Sleep Paralysis

What Is Sleep Paralysis?

Sleep paralysis is a condition marked by a brief loss of muscle control, known as atonia Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , that happens just after falling asleep or before waking up. In addition to atonia, people often experience hallucinations during episodes of sleep paralysis.

Sleep paralysis is considered a parasomnia, which are abnormal behaviors during sleep. Because it’s linked to the rapid eye movement (REM) sleep, sleep paralysis is considered to be a REM parasomnia. While standard REM sleep involves vivid dreaming along with atonia, both typically end upon waking up, so a person never becomes conscious of this inability to move.

As a result, researchers believe that sleep paralysis involves a mixed state of consciousness Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source that blends both wakefulness and REM sleep. In effect, the atonia and mental imagery of REM sleep seems to persist even into a state of being aware and awake.

Types of Sleep Paralysis

Medical experts typically group sleep paralysis cases into two categories Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

• Isolated sleep paralysis: These one-off episodes are not connected to an underlying diagnosis of narcolepsy, a neurological disorder that prevents the brain from properly controlling wakefulness.
• Recurrent sleep paralysis: This condition involves multiple episodes over time. Recurrent sleep paralysis can be associated with narcolepsy. 

In many cases, these two defining characteristics are combined to describe a condition called recurrent isolated sleep paralysis (RISP), which involves ongoing episodes in someone who does not have narcolepsy.

What Are the Symptoms of Sleep Paralysis?

The defining symptom of sleep paralysis is atonia, or the inability to move the body or speak. People also report:

• Difficulty breathing
• Chest pressure
• Distressing emotions like panic or helplessness
• Feeling excessively sleepy or fatigued the day after

An estimated 75% of episodes also involve hallucinations that are distinct from typical dreams. These can occur as hypnagogic hallucinations when falling asleep or as hypnopompic hallucinations when waking up. These hallucinations fall into three categories.

• Intruder hallucinations: These hallucinations involve the perception of a dangerous person or presence in the room, sometimes referred to as sleep paralysis demons.
• Chest pressure hallucinations: Also called incubus hallucinations, these episodes may incite feelings of suffocation or the sensation that someone is sitting on your chest. These frequently occur in tandem with intruder hallucinations.
• Vestibular-motor (V-M) hallucinations: V-M hallucinations can include feelings of movement, such as flying, or out-of-body sensations.

Sleep paralysis symptoms typically last anywhere from a few seconds to 20 minutes, and the average length is around six minutes Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . In most cases, episodes end on their own but occasionally are interrupted by another person’s touch or voice, or by intense effort to move that overpowers atonia.

What Causes Sleep Paralysis?

The exact cause of sleep paralysis is unknown. Studies have analyzed data to determine what heightens one’s risk of sleep paralysis, and have found mixed results. Based on those findings, researchers believe that multiple factors are involved in the onset of sleep paralysis.

Sleep Disorders

Sleep disorders and other sleeping problems have shown some of the strongest correlations with isolated sleep paralysis. Higher rates of sleep paralysis — 38% in one study Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source — are reported by people with obstructive sleep apnea (OSA), a sleep disorder marked by repeated lapses in breathing. It’s also more common in people with chronic insomnia, circadian rhythm dysregulation and nighttime leg cramps.

Narcolepsy

A pattern of multiple episodes over a period of time may be connected to narcolepsy. Narcolepsy can alter the function of neurotransmitters in the brain, which may cause complications during REM sleep, including sleep paralysis.

While roughly 20% of the general population experiences infrequent bouts of sleep paralysis, episodes are generally more frequent in those with narcolepsy. Consider speaking with your doctor if you experience signs of narcolepsy, including episodes of falling asleep without warning at inappropriate times, excessive daytime sleepiness, or muscle weakness. 

Mental Health Disorders

Certain mental health conditions have shown a connection Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source to sleep paralysis. Some of the strongest associations are in people with post-traumatic stress disorder (PTSD) and others who have been exposed to physical and emotional distress.

Those with anxiety disorders, including panic disorder, also appear to be more likely to experience the condition. Stopping alcohol or antidepressants can lead to REM rebound, which may also cause sleep paralysis. Studies have found a higher risk in people with a family history of sleep paralysis, but no specific genetic basis has been identified.

Dream Patterns    

Some studies have found that people who show traits of imaginativeness and disassociation Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source from their immediate environment, such as daydreaming, are more likely to experience sleep paralysis. There may be a link as well between sleep paralysis and vivid nightmares or lucid dreaming. Further research is necessary to investigate these correlations and better understand the numerous potential causes of sleep paralysis.

Is Sleep Paralysis Dangerous?

For most people, sleep paralysis is not considered dangerous. Though it may cause emotional distress, it is classified as a benign condition and usually does not happen frequently enough to cause significant health effects.

However, an estimated 10% of people have more recurrent or bothersome episodes that make it especially troubling. As a result, they may develop negative thoughts about going to bed, reducing time allotted for sleep or provoking anxiety around bedtime that makes it harder to get restful sleep. This resulting sleep deprivation can lead to excessive daytime sleepiness and numerous other consequences for a person’s overall health.

What Are the Treatments for Sleep Paralysis?

While sleep paralysis can feel frightening, it’s often manageable with the right approach. If you find yourself experiencing sleep paralysis, it can be helpful to focus on small, intentional movements, such as wiggling a finger or toe. Reminding yourself that the episode is temporary and not dangerous may reduce panic. Deep, steady breathing and keeping your eyes focused (if they’re open) on a fixed point can also help ease you out of paralysis more quickly.

One of the most important steps is identifying and treating any underlying issues that may be contributing to disrupted sleep. Conditions like insomnia, anxiety, depression, and narcolepsy can all increase the risk of sleep paralysis episodes. A health care provider can help diagnose these conditions and recommend appropriate treatment, which may reduce or eliminate episodes altogether.

Cognitive behavioral therapy for insomnia (CBT-I) is another evidence-based treatment Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source that may help. CBT-I works by changing unhelpful thoughts and behaviors around sleep, promoting more restful and consistent sleep patterns.

Because poor sleep habits and stress are often linked to sleep paralysis, CBT-I may indirectly reduce the frequency of episodes. Researchers are also exploring a version of CBT tailored specifically to sleep paralysis Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , but more studies are needed to confirm its effectiveness.

How Can You Prevent Sleep Paralysis?

Because of the connection between sleep paralysis and general sleeping problems, improving sleep hygiene is a common focus in preventing sleep paralysis. Creating a consistent, calming sleep routine can help stabilize your sleep cycle and reduce the likelihood of experiencing paralysis upon waking or falling asleep.

Here are several science-backed sleep hygiene tips:

• Establish a routine: Follow the same schedule for going to bed and waking up every day, including on weekends. A soothing pre-bed routine can help you get comfortable and relaxed.
• Optimize your sleep space: Outfit your bed with the best mattress and pillow for your needs. It is also useful to design your bedroom to have limited intrusion from light or noise.
• Curb substance use: Reduce alcohol and caffeine intake, especially in the evening.
• Remove distractions: Put away electronic devices, including smartphones, for at least an hour before bed.
• Manage stress: Daily stress management through mindfulness, journaling, therapy, or deep breathing can support more restful sleep.
• Get enough sleep: Most adults need seven to nine hours of sleep per night. Skimping on sleep or staying up too late can increase your risk of sleep disruptions, including paralysis.

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