Sleep paralysis is a feeling of being unable to move, either at the onset of sleep or upon awakening.

The individual’s senses and awareness are intact, but they may feel as if there is pressure on them, or as if they are choking.

It may be accompanied by hallucinations and intense fear.

Sleep paralysis is not life-threatening, but it can cause anxiety. It can happen alongside other sleep disorders, such as narcolepsy.

It often starts during adolescence, and it can become frequent during the 20s and 30s. It is not a serious risk.

[Sleep paralysis]
Hallucinations and a feeling of terror often accompany sleep paralysis.

Sleep paralysis is a parasomnia, or an undesired event that is associated with sleep.

It happens just after falling asleep or upon awakening in the morning, in the time between waking and sleep.

Episodes are often accompanied by hypnagogic experiences, which are visual, auditory, and sensory hallucinations.

These occur during the transition between sleeping and waking, and they consistently fall into one of three categories:

  • Intruder: There are sounds of doorknobs opening, shuffling footsteps, a shadow man, or sense of a threatening presence in the room.
  • Incubus: Feelings of pressure on the chest, difficulty breathing with the sense of being smothered, strangled or sexually assaulted by a malevolent being. The individual believes they are about to die.
  • Vestibular-motor: A sense of spinning, falling, floating, flying, hovering over one’s body or another type of out-of-body experience.

The experience of sleep paralysis has been documented for centuries. People from different cultures have similar experiences.

Sleep paralysis is brief and not life threatening, but the person may remember it as haunting and horrifying.

[Sleep paralysis stress]
Sleep paralysis is more likely when a person is under stress.

While sleeping, the body relaxes, and voluntary muscles do not move. This prevents people from injuring themselves due to acting out dreams. Sleep paralysis involves a disruption or fragmentation of the rapid eye movement (REM) sleep cycle.

The body alternates between rapid eye movement (REM) and non-rapid eye movement (NREM).

One REM-NREM cycle lasts around 90 minutes, and most of the time spent sleeping is in NREM. During NREM, the body relaxes. During REM, the eyes move quickly, but the body is relaxed. Dreams occur at this time.

In sleep paralysis, the body’s transition to or from REM sleep is out of sync with the brain. The person’s consciousness is awake, but their body remains in the paralyzed sleep state.

The areas of the brain that detect threats are in a heightened state and overly sensitive.

Factors that have been linked to sleep paralysis include:

  • narcolepsy
  • irregular sleeping patterns, due, for example, to jet lag or shift work
  • sleeping on your back
  • a family history of sleep paralysis

Sleep paralysis can be a symptom of medical problems such as clinical depression, migraines, obstructive sleep apnea, hypertension, and anxiety disorders.

Signs and symptoms include:

  • an inability to move the body when falling asleep or on waking, lasting for seconds or several minutes
  • being consciously awake
  • being unable to speak during the episode
  • having hallucinations and sensations that cause fear
  • feeling pressure on the chest
  • having difficulty breathing
  • feeling as if death is approaching
  • sweating
  • having headaches, muscle pains, and paranoia

Everyday non-threatening sounds, sensations, and other stimuli that the brain normally ignores become disproportionately significant.

[Sleep paralysis exercise]
Regular exercise at least two hours before you sleep can help to combat sleep paralysis.

Sleep paralysis is not normally considered a medical diagnosis, but if symptoms are of concern, it may be a good idea to see a doctor.

Medical attention may help when:

  • sleep paralysis happens regularly
  • there is anxiety about going to sleep or difficulty falling asleep
  • the individual falls asleep suddenly or feels unusually sleepy during the day

Suddenly falling asleep during the day could be a sign of narcolepsy, a rare brain disorder that causes a person to fall asleep or lose muscle control at unexpected or inappropriate times.

If stress or anxiety are present, addressing these may help relieve symptoms.

There is no specific treatment for sleep paralysis, but stress management, maintaining a regular sleep schedule, and observing good sleep habits can reduce the likelihood of sleep paralysis.

Strategies for improving sleep hygiene include:

  • keeping bedtime and wake-up time consistent, even on holidays and weekends
  • ensuring a comfortable sleep environment, with suitable bedding and sleepwear and a clean, dark and cool bedroom
  • reducing light exposure in the evening and using night-lights for bathroom trips at night
  • getting good daylight exposure during waking hours
  • not working or studying in the bedroom
  • avoiding napping after 3.00 p.m. and for longer than 90 minutes
  • not eating a heavy evening meal, or eating within 2 hours of going to bed
  • not sleeping with the lights or television on
  • abstaining from evening alcohol or caffeine products
  • exercising daily, but not within 2 hours of bedtime
  • including a calming activity in the bedtime ritual, such as reading or listening to relaxing music
  • leaving phones and other devices outside the bedroom
  • putting electronics aside at least 1 hour before going to bed

The following additional measures may help:

  • managing any depression or anxiety disorder
  • reducing intake of stimulants
  • practicing meditation or regular prayer
  • not sleeping on your back

Understanding the physiology of sleep and the mechanism for sleep paralysis is an important step to overcoming it.

Ongoing stress and disruption in the sleep cycle can have serious health implications. Healthy sleep habits are not just necessary for sleep paralysis management, but for overall health and wellness.

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