J. Sleep Res.

(2008) 17, 464–467 Historical note

doi: 10.1111/j.1365-2869.2008.00672.x

ÔThe devil lay upon her and held her downÕ

Hypnagogic hallucinations and sleep paralysis described
by the Dutch physician Isbrand van Diemerbroeck (1609–1674)
in 1664
E. J. O. KOMPANJE
Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

Accepted in revised form 30 April 2008; received 1 February 2008

SUMMARY Hypnagogic and hypnopompic hallucinations are visual, tactile, auditory or other
sensory events, usually brief but sometimes prolonged, that occur at the transition from
wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic).
Hypnagogic and hypnopompic hallucinations are often associated with sleep paralysis.
Sleep paralysis occurs immediately prior to falling asleep (hypnagogic paralysis) or
upon waking (hypnopompic paralysis). In 1664, the Dutch physician Isbrand Van
Diemerbroeck (1609–1674) published a collection of case histories. One history with the
title ÔOf the Night-MareÕ describes the nightly experiences of the 50-year-old woman.
This case report is subject of this article. The experiences in this case could without
doubt be diagnosed as sleep paralysis accompanied by hypnagogic hallucinations. This
case from 1664 should be cited as the earliest detailed account of sleep paralysis
associated with hypnagogic illusions and as the first observation that sleep paralysis and
hypnagogic experiences occur more often in supine position of the body.
k e y w o r d s historical review, hypnagogia, hypnopompic hallucinations, night-mare,
sleep paralysis, the Netherlands

(Cheyne et al., 1999a,b; Hishiwaka, 1976). Most often there is

INTRODUCTION
Hypnagogic and hypnopompic hallucinations are visual,
tactile, auditory, or other sensory events, usually brief but
sometimes prolonged that occur at the transition from
wakefulness to sleep (hypnagogic) or from sleep to wakefulness
(hypnopompic). The affected individual usually suffers from
combinations of auditory and visual hallucinations. These
visual and auditory illusions are very vivid and may be bizarre
or very disturbing to the subject. Hypnagogic and hypnopom-
pic hallucinations are often associated with sleep paralysis.
Sleep paralysis occurs immediately prior to falling asleep
(hypnagogic paralysis) or upon waking (hypnopompic paral-
ysis). Individuals are conscious of their surroundings and able
to open their eyes, but usually completely unable to move
Correspondence: Erwin J.O. Kompanje, Department of Intensive Care,
Erasmus MC University Medical Center Rotterdam, 3000 CA
Rotterdam PO Box 2040, The Netherlands. Tel.: +31-6-53837655;
fax: +31-10-4366978; e-mail: e.j.o.kompanje@erasmusmc.nl
pervasive fear, sometimes so strong that people are sure they
are about to die and are afraid to go to sleep again. Other parts
of their hallucination, which may include people, animals,
parts of objects, or just shapes, have a nightmarish quality.
People visualize intruders, demons, spirits, animals or vam-
pires in their bedroom; they see someone or something coming
through the window, they hear footsteps getting closer and
they fear they would be killed or raped in their bed being
unable to escape. Some victims see strangers walk in and out of
their bedroom. Sleep paralysis and hypnagogic and hypno-
pompic hallucinations form the basis for historical Ôold hag
attacksÕ, noctural attacks and rapes, space alien abductions
and ghostly visitations (Cheyne et al., 1999a,b; Gangdev, 2006;
McNally and Clancy, 2005). Sleep paralysis and hypna-
gogic ⁄ hypnopompic hallucinations can be related to specific
physiological conditions identified for REM states (Cheyne
et al., 1999a,b). They arise from temporary discordance in the
architecture of REM sleep (McNally and Clancy, 2005).

464  2008 European Sleep Research Society

 Sleep paralysis and hallucinations described in 1664
Most often is cited that the first description of hypnogogic
hallucinations is published in 1846 by the French psychiatrist
Jules-Gabriel-François Baillarger (1809–1890), who called
them psycho-sensory hallucinations (Baillarger, 1846). The
term ÔhypnagogicÕ (ÔHallucinations HypnagogiquesÕ), from
hypnos (sleep) and agogeus (leader) was introduced by Alfred
Maury (1817–1892) in 1848, to designate the illusions herald-
ing sleep (Maury, 1848). The term ÔhypnopompicÕ, from pompe
(act of sending), was first used by Frederic W.H. Myers (1843–
1901) to describe these phenomena occurring during the
transition between sleep and awakening. This was described
in his posthumously published book ÔHuman personality and
its survival of bodily deathÕ in 1903 (Myers, 1903).
In 1664, the Dutch physician Isbrand Van Diemerbroeck
(1609–1674) (Fig. 1) published a collection of case histories
(Van Diemerbroeck, 1664). His collected work was published
in 1672 for the first time. Isbrand van Diemerbroeck was
professor of anatomy and medicine at the University of
Utrecht, The Netherlands. He is remembered for his detailed
description of the 1635 plague epidemic of Nijmegen (Van
Diemerbroeck, 1646), but also for his comprehensive work on
anatomy. His book on the plague was reprinted nine times, the
last one in 1722. The work was also translated in English in
Figure 1. Prof Dr Isbrand van Diemerbroeck (1609–1674).
 2008 European Sleep Research Society, J. Sleep Res., 17, 464–467
465
1722. Van Diemerbroeck saw the plague primarily as GodÕs
punishment for the nationsÕs sins.
The English physician and book collector William Salmon
translated the collected works in 1689 from Latin in English
under the title ÔPractical Disputations of Isbrand de Die-
merbroeck, concerning the diseases of the head, breast and
lower belly. The cures of the chief diseases of the whole head,
in Twenty Five Disputations, annexed to the Cures of the
Patients themselvesÕ. In ÔHistory XIÕ with the title ÔOf the
Night-Mare Van Diemerbroeck described the nightly experi-
ences of the 50-year-old woman. This case report is described
here in more detail. The experiences in this case could without
doubt be diagnosed as sleep paralysis accompanied by
hypnagogic hallucinations.
CASE REPORT
A woman of fifty years of age, in good plight, fleshy, strong
and plethoric, sometimes troubled with a headache, and
catarrhs falling upon her breast in the winter; the last winter,
molested with no catarrhs, but a very sore in the daytime,
but in the night time, when she was composing her self to
sleep, sometimes she believed the devil lay upon her and held
her down, sometimes that she was choaked 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, sometimes her husband hearing her make a doleful
inarticular voice, waked her himself; at what time she was
forced to sit up in bed to fetch her breath; sometimes the
same fit returned twice in a night upon her going again to
rest (citation litteral from Van Diemerbroeck, 1689: 183–
185).
Van Diemerbroeck diagnosed this condition as follows:
This affection is called Incubus or the Night-Mare, which is
an Intercepting of the Motion of the Voice and Respiration,
with a false dream of something lying ponderous upon the
Breast, the free Influx of the Spirits to the Nerves being
obstructed. He thought that due to over-redundancy of
blood in the whole body ... the Motion of the Muscles fail ...
Now, because the motion of the Muscles, for the most part
ceases in time of sleep, except the Respiratory Muscles,
therefore the failing of their Motion is first perceived, by
reason of the extraordinary trouble that arises for want of
Respiration. Now the Patient in her sleep growing sensible
of that Streightness, but not understanding the cause in that
Condition, believes her self to be overlayÕd by some Demon,
Thief, or other ponderous Body, being neither able to move
het Breast, nor to Breath. The experiences can return the
same night: ... that if she fall asleep agin, especially if she lye
upon her Back, the same Evil returns ... Van Diemerbroeck
thought that this condition was dangerous for the sleeper:
This Malady is dangerous, least the collected Vapors being
condensed in the Head, should breed a Coma, Apoplexy, or
466 E. J. O. Kompanje
the like. He gives as advice: Keep her in a pure and moderate
hot Air. Let her Diet be sparing, but of good Juice and easie
Digestion. Let her Suppers be more moderate than her
Dinners. Her Drink must be small, her Exercise moderate,
and so must her Sleep be, and let her be careful of sleeping
upon her Back. Lastly, a sedate Mind, and a soluble Body
are of great moment in this case (citations litteral from Van
Diemerbroeck, 1689).
DISCUSSION
Van Diemerbroeck described in this case report all the classic
symptoms of sleep paralysis accompanied by hypnagogic
hallucinations: 1. The woman in the case report experienced
a night-mare prior to falling asleep (Van Diemerbroeck: ...
when she was composing her self to sleep ...). 2. She was
conscious of her surroundings and able to open her eyes, but
unable to move (Van Diemerbroeck: ... she was not able to stir
her members ...). 3. She had feelings of pressure on the chest,
and feelings of suffocating and choking. In several published
accounts of sleep paralysis is described that a dreadful and evil
presence in the form of a demon, or hag sits on the victimÕs
chest and smothers or chokes the sleeper (Cheyne et al.,
1999a,b; Stores, 1998) (Van Diemerbroeck: ... she believed the
devil lay upon her and held her down, sometimes that she was
choaked by a great dog or thief lying upon her breast, so that she
could hardly speak or breath..). The motor paralysis of REM
will lead to the experience of breathing difficulties when a
subject attempt to breath deeply (Hishiwaka and Shimizu,
1995) (Van Diemerbroeck: Now, because the motion of the
Muscles, for the most part ceases in time of sleep, except the
Respiratory Muscles, therefore the failing of their Motion is first
perceived, by reason of the extraordinary trouble that arises for
want of Respiration). 4. Hypnagogic-hypnopompic speech
phenomena are apparently non-sensical or irrelevant state-
ments or responses the subject makes as he ⁄ she falls asleep or
wakes up (Mavromatis, 1987.), (Van Diemerbroeck: ... her
husband hearing her make a doleful inarticular voice ...).
Other possible diagnoses are other parasomnia as Pavor
nocturnus (night terror or night panic) or a nightmare. However
this seems not very plausible. Pavor nocturnus is common in
children, but rare in adults. Further, Van Diemerbroeck does
not describe the characteristic extreme terror, the temporary
inability to regain full consciousness, the loud screaming which
is usually associated with waking and the inability to recall the
night terror by the subject. The subjects have usually complete
amnesia for the episode. Further pavor nocturnus usually occurs
after REM-sleep, and not directly after falling asleep (Pressman
et al., 2005). A nightmare is a long, frightening dream which
wakes the dreamer (Nielsen & Levin, 2007). Hypnagogic
hallucinations are waking-nightmares (Cheyne, 2003), as in
the case described by Van Diemerbroeck.
Very interesting is Van DiemerbroeckÕs observation: ... that
if she fall asleep agin, especially if she lye upon her Back, the
same Evil returns ... and the advice Van Diemerbroeck give to
the woman: ... and so must her Sleep be, and let her be careful of
sleeping upon her Back. Dahmen and Kasten (2001), Dahmen
et al. (2002) and Cheyne (2002) found that supine position of
the body was by far the most likely position to be associated
with hallucinations and ⁄ or sleep paralysis. Dahmen and
Kasten (2001), Dahmen et al. (2002) found in narcoleptic
patients that 80% of hallucinations and 86% of sleep paralysis
occur in supine position. They concluded that underlying brain
functions in sleep are affected by posture. No less than
337 years earlier than the observations by Dahmen et al., Van
Diemerbroeck must have based his advice on the same kind of
observations and stories told by his patients in which night-
mares, sleep paralysis and hallucinations occur more frequent
in supine position.
The famous painting ÔThe nightmareÕ by the Swiss-born artist
Henry Fuseli (1781) which is present in the Detroit Institute of
the Arts, is a classic depiction of sleep paralysis and hypnagogic
hallucination, and is often seen as the earliest account of the
condition (Baumann et al., 2007). Baumann et al. concluded
that Füssli himself might have suffered from sleep paralysis with
hallucinations and that, to the best of their knowledge, there was
no comparably correct description in the world literature, which
was the inspiration fro his paintings. However, the description
by Van Diemerbroeck from 1664 should be cited as one of the
earliest detailed scientific accounts of sleep paralysis associated
with hypnagogic illusions and as the first observation that sleep
paralysis and hypnagogic experiences occur more often in supine
position of the body. Pearce (1993) gives some early descriptions
of sleep paralysis, dating back to 1834.
CONFLICT OF INTEREST
None.
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