Ñîí ñêëàäàºòüñÿ ç äâîõ îñíîâíèõ ôàç — ïîâ³ëüíîãî (NREM) òà øâèäêîãî (REM) ñíó. ϳä ÷àñ NREM-ôàçè ñïîñòåð³ãàºòüñÿ çíèæåííÿ ì’ÿçîâîãî òîíóñó, â³äáóâàºòüñÿ â³äíîâëåííÿ ðåñóðñ³â, çíèæåííÿ àêòèâíîñò³ ìîçêó òà ñåðöåâî- ñóäèííî¿ ñèñòåìè. REM-ôàçà õàðàêòåðèçóºòüñÿ âèñîêîþ ÅÅà àêòèâí³ñòþ ìîçêó, øâèäêèìè ðóõàìè î÷åé ³ íàÿâí³ñòþ ÿñêðàâèõ ñíîâèä³íü. Ñàìå â ö³é ôàç³ â³äáóâàºòüñÿ ôåíîìåí ì’ÿçîâî¿ àòîí³¿ — ïîâíîãî ðîçñëàáëåííÿ ñêåëåòíèõ ì’ÿç³â, ùî çàïîá³ãຠô³çè÷íèì ðåàêö³ÿì íà ñíîâèä³ííÿ. Îäíàê ÿêùî öåé ìåõàí³çì çàòðèìóºòüñÿ ï³ñëÿ ïðîáóäæåííÿ, ëþäèíà ïîòðàïëÿº â ñâîºð³äíó ïàñòêó ì³æ äâîìà ñòàíàìè ñâ³äîìîñò³ [1,2].
Ñîííèé ïàðàë³÷ — öå ôåíîìåí, ùî ñïîñòåð³ãàºòüñÿ ó ïåðåõ³äíèõ ôàçàõ ì³æ íåñïàííÿì ³ ñíîì, ïðè ÿêîìó ëþäèíà ïåðåáóâຠâ ñòàí³ ñâ³äîìîñò³, àëå íå ìîæå ðóõàòèñÿ. Ç á³îëîã³÷íî¿ òî÷êè çîðó, ñîííèé ïàðàë³÷ ìîæíà ïîð³âíÿòè ç òèì÷àñîâèì êîíôë³êòîì ì³æ ï³äñâ³äîìèìè ìåõàí³çìàìè êîíòðîëþ ñíó òà ñâ³äîìèìè ñïðîáàìè êîíòðîëþâàòè ò³ëî. Íåçâàæàþ÷è íà â³äñóòí³ñòü íåáåçïåêè äëÿ çäîðîâ’ÿ, â³í ìîæå ñóïðîâîäæóâàòèñü ñòðàõîì ÷åðåç â³ä÷óòòÿ áåçïîðàäíîñò³ òà ãàëþöèíàö³¿, ùî ÷àñòî éîãî ñóïðîâîäæóþòü. Ñîííèé ïàðàë³÷ º ïðèðîäíèì íåéðîô³ç³îëîã³÷íèì ÿâèùåì, ÿêå äîïîìàãຠçðîçóì³òè ñêëàäí³ñòü âçàºìî䳿 ì³æ ñâ³äîì³ñòþ ³ ò³ëîì [3,4].
Êîëè ëþäèíà ïðîêèäàºòüñÿ ï³ä ÷àñ REM-ñíó, ¿¿ ìîçîê ³ ò³ëî àêòèâ³çóþòüñÿ îäíî÷àñíî, îäíàê ó âèïàäêó ñîííîãî ïàðàë³÷ó ñâ³äîì³ñòü àêòèâ³çóºòüñÿ ðàí³øå, í³æ ïðèïèíÿºòüñÿ ä³ÿ ì’ÿçîâî¿ àòîí³¿. Öå â³äáóâàºòüñÿ ÷åðåç äèñáàëàíñ ó ðîáîò³ íåéðîìåä³àòîðíèõ ñèñòåì. Çîêðåìà, àöåòèëõîë³í, ÿêèé ï³äòðèìóº REM-ôàçó òà ñïðèÿº âèñîê³é àêòèâíîñò³ ìîçêó ï³ä ÷àñ ñíîâèä³íü, çàëèøàºòüñÿ àêòèâíèì ó òîé ÷àñ, êîëè ³íø³ íåéðîìåä³àòîðè, òàê³ ÿê ñåðîòîí³í 2À (5-HT2AR) ³ íîðàäðåíàë³í, ùî â³äïîâ³äàþòü çà â³äíîâëåííÿ ì’ÿçîâîãî òîíóñó òà ïåðåõ³ä ó ñòàí ïîâíîãî íåñïàííÿ, ùå íå ïî÷àëè ïðàöþâàòè íà ïîâíó ñèëó. Äîñë³äæåííÿ ïîêàçàëè, ùî àêòèâàö³ÿ 5-HT2AR ìîæå âèêëèêàòè â³çóàëüí³ ãàëþöèíàö³¿, "ì³ñòè÷í³" ñóá'ºêòèâí³ ñòàíè òà ïîçàò³ëåñí³ ïåðåæèâàííÿ (OBE), à òàêîæ ìîäóëþâàòè ñõåìè ñòðàõó [3,4,5].
Ìîæëèâèé ìåõàí³çì ïðè÷åòíîñò³ ñåðîòîí³íó äî ñîííîãî ïàðàë³÷ó, ðåàêö³é ñòðàõó, òðèâîãè òà ïàí³êè, ðåàë³çóºòüñÿ ÷åðåç àêòèâàö³þ 5-HT2AR òà 5-HT2C ðåöåïòîð³â. Òàê, îðá³òîôðîíòàëüíà êîðà, áàãàòà ðåöåïòîðàìè 5-HT2A, ìîæå çä³éñíþâàòè âïëèâ íà â³çóàëüí³ øëÿõè ï³ä ÷àñ ñîííîãî ïàðàë³÷ó, ³, ïî ñóò³, ôîðìóâàòè ãàëþöèíàö³¿. Öÿ òåîð³ÿ ïåðåäáà÷ຠíàÿâí³ñòü ãåíó HTR2A íà õðîìîñîì³ 13q ÿê îñíîâíó ïðè÷èíó ãàëþöèíàö³é ñîííîãî ïàðàë³÷ó, ùî ìîæå áóòè äîñë³äæåíî çà äîïîìîãîþ ïîçèòðîííî-åì³ñ³éíî¿ òîìîãðàô³¿. Ñåëåêòèâíèé çâîðîòíèé àãîí³ñò 5-HT2AR, ï³ìàâàíñåðèí, ìîæå áóòè âèêîðèñòàíèé ç ìåòîþ çìåíøåííÿ ïðîÿâ³â ñîííîãî ïàðàë³÷ó, çîêðåìà ãàëþöèíàö³é òà ñòðàõó [5].
Êð³ì òîãî, ³ñíóþòü ³íø³ ôàêòîðè, ùî âïëèâàþòü íà öåé äèñáàëàíñ. Òàê, õðîí³÷íèé ñòðåñ, òðèâîæí³ ðîçëàäè òà äåïðèâàö³ÿ ñíó ìîæóòü çì³íþâàòè ð³âåíü íåéðîìåä³àòîð³â, îñîáëèâî íîðàäðåíàë³íó, ùî ñïðèÿº øâèäêîìó ïðîáóäæåííþ ìîçêó, àëå çàòðèìóº â³äíîâëåííÿ êîíòðîëþ íàä ò³ëîì. Äåÿê³ äîñë³äíèêè ââàæàþòü, ùî öå ìîæå áóòè åâîëþö³éíèì ìåõàí³çìîì, ÿêèé êîëèñü äîïîìàãàâ ëþäèí³ øâèäêî ïðîêèäàòèñÿ ó íåáåçïå÷íèõ ñèòóàö³ÿõ, àëå â ñó÷àñíîìó ñâ³ò³ ïðèçâîäèòü äî òàêèõ àíîìàë³é, ÿê ñîííèé ïàðàë³÷ [3,4,6].
ϳä ÷àñ ñîííîãî ïàðàë³÷ó àêòèâ³çóþòüñÿ òàëàìóñ, ùî â³äïîâ³äຠçà ñåíñîðíó îáðîáêó, ³ ë³ìá³÷íà ñèñòåìà, â³äïîâ³äíà çà åìîö³¿. Äîäàòêîâî àêòèâ³çóþòüñÿ îáëàñò³ ãîëîâíîãî ìîçêó, â³äïîâ³äàëüí³ çà ñïðèéíÿòòÿ çàãðîç, çîêðåìà ìèãäàëèíà. Ó çâè÷àéíèõ óìîâàõ ìîçîê çäàòåí â³äð³çíÿòè ðåàëüí³ çàãðîçè â³ä óÿâíèõ. Ïðîòå ï³ä ÷àñ ñîííîãî ïàðàë³÷ó ïðåôðîíòàëüíà êîðà, ÿêà â³äïîâ³äຠçà ëîã³êó òà êðèòè÷íå ìèñëåííÿ, ùå íå ïîâí³ñòþ àêòèâ³çîâàíà, òîä³ ÿê åìîö³éí³ öåíòðè âæå ïðàöþþòü íà ïîâíó ñèëó. ×åðåç öå ìîçîê ñïðèéìຠíåçâè÷íèé ñòàí íåðóõîìîñò³ ÿê ïîòåíö³éíî íåáåçïå÷íó ñèòóàö³þ, ³ ëþäèíà ïî÷èíຠâ³ä÷óâàòè ïàí³êó, ùî ùå á³ëüøå çàãîñòðþº â³ä÷óòòÿ ñòðàõó [7,8]. Öåé ìåõàí³çì òàêîæ ïîÿñíþº ïîÿâó ãàëþöèíàö³é, ÿê³ ñóïðîâîäæóþòü ñîííèé ïàðàë³÷. Êîëè ò³ëî çàëèøàºòüñÿ íåðóõîìèì, àëå ñâ³äîì³ñòü óæå ïðîáóäæåíà, ìîçîê íàìàãàºòüñÿ ðàö³îíàë³çóâàòè öå â³ä÷óòòÿ, çàïîâíþþ÷è ïðîãàëèíè ³íôîðìàö³¿ ç âëàñíîãî äîñâ³äó, ï³äñâ³äîìèõ ñòðàõ³â ³ êóëüòóðíèõ óÿâëåííÿõ. ßê íàñë³äîê, ó òåìðÿâ³ ìîæóòü ìàðèòèñÿ çàãàäêîâ³ ñèëóåòè, â³ä÷óòòÿ ñòîðîííüî¿ ïðèñóòíîñò³ àáî íàâ³òü íàòèñê íà ãðóäíó êë³òêó, ùî òðàäèö³éíî îïèñóºòüñÿ â áàãàòüîõ êóëüòóðàõ ÿê äåìîí³÷íèé âïëèâ àáî àòàêà ïàðàíîðìàëüíèõ ³ñòîò. Ëþäè, ÿê³ ñõèëüí³ äî òðèâîæíîñò³ àáî ìàþòü áàãàòó óÿâó, ÷àñò³øå ïåðåæèâàþòü òàê³ ãàëþöèíàö³¿ [8,9,10].
Ùå îäí³ºþ ö³êàâîþ îñîáëèâ³ñòþ º òå, ùî ï³ä ÷àñ ñîííîãî ïàðàë³÷ó ñïîñòåð³ãàºòüñÿ ï³äâèùåíà àêòèâí³ñòü âåñòèáóëÿðíî¿ ñèñòåìè, ÿêà â³äïîâ³äຠçà ð³âíîâàãó ³ ïðîñòîðîâå îð³ºíòóâàííÿ. Íåìîæëèâ³ñòü ðóõàòèñü ïðè àêòèâíîñò³ ìîçêó ñòâîðþº ³ëþç³þ òîãî, ùî ò³ëî ïåðåáóâຠ⠳íøîìó ñòàí³, í³æ çàçâè÷àé. Äåÿê³ ëþäè ïîâ³äîìëÿþòü ïðî â³ä÷óòòÿ ëåâ³òàö³¿, ïîëüîòó àáî âèõîäó ç ò³ëà, ÿê³ ÷àñòî òðàêòóþòüñÿ ÿê ïîçàò³ëåñíèé äîñâ³ä [6]. Öå ìîæå áóòè ïîâ’ÿçàíî ç òèì, ùî ñåíñîðíà ³íôîðìàö³ÿ, ÿêà çàçâè÷àé íàäõîäèòü â³ä ì’ÿç³â ³ ñóãëîá³â äëÿ ï³äòâåðäæåííÿ ô³çè÷íîãî ïîëîæåííÿ ò³ëà, ï³ä ÷àñ ñîííîãî ïàðàë³÷ó òèì÷àñîâî áëîêóºòüñÿ. Ó òàêîìó âèïàäêó ìîçîê ïîêëàäàºòüñÿ íà çàëèøêîâó àêòèâí³ñòü REM-ôàçè, ùî ìîæå ñïðè÷èíÿòè ÿñêðàâ³ ñåíñîðí³ ³ëþ糿 [9]. Äåÿê³ ëþäè, ÿê³ ïðàêòèêóþòü óñâ³äîìëåí³ ñíîâèä³ííÿ, íàâ³òü íàâ÷èëèñÿ âèêîðèñòîâóâàòè ñîííèé ïàðàë³÷ äëÿ âõîäæåííÿ ó òàê çâàí³ «àñòðàëüí³ ïîäîðîæ³» àáî êîíòðîëþâàííÿ ñâî¿õ ñí³â [8].
Ôàêòîðè, ùî ï³äâèùóþòü ðèçèê ñîííîãî ïàðàë³÷ó, âêëþ÷àþòü ïîðóøåííÿ ðåæèìó ñíó, ñòðåñ, õðîí³÷íó âòîìó òà íåâðîëîã³÷í³ ðîçëàäè, òàê³ ÿê íàðêîëåïñ³ÿ. Äîñë³äæåííÿ òàêîæ âêàçóþòü íà ìîæëèâó ãåíåòè÷íó ñõèëüí³ñòü äî öüîãî ÿâèùà, õî÷à òî÷í³ ìåõàí³çìè ùå ïîòðåáóþòü ïîäàëüøîãî âèâ÷åííÿ [11,12].
Âèñíîâîê: Ñîííèé ïàðàë³÷ — öå íàñë³äîê ïîðóøåííÿ ñèíõðîí³çàö³¿ ì³æ ïðîáóäæåííÿì ìîçêó òà â³äíîâëåííÿì ì’ÿçîâîãî òîíóñó. Ãîëîâíó ðîëü ó öüîìó â³ä³ãðຠíåéðîõ³ì³÷íèé áàëàíñ, ÿêèé ðåãóëþº ïåðåõ³ä ì³æ ôàçàìè ñíó.
Íåçâàæàþ÷è íà ñòðàõ³òëèâ³ â³ä÷óòòÿ, ùî ñóïðîâîäæóþòü öåé ñòàí, â³í º ïðèðîäíèì ïðîÿâîì ðîáîòè ìîçêó, ³ ðîçóì³ííÿ éîãî ìåõàí³çì³â ìîæå äîïîìîãòè ëþäÿì âïîðàòèñÿ ç íèì òà íàâ³òü çàïîá³ãòè éîãî âèíèêíåííþ.
Êëþ÷îâ³ ñëîâà: ñîííèé ïàðàë³÷, REM-ñîí, ì’ÿçîâà àòîí³ÿ, ìîçêîâà àêòèâí³ñòü, ïàðàñîìí³¿.
Äæåðåëà:
1. Scammell T. E., Arrigoni E., Lipton J. O. Neural Circuitry of Wakefulness and Sleep. Neuron. 2017. Vol. 93, No 4. P. 747–765. https://doi.org/10.1016/j.neuron.2017.01.014
2. Peever J., & Fuller P. M. The Biology of REM Sleep. Current biology : CB. 2017. Vol. 27, No 22. P 1237–R1248. https://doi.org/10.1016/j.cub.2017.10.026
3. Bergmann M., Högl B., Stefani A. "Clinical Neurophysiology of REM Parasomnias: Diagnostic Aspects and Insights into Pathophysiology." Clinical Neurophysiology Practice. 2024. Vol. 9, P. 53–62. https://doi.org/10.1016/j.cnp.2023.10.003
4. Jalal B. The Neuropharmacology of Sleep Paralysis Hallucinations: Serotonin 2A Activation and a Novel Therapeutic Drug. Psychopharmacology. 2018. Vol. 235, No 11, P. 3083–3091. https://doi.org/10.1007/s00213-018-5042-1
5. Baldini T., Loddo G., Ferri R., Provini F. Neurobiology of Parasomnias. In: DelRosso, L.M., Ferri, R. (eds) Sleep Neurology. Springer, 2021. Cham. https://doi.org/10.1007/978-3-030-54359-4_9
6. Cheyne J. A. Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects. Journal of sleep research. 2002. Vol. 11, No 2. P. 169–177. https://doi.org/10.1046/j.1365-2869.2002.00297.x
7. Madari S., Golebiowski R., Mansukhani M. P., Kolla B. P. Pharmacological Management of Insomnia. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. 2021. Vol. 18, No. 1. P. 44–52. https://doi.org/10.1007/s13311-021-01010-z
8. Denis D., French C. C., Gregory A. M. (2018). A systematic review of variables associated with sleep paralysis. Sleep medicine reviews. 2018. Vol. 38. P. 141–157. https://doi.org/10.1016/j.smrv.2017.05.005
9. Mainieri G., Maranci J. B., Champetier P., Leu-Semenescu S., Gales A., Dodet P., & Arnulf I. Are sleep paralysis and false awakenings different from REM sleep and from lucid REM sleep? A spectral EEG analysis. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine,. 2021. Vol. 17, No 4. P. 719–727. https://doi.org/10.5664/jcsm.9056
10. Schenck C. H., Mahowald M. W. REM sleep parasomnias. Neurologic clinics. 1996. Vol. 14, No 4. P. 697–720. https://doi.org/10.1016/s0733-8619(05)70281-4
11. Sateia M. J. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014. Vol. 146, No 5. P. 1387–1394. https://doi.org/10.1378/chest.14-0970
12. Sehgal A., Mignot E. Genetics of sleep and sleep
disorders. Cell. 2011. Vol. 146, No 2. P. 194–207. https://doi.org/10.1016/j.cell.2011.07.004
|
Ãîëîñóâàííÿ 
Öÿ ðîáîòà ë³öåíçóºòüñÿ â³äïîâ³äíî äî Creative Commons Attribution 4.0 International License
Çíàéøëè ïîìèëêó? Âèä³ë³òü ïîìèëêîâèé òåêñò ìèøêîþ ³ íàòèñí³òü Ctrl + Enter