We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs).

RESULTS

We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%).

CONCLUSION

This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses.

Sleep medicine in Africa: past, present, and future

NONE

Interest in sleep and sleep disorders in Africa dates back thousands of years, influenced by various cultural and religious beliefs. However, the practice of sleep medicine as a specialty has been inadequate compared to other regions of the world. The objective of this study was to explore the current status of sleep medicine in Africa vis-à-vis education, professional societies, and facilities, and to identify challenges of the specialty in the region. A literature search of major electronic databases (PubMed, Google Scholar) was done. This revealed that there is a high prevalence of sleep disorders in Africa and a significant association with epilepsy, human African trypanosomiasis, human immunodeficiency virus, and other diseases. There are 6 sleep societies in Africa located in 4 countries. Forty-one sleep laboratories were identified located in 4 countries. The challenges hindering development of sleep medicine in Africa include lack of awareness, poor funding, lack of facilities, and inadequate training.

Sleep Paralysis in Brazilian Folklore and Other Cultures: A Brief Review

Sleep paralysis (SP) is a dissociative state that occurs mainly during awakening. SP is characterized by altered motor, perceptual, emotional and cognitive functions, such as inability to perform voluntary movements, visual hallucinations, feelings of chest pressure, delusions about a frightening presence and, in some cases, fear of impending death. Most people experience SP rarely, but typically when sleeping in supine position; however, SP is considered a disease (parasomnia) when recurrent and/or associated to emotional burden. Interestingly, throughout human history, different peoples interpreted SP under a supernatural view. For example, Canadian Eskimos attribute SP to spells of shamans, who hinder the ability to move, and provoke hallucinations of a shapeless presence. In the Japanese tradition, SP is due to a vengeful spirit who suffocates his enemies while sleeping. In Nigerian culture, a female demon attacks during dreaming and provokes paralysis. A modern manifestation of SP is the report of "alien abductions", experienced as inability to move during awakening associated with visual hallucinations of aliens. In all, SP is a significant example of how a specific biological phenomenon can be interpreted and shaped by different cultural contexts. In order to further explore the ethnopsychology of SP, in this review we present the "Pisadeira", a character of Brazilian folklore originated in the country's Southeast, but also found in other regions with variant names. Pisadeira is described as a crone with long fingernails who lurks on roofs at night and tramples on the chest of those who sleep on a full stomach with the belly up. This legend is mentioned in many anthropological accounts; however, we found no comprehensive reference on the Pisadeira from the perspective of sleep science. Here, we aim to fill this gap. We first review the neuropsychological aspects of SP, and then present the folk tale of the Pisadeira. Finally, we summarize the many historical and artistic manifestations of SP in different cultures, emphasizing the similarities and differences with the Pisadeira.

Neurobiology and clinical implications of lucid dreaming

Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.

Lifetime prevalence and incidence of parasomnias in a population of young adult Nigerians

Lifetime prevalence, incidence, and risk factors for parasomnias were determined. Past experiences of non-REM, REM, and sleep-transition parasomnias were recorded. Diaries of night sleep duration, parasomnias, perception of aliens, levels of physical activity, headaches and intake of all substances, drugs, and tobacco were kept for 14 consecutive days. A total of 276 subjects were studied. Lifetime prevalences (95% CI) were 725 (668-776) for occurrence of any parasomnia, 43 (25-74) for sleepwalking, 112 (80-155) for sleep terror, 475 (416-533) for nightmares, 225 (179-277) for sleep paralysis, 43 (25-74) for sleep starts, 322 (270-380) for sleep talking, and 344 (291-402) for enuresis. Incidences (95% CI) were 210 (166-262) for occurrence of any parasomnia, 14 (6-37) for sleepwalking, 11 (4-31) for sleep terror, 170 (131-219) for confusional arousal, 18 (8-42) for nightmares, 14 (6-37) for sleep paralysis, 33 (17-61) for sleep starts, and 4 (1-20) for sleep enuresis. Multivariate analysis showed associations of increase occurrence of parasomnias and duration of sleep >7 h (p < 0.05) and intake of alcohol (p < 0.001), but heavy workload before sleep was associated with decreased occurrence of parasomnias (p < 0.01). Gender, smoking, caffeinated drinks, hypnotics, and headaches were not associated with parasomnias. Incidence of presence of aliens (95% CI) in the room was 25(0/infinity) (12-51). This study shows that more than 70% of the population have experienced parasomnias at any time in the past. Nightmares, enuresis, sleep paralysis and night terrors are the commonest parasomnias experienced in the past, while confusional arousal, sleep starts, and nightmares are the commonest parasomnias currently experienced. Incidence estimates show that all parasomnias persist into adulthood at reduced rates, but reduction of occurrence was greatest for enuresis. Long duration of night sleep and intake of alcohol predisposed subjects to higher occurrence of parasomnias.