Sleep Paralysis

Table of Contents

Sleep paralysis refers to an inability to move the body just as a person is falling asleep or waking up. During an episode of sleep paralysis a person remains fully conscious and able to breathe, yet feels paralyzed and may experience hallucinations. While episodes of sleep paralysis are brief and not considered dangerous, fear associated with this condition can lead to anxiety and affect the quality of a person’s sleep.

Fortunately, people who experience sleep paralysis can take steps to minimize the effects of this condition. We take a closer look at sleep paralysis, including causes, symptoms, treatments, and how to reduce the risk of an episode.

Sleep paralysis is a parasomnia, which is a group of sleep disorders that involve abnormal experiences while a person is sleeping or transitioning between wakefulness and sleep.

During a night of sleep, people move through several sleep cycles, each consisting of four sleep stages. One of these stages, called rapid eye movement (REM) sleep, is a period in which breathing becomes quick and irregular, heart rate increases, and the eyes move quickly back and forth. At the same time, many muscles in the body become temporarily paralyzed.

Sleepers often have vivid dreams during this sleep stage and experts believe that temporary muscle paralysis during REM sleep may prevent people from acting out their dreams.

Sleep paralysis occurs when aspects of REM sleep continue even after a person wakes up. Although the sleeper is fully conscious, the eye movements, breathing patterns, heart rate, and muscle paralysis characteristic of REM sleep continue for a few seconds to several minutes.

While estimates vary, experts believe that up to 20% of the general population may experience sleep paralysis on occasion. Sleep paralysis often begins between 14 and 17 years old, but can occur in any age group. Episodes of sleep paralysis are more common in people with narcolepsy, a sleep disorder that affects the brain’s ability to regulate sleep-wake cycles, as well as in people with certain mental health conditions.

Types of Sleep Paralysis

Sleep paralysis may be a rare and isolated symptom or it may be related to another condition. Researchers generally categorize sleep paralysis into two categories.

• Isolated recurrent sleep paralysis: According to the American Academy of Sleep Medicine, isolated recurrent sleep paralysis is a diagnosable sleep disorder that involves multiple episodes of sleep paralysis that can’t be attributed to another cause, like a sleep disorder, medical condition, or medication.
• Sleep paralysis associated with another condition: Sleep paralysis may also be a symptom of an underlying condition. Several sleep disorders can trigger episodes of sleep paralysis, as can certain mental health conditions, medical conditions, medications, and the use of some illegal drugs.

Is Sleep Paralysis Dangerous?

Although episodes of sleep paralysis can be frightening, they are not dangerous. Episodes are usually brief and a person quickly regains their ability to move. There are no known complications or long-term medical problems that are caused by sleep paralysis.

Although a sleeper is safe during an episode of sleep paralysis, the experience can be disturbing and lead to anxiety. Fear associated with sleep paralysis may develop into an anxiety disorder if left untreated. Anxiety can contribute to poor quality sleep, which may then lead to additional episodes of sleep paralysis.

Sleep Paralysis Interpretation

The interpretation of sleep paralysis varies across cultures, yet there are common threads from place to place. Many cultures refer to a supernatural element, such as a ghost or demon in the room, as the cause of hallucinations and other symptoms of sleep paralysis.

In China, sleep paralysis may also be called “ghost oppression.” Across the world in Germany, the same experience may be interpreted as “hexendruchem” which roughly translates to “witches passing.” In areas of Vietnam and Laos, the expression “a pressing spirit” describes the sensations of chest pressure associated with sleep paralysis.

Researchers are still working to understand the causes of sleep paralysis. However, research indicates that sleep paralysis can be associated with a variety of other issues, like sleep loss, sleep disorders, and the side effects of certain medications.

Experts believe that, for most people, isolated experiences of sleep paralysis are caused by sleep deprivation. People who do not get enough sleep, along with individuals with irregular sleep schedules like shift workers, are more likely to experience sleep paralysis.

Individuals with sleep disorders, including narcolepsy, circadian rhythm sleep disorders, and obstructive sleep apnea, may also experience sleep paralysis. Mental health conditions may also play a role and people with anxiety, post-traumatic stress disorder, and bipolar disorder are more susceptible to episodes of sleep paralysis.

Sleep paralysis is also linked to the use of certain substances. Many people use medications and other substances that suppress REM sleep, like alcohol, amphetamines, and antidepressants. If these medications are stopped abruptly, a sleeper may experience a sudden increase in REM sleep that could trigger an episode of sleep paralysis.

Other factors that may influence a person’s risk of experiencing sleep paralysis include family history and stress. Interestingly, research has shown that sleep paralysis is more common when people sleep on their back.

The primary symptom of sleep paralysis is the inability to move when falling asleep or waking up. A person experiencing sleep paralysis is awake, but unable to speak or move their torso, limbs, or head. Breathing is typically unaffected and episodes of sleep paralysis typically last several seconds to minutes.

Up to 75% of episodes of sleep paralysis involve hallucinations. Hallucinations are often visual and dreamlike, but may also involve hearing, feeling, or a vague sense of a presence in the sleeper’s room. For many people, hallucinations can be frightening and come with the desire to get away. In general, hallucinations associated with sleep paralysis can be separated into three categories.

• Intruder hallucinations: Intruder hallucinations involve sensing, hearing, feeling, or seeing a dangerous person or other presence in the bedroom.
• Incubus hallucinations: Incubus hallucinations involve feeling pressure on the chest. These hallucinations often occur at the same time as intruder hallucinations.
• Vestibular-motor hallucinations: These hallucinations include imagined feelings of movement or an out-of-body experience.

For most people, sleep paralysis is a rare occurrence that doesn’t require treatment. Episodes are short lived and people regain muscle control after a few seconds or minutes. While episodes of sleep paralysis can be frightening and produce anxiety, episodes are not inherently dangerous.

While there’s no treatment that can stop an active episode of sleep paralysis, one study shows a potential benefit from a combination of meditation techniques and muscle relaxation. In some cases, an active episode can be stopped with focused attention or by the touch or voice of another person.

In people who experience regular episodes of sleep paralysis, or when an underlying cause of episodes is found, there are several options for treatment. Treatments generally focus on identifying and treating the underlying trigger, like sleep loss, mental health conditions, or medical issues.

Talking to a doctor is important because, without support, people with sleep paralysis may feel ashamed or embarrassed. Doctors can offer reassurance and suggest treatments that may be beneficial.

• Sleep: In most cases, sleep paralysis is linked to sleep loss, and catching up on sleep can help to reduce the risk of future episodes.
• Medication: While several drugs may be used to treat sleep paralysis, there is limited evidence about the benefit of medication.
• Talk therapy: People with sleep paralysis may benefit from talking to a professional who can help reduce the fear and anxiety caused by episodes. Professionals can also address any underlying mental health conditions and provide more structured therapy that focuses on improving sleep habits as well as thoughts and behaviors.

Although it’s not always possible to prevent an episode of sleep paralysis, there are steps people can take to reduce their risk. Because sleep loss is the most common cause of this condition, people can start by improving their sleep hygiene.

• Stick to a bedtime: Aim to maintain a consistent time for going to bed and waking up throughout the week, including weekends.
• Watch the caffeine: Reduce your intake of caffeine before bed, as it can make it difficult to fall asleep and negatively affect your sleep quality.
• Eat dinner early: Avoid eating a large meal before going to sleep. If you are hungry around bedtime, try a light snack instead.
• Wind down before bed: Schedule some relaxing activities before bed that can help you slow down and prepare for sleep. Consider a hot bath, reading a book or magazine, or listening to soft music.

One of the most important steps to avoiding sleep paralysis is to talk to a doctor. A doctor can help to explain sleep paralysis, provide support, check for underlying health conditions, and offer advice on how to improve your sleep habits.

About The Author

Dr. Michael Breus

Clinical Psychologist, Sleep Medicine Expert

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Michael Breus, Ph.D is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. He holds a BA in Psychology from Skidmore College, and PhD in Clinical Psychology from The University of Georgia. Dr. Breus has been in private practice as a sleep doctor for nearly 25 years. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is also the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan, Good Night!, and Energize!

• POSITION: Combination Sleeper
• TEMPERATURE: Hot Sleeper
• CHRONOTYPE: Wolf

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