What Is Sleep Paralysis?

Sleep paralysis is when you're temporarily unable to move or speak as you go from sleep to wakefulness, or vice versa. It can last seconds to minutes, during which time you may feel like you are touching, hearing, smelling, or seeing people or things that aren't really there.

You may feel anxious, scared, or even like you're going to die (or that you're already dead). You are aware of the experience, but unable to do anything to control it.

Luckily, most people who experience sleep paralysis don't typically have it often. When they do, the cause is usually relatively harmless with no serious risks. However, some conditions that can affect your health may be to blame.

Here's everything you need to know about sleep paralysis, including what causes it and what you can do if it happens to you.

Sleep Paralysis Symptoms

Sleep paralysis can occur when you're waking up, or what's called a hypnopompic state. It can also happen when you're falling asleep, or in a hypnagogic state. The latter is more common in people with narcolepsy, a sleep disorder that makes you sleep too much.

You're more likely to experience sleep paralysis closer to the morning. That's when rapid eye movement (REM), the sleep stage associated with vivid dreaming, occurs. It also happens more often when you sleep on your back.

Common features of sleep paralysis include:

• Limited eye movement
• Sense of an evil presence or impending doom
• Hallucinations: For example, having a feeling of being touched, hearing voices in the room, or seeing people or faces by the bed.
• Feeling short of breath or pressure on your chest: It may seem like someone is standing or sitting on the chest, though your breathing is not actually being affected.

For example, you may 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 feel like you can't breathe.

You may try to thrash your arms and legs, but you're frozen in place. Sheer panic washes over you. You may even fear like your life is in danger.

While many people have scary sensations, it's also possible to have pleasant ones.

Prevalence

Sleep paralysis usually happens to people in their 20s and 30s, but some have their first episode as teenagers.

People with certain medical or mental health conditions—like narcolepsy or sleep apnea—are more likely to have sleep paralysis.

Sleep paralysis has a strong genetic component and may run in families, according to a 2011 review of several studies.

A 2018 study found that student-athletes regularly reported sleep paralysis. The study also found students with depression had higher instances of sleep paralysis.

Causes

Sleep deprivation, stress, and a disrupted sleep schedule can trigger sleep paralysis.

Anxiety disorders also have a strong link, likely because they lead to insomnia or lighter, fragmented sleep.

A 2016 review found that sleep paralysis occurs with disruption of rapid eye movement (REM), or dream sleep. Although specific triggers play a role, some people believe it's related to a problem with REM regulation. During this phase of sleep, your body relaxes so that it doesn't physically act out dreams.

This type of relaxation can cause temporary paralysis if it happens while a person is awake. Other elements of vivid dream sleep can continue as you wake up and also occur with disrupted REM.

Obstructive sleep apnea can disrupt your breathing. This causes you to wake up throughout the night, resulting in an episode of sleep paralysis. This explains why someone who sleeps on their back is more likely to have sleep paralysis.

Your condition may have an underlying cause, such as sleep apnea if you have symptoms like:

• Snoring
• Teeth grinding (bruxism)
• Pauses in breathing
• Gasping or choking
• Daytime sleepiness
• Frequently waking to urinate at night (nocturia)

In rare cases, another disorder mimics sleep paralysis. One example is a focal epileptic seizure. A video electroencephalogram (EEG) can help differentiate between the two. An EEG is a test that records your brain's electrical activity.

Treatment

Sleep paralysis ends within a few minutes, either when you go back to sleep or fully wake up. Treatment is not typically needed and most people feel like they can cope after they know they're not actually in danger.

If you're prone to episodes of sleep paralysis, improving your sleep hygiene can often help. While it sounds like a sleepy shower, sleep hygiene actually refers to healthy habits that help you fall into a deep sleep. Some of these include:

• Get enough sleep
• Avoid alcohol and caffeine before bed
• Manage your stress

In rare cases, people suffer from repeated episodes and feel like they can't handle the psychological distress.

Medicine that suppresses the REM cycle of sleep sometimes helps. This includes selective serotonin receptor inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Ask your healthcare provider to evaluate you to address any sleep, mental health, or other medical disorders that can disrupt sleep, like sleep apnea or narcolepsy.

If you have multiple or recurring episodes of sleep paralysis and these strategies don't help, your healthcare provider might refer you to a board-certified sleep specialist for an evaluation that will likely include a sleep study.

Coping

Some people find that mindfulness meditation and muscle relaxation exercises help them cope with sleep paralysis.

When you experience sleep paralysis, focus on relaxing your mind. Tell yourself that:

• You know what's happening
• It's not real
• You're not in any danger
• The sleep paralysis will end soon

Some people even like to engage in the experience. They'll pretend they're an actor in a scary movie. This gives them a sense of control over something that otherwise makes them feel powerless.

If you can reassure and distract yourself enough to fall back asleep, the experience will quickly end.

Summary

Sleep paralysis is somewhat common in adults but especially affects students and people with panic disorders. It happens when the transition to sleep or awakening is disrupted, and there's an interruption in your REM sleep.

Many times people experience hallucinations that they can see, hear, smell, or feel. Most people don't like the experience and often feel scared. But usually, sleep paralysis is harmless.

If it's really bothering you or if you have other symptoms of sleep disorders, see your healthcare provider or a sleep specialist.