Sleep Paralysis Overview

Sleep paralysis sounds unbelievable: As you lie in bed, trying to fall asleep or just beginning to wake, you feel like someone is standing over you. You try to move your head to look, but you can't. It feels like someone – or something – is holding you down.

You try to thrash your arms and legs, but you are frozen in place. Sheer panic washes over you and you may even fear you will die (or that you're already dead!).

Though this may sound like a scene from a horror movie, sleep paralysis is a very real experience. While it can be terrifying, it's not harmful.

Here's everything you need to know about what causes sleep paralysis, how it can be managed, and what you can do if you experience it.

By definition, sleep paralysis refers to the transient inability to move or speak as you go from sleep to wakefulness without symptoms of narcolepsy.

If you have experienced something similar while awake, you are familiar with the unforgettable horrors of sleep paralysis.

Sleep paralysis can occur when awakening (hypnopompic) or when falling asleep (hypnagogic), though the latter is more common in narcolepsy.

One reason people may be more likely to experience sleep paralysis closer to the morning is that this is when rapid eye movement (REM) sleep, which is associated with vivid dreaming, predominates.

There are some common features that characterize sleep paralysis, including:

• Eye movements are typically preserved
• Occurs more often when sleeping on the back
• Visual and auditory hallucinations frequently occur (such as sensing an "evil presence," a feeling of being touched, hearing voices or noises in the room, or seeing people or faces at the bedside). Some people experience happy rather than scary visions.
• Feeling of breathlessness or chest pressure, like someone standing or sitting on the chest (however, the diagram is still functional during sleep paralysis so breathing is possible)

Sleep paralysis typically occurs in people in their 20s and 30s, but someone may have had their first episode as a teen. People with certain medical or mental health conditions, such as narcolepsy, may be more likely to report episodes of sleep paralysis.

Several studies have proposed sleep paralysis has a strong genetic component and may run in families.

The study also noted that reported rates were higher in students (28%) and people with panic disorder (34%).

A 2018 study published in the online supplement to the American Academy of Sleep Medicine and the Sleep Research Society's journal Sleep found that sleep paralysis was commonly reported by student-athletes.

The study also found that that reports of sleep paralysis from students were strongly associated with depression.

Sleep paralysis is thought to be precipitated by sleep deprivation, stress, and sleep schedule disruption. It's also been associated with anxiety disorders (which can lead to lighter or fragmented sleep and insomnia).

In experiments, sleep paralysis has been shown to occur with disruption of rapid eye movement (REM) or dream sleep.

Although there may be specific triggers, sleep paralysis is believed to be a problem with the regulation of REM. During this phase of sleep, the body is kept relaxed so that dreams are not physically acted out.

When this type of relaxation (called atonia) occurs while a person is awake, it can cause temporary paralysis. Other elements of vivid dream sleep can also persist into wakefulness and may be experienced when the REM period is disrupted. 

Obstructive sleep apnea can trigger awakenings when breathing is disrupted, which in turn may result in an episode of sleep paralysis.

The association may also explain why sleep paralysis is more likely to occur when someone is sleeping on their back.

The presence of other symptoms of sleep apnea such as snoring, teeth grinding (bruxism), witnessed pauses in breathing, gasping or choking, daytime sleepiness, and frequently waking to urinate at night (nocturia) would suggest the condition as an underlying cause.

Rarely another disorder, such as focal epileptic seizures, may mimic sleep paralysis; a video EEG can help differentiate between the two.

While it can be a truly terrifying experience, sleep paralysis is harmless. It will come to an end within a few minutes, either when someone goes back to sleep or fully awakens. Most people find they are able to cope after getting reassurance that they aren't in any danger.

People who experience sleep paralysis don't typically have it frequently. When they do, the cause is usually relatively benign and there are no serious risks.

Though these episodes may be frightening and a person might even be afraid of dying during them, sleep paralysis is not harmful and generally resolves on its own without treatment.

If you're prone to episodes of sleep paralysis, avoiding sleep deprivation, stress, and alcohol and caffeine before bedtime, as well as following other sleep hygiene guidelines may be helpful.

In rare cases, people may suffer from repeated episodes and find they are unable to tolerate the associated psychological distress. Medications that suppress the REM cycle of sleep, such as selective serotonin receptor inhibitors (SSRIs) and tricyclic antidepressants (TCAs) sometimes help.

It's important that you are evaluated by your doctor to address any sleep, mental health, or other medical disorders that can disrupt sleep. For example, having a condition like sleep apnea or narcolepsy.

If you have multiple or recurring episodes of sleep paralysis and these strategies don't effectively address your distress, your doctor might refer you to a board-certified sleep specialist or have you do a sleep study.

Sleep paralysis can be terrifying while it's happening, but the experience is harmless and won't cause any lasting harm. However, if it's causing you distress, talk to your doctor about the possibility of medication or seeing a sleep specialist.

Most people who experience sleep paralysis don't need any specific treatment, but good sleep habits can help. Some people find mindfulness practices and muscle relaxation techniques helpful for coping with sleep paralysis.

When you experience sleep paralysis, focus on trying to relax your mind. Reassure yourself that you are aware of what is happening, that it is not real, that you are not in any danger, and that the sleep paralysis will soon resolve.

Some people even like to engage in the experience, such as by pretending they're an actor in a scary movie. This can give you a sense of control over an experience that can otherwise make you feel powerless.

If you can reassure and distract yourself enough to fall back asleep, the experience will quickly end. The mind is a strange and powerful thing, and sleep paralysis is another manifestation of its wondrous abilities.