Have you ever had a nightmare so vivid that you worried it might be real?
Or woken from a dream with a feeling that you might not actually be awake? These are some of the feelings you might have during an episode of sleep paralysis, but there are much scarier symptoms as well.
Sleep paralysis is a type of parasomnia in which you are conscious but unable to move your body.
It can happen when you’re falling asleep or as your waking up, and these episodes can last anywhere from a few seconds to several minutes. As you lie there, unable to move, you may be overcome by an increasing sense of anxiety or fear – some people even hallucinate.
Though sleep paralysis may make you feel as if you are living a nightmare, it is generally not an indication of an underlying psychiatric disturbance.
It happens when your body has trouble moving from one sleep stage to the next, and it can result from stress, sleep deprivation, or other sleep conditions.
In this article, we’ll explore the topic of sleep paralysis in depth, providing an overview of what it is, what symptoms it causes, and how it is related to other sleep disorders. We’ll also provide information about diagnosis and treatment options.
What is Sleep Paralysis?
Sleep paralysis is classified as a parasomnia. According to the National Sleep Foundation, the term parasomnia refers to abnormal things that occur during sleep. Examples of other parasomnias include sleep walking, sleep-related eating disorder, and nightmares.
In order to understand sleep paralysis, you need to understand the way your body moves through the different stages of sleep.
There are four stages of sleep – three stages of non-REM (NREM) sleep and REM sleep.
The first is the lightest stage of NREM sleep and is characterized by slow eye movements and relaxed body tone and brain wave activity.
Stage 2 is the first clearly defined stage of NREM sleep in which brain waves continue to slow with specific bursts of rapid activity known as sleep spindles. The third stage is deep NREM sleep, the most restorative stage.
Rapid Eye Movement (REM) sleep is the dreaming stage. Your brain becomes more active during this stage, and your eyes move quickly from side to side.
Sleep paralysis is often described as an extension of this dream state. As such, it is technically harmless, but it can be accompanied by unpleasant symptoms and hallucinations which can be unsettling or even scary.
What exactly is sleep paralysis?
When you are asleep, your brain allows your muscles to relax – this is called atonia. Sleep paralysis is atonia that occurs while you are conscious.
During an episode of sleep paralysis, you may feel as though you are awake but may be unable to move or speak.
You’re still able to breathe normally, but your ability to move your arms, legs, head, and body is lost. You’ll be fully aware of what is happening but may be unable to break free from the episode.
For many people, episodes of sleep paralysis can be very scary. As you become more aware of the parasomnia, you may start to feel increasingly more anxious and afraid. Some people even experience hallucinations in which they are able to see, hear, or feel things that aren’t really there – one of the most common hallucinations is the feeling that someone else is in the room.
What Are the Symptoms of Sleep Paralysis?
Many people who experience sleep paralysis have their first episode during the teen years. The condition typically occurs most frequently during the 20s and 30s but may taper off into the later years. Though it appears most commonly in adolescents aged 14 to 17, sleep paralysis can affect men and women of any age.
According to a systematic review, an estimated 7.6% to nearly 35% of people have the condition and having a relative with sleep paralysis increases your risk.
You may also be more likely to develop sleep paralysis if you are sleep-deprived or have a sleep schedule that changes frequently.
Chronic stress is a risk factor as well, and you may be more likely to experience sleep paralysis when sleeping on your back.
The use of certain medications and concurrent psychiatric disorders like bipolar disorder or panic disorder have also been linked to sleep paralysis.
Some of the most common symptoms of sleep paralysis include the following:
- Inability to move or speak while falling asleep or waking up
- Visual or auditory hallucinations (such as a sense of evil presence, a feeling of being touched, or hearing voices or noises)
- Seeing faces or people standing by the bed
- A sense of breathlessness or pressure on the chest
There are two types of sleep paralysis: hypnopompic and hypnagogic.
Hypnopompic sleep paralysis occurs while you are waking from sleep while hypnagogic sleep paralysis happens while falling asleep.
Again, it is thought to be a problem related to the regulation of REM sleep because the body is physically paralyzed by sleep, but the mind is awake.
What Causes Sleep Paralysis?
Estimates regarding the prevalence of sleep paralysis vary and certain populations seem to be affected at a higher rate than others.
For example, in a study of college students, as many as 21% were found to have experienced at least one episode while only 4% had experienced 5 or more.
People with certain psychiatric disorders such as anxiety, depression, bipolar disorder, and panic disorder may have a higher risk, as do people who frequently use or abuse drugs and alcohol.
The cause of sleep paralysis is simply a disruption in the transition between sleep stages or between sleeping and waking.
Though this is the underlying cause, there are several things which can trigger an episode of sleep paralysis, including the following:
- Sleep deprivation
- Changes in sleep schedule
- Sleeping on your back
- Using certain medications
- Sleep disorders
Sleep paralysis is a symptom of several sleep disorders including narcolepsy and obstructive sleep apnea.
Narcolepsy is a neurological condition characterized by excessive daytime sleepiness and, in some patients, uncontrollable attacks of sleep.
Another condition that has been linked to sleep paralysis is obstructive sleep apnea.
People with this condition experience periodic cessations in breathing during sleep which can trigger the brain to wake the body. Symptoms are most likely to occur when sleeping on the back, which may be why it is also linked to sleep paralysis.
Though sleep paralysis is known to be a physical phenomenon, it has a long history of association with supernatural or paranormal experiences.
Sleep paralysis has occurred throughout history and, prior to modern medicine, it was given many unscientific explanations such as the following:
- Paranormal encounters such as ghosts, demons, or devils
- Supernatural beings such as aliens
- Near-death experiences
- Underlying psychiatric disturbances
- Intense dreams or nightmares
The important thing to remember is that while episodes of sleep paralysis may be unpleasant or scary, they are not inherently dangerous.
For many people, sleep paralysis is an isolated incident, but if it starts to happen with some regularity, you may want to talk to your doctor. The explanation could be as simple as stress or a new medication, but it is worth your peace of mind to find out.
How is Sleep Paralysis Diagnosed?
As a parasomnia and a symptom of several sleep disorders, sleep paralysis is not considered a clinical diagnosis in most cases.
You may, however, want to seek treatment or at least consult your primary care physician if you experience the following:
- You have episodes of sleep paralysis on a regular basis
- You start to experience anxiety about going to sleep
- You have difficulty falling asleep at night
- You fall asleep suddenly during the day or at inappropriate times
- You experience excessive daytime sleepiness
Feeling excessively sleepy during the day or falling asleep uncontrollably are both symptoms of narcolepsy which is a serious but treatable condition.
Even if you don’t have narcolepsy, there are still things that can be done to manage or reduce the risk of sleep paralysis. The first step, however, is talking to your doctor about your concerns.
To gather more information about your symptoms, your doctor may do the following:
- Ask you to describe your symptoms in detail
- Request that you keep a sleep diary for 7 days or so
- Discuss your medical history and family history, including sleep disorders
- Conduct an overnight sleep study or daytime nap study
- Refer you to a sleep specialist for further evaluation
The primary goal of diagnosis for sleep paralysis is ruling out underlying conditions which may be contributing to your symptoms.
If your doctor doesn’t think you have a sleep disorder or contributing medical condition, you might still benefit from seeing a sleep specialist or a counselor who might be able to help you identify potential triggers such as stress or an underlying psychiatric condition.
What Are the Treatment Options for Sleep Paralysis?
Because sleep paralysis is not technically a sleep disorder or medical problem, it may not require treatment. You may, however, be wondering whether there is anything you can do to stop an episode once it starts. In some cases, concentrating very hard on moving your body in some way might be able to help you break through – another option is to simply wait to fall back asleep or for it to pass.
If you find yourself becoming anxious, try to focus on your breathing as one thing you can fully control – remind yourself that the episode is temporary and that it won’t hurt you.
If you begin to experience hallucinations, you might try imagining yourself as a character in a horror film as a way of staying in control of the situation and keeping as calm as possible.
If all else fails, engage your mind by thinking of something else entirely until the moment passes, or you fall back asleep.
Dealing with an episode of sleep paralysis as it happens is one thing, but what can you do to prevent it from happening again or, at the very least, to reduce the likelihood?
The first step in treating sleep paralysis is to think about any underlying factors that might be at play. If you’ve been particularly stressed or sleep-deprived lately, that could certainly be a factor. Sleeping on your back rather than your stomach or side can sometimes trigger an episode, and substances that affect your sleep cycle can be a factor as well. If your doctor has diagnosed you with another sleep disorder like obstructive sleep apnea or narcolepsy, treating that condition may resolve your symptoms.
Here are some other things you can try to treat or prevent sleep paralysis:
- Sticking to a regular sleep schedule. One of the main triggers for sleep paralysis is sleep deprivation, so creating and sticking to a regular sleep schedule with consistent bedtimes and wake times may help you get the sleep you need.
- Improving your sleep hygiene. Getting better quality sleep and staying asleep through the night may reduce the risk for episodes of sleep paralysis. It may help to keep your bedroom cool, dark, and quiet, and you should limit screen time in the evenings.
- Using antidepressant medication. In some cases, a brief course of antidepressant medication might help to regulate your sleep cycle and prevent sleep paralysis. Selective serotonin reuptake inhibitors (SSRIs), for example, suppress REM sleep and may prevent sleep paralysis.
- Take steps to manage your stress. Mental stress is a key trigger for sleep paralysis, so taking steps to relax and reduce your stress may help. Try meditation or breathing exercises and make time to do a relaxing activity for 30 minutes before bed.
- Try different sleeping positions. Many episodes of sleep paralysis occur when the patient is sleeping on their back, so try sleeping on your side or on your stomach, if it’s comfortable.
- Talk to your doctor about medications you are taking. In some cases, sleep paralysis can be a side effect of medication, or it can be triggered by a change in medications. Talk to your doctor about any medications you are taking to see if it might be a factor in your sleep paralysis.
Sleep paralysis can be an unsettling experience at best and a terrifying one at worst.
Though there is no risk of physical harm during these episodes, experiencing just one is more than enough for most people.
If you’ve experienced sleep paralysis or if you have recurring episodes, it may be worth talking to your doctor to identify potential triggers or underlying medical factors.
Disclaimer: The information on this website is not intended to be used as a substitute for professional medical advice, clinical diagnosis, or treatment. Always seek the advice of your personal physician or another qualified health provider with any questions you may have regarding a medical condition.