The truth about sleep paralysis

Annie Hayes
·8-min read
Photo credit: DeanDrobot - Getty Images
Photo credit: DeanDrobot - Getty Images

From Netdoctor

Sleep paralysis is characterised by a temporary inability to move or speak when you are waking up or falling asleep and can also include vivid hallucinations. Fortunately sleep paralysis is short-lived, but that doesn’t make the experience any less frightening and intense for those unlucky enough to endure it in the night hours.

But what causes sleep paralysis, is it dangerous and how do you treat it? We spoke to Amy Gallagher, senior sleep physiologist at Bupa’s Cromwell Hospital; and Dr Nerina Ramlakhan, a physiologist and sleep therapist; and sleep expert James Wilson AKA The Sleep Geek, to find out more about the causes, triggers and treatment options for sleep paralysis:

What is sleep paralysis?

Sleep paralysis is included within a group of sleep disorders called the parasomnias, Dr Ramlakhan explains. ‘These are abnormal behaviours which occur during sleep and which also include nightmares, night terrors, sleep walking and talking and teeth grinding.’

A person experiencing sleep paralysis has a brief loss of muscle control, known as atonia, which means they are unable to move or speak. It occurs when you’re falling asleep or just waking up, during a rapid eye movement (REM) cycle – the dreaming phase.

The main symptom of sleep paralysis is the inability to move, says Gallagher, though you may experience hallucinations, too. ‘You might feel like someone is in your bedroom, frightened or feel like a weight is on your chest,’ she says. ‘These feelings can last a few minutes.’

Under typical circumstances, atonia and vivid visions are normal aspects of REM sleep. The mental imagery makes your dreams feel real, and the loss of muscle control prevents you from acting out them out in real life. Most importantly, they end when you wake up. During sleep paralysis, however, the atonia and imagery overlap with wakefulness, resulting in an often-terrifying episode during which you’re neither fully awake nor asleep.

‘Most of us will experience an episode during our lives – known as isolated sleep paralysis – but for some sufferers it can happen numerous times a night, night after night, which is known as recurring sleep paralysis,’ says Wils0n. ‘It can be quite a horrifying experience and if you have an episode, you often feel very stressed and anxious afterwards.’

For most people, sleep paralysis is not an issue, he adds, ‘but for others who are experiencing episodes more frequently, it can cause issues around going to bed and avoiding going to sleep. This can led to sleep deprivation and have a long term impact on their physical and mental health.’

What causes sleep paralysis?

Why sleep paralysis occurs is still not fully understood. Studies that have examined data to pinpoint factors associated with a higher risk of sleep paralysis have reported mixed results. As such, multiple factors can contribute to the likelihood of experiencing the phenomenon – but, as ever, correlation does not imply causation.

Sleep paralysis appears to be especially prevalent among people with sleep disorders and other sleeping issues. ‘If you have an existing sleep disorder, such as sleep apnoea – where your breathing stops and starts while you sleep – you may experience more episodes of sleep paralysis, and it’s also more common in those with night-time leg cramps,’ says Gallagher.

Photo credit: themacx
Photo credit: themacx

It’s also more common among people who have experienced traumatic events, such as sexual abuse or emotional distress, or those who have certain mental health conditions, for example, ‘an anxiety disorder, post-traumatic stress disorder or panic attacks,’ she adds. People who have a family history of sleep paralysis are more likely to experience it, though no genetic link has been identified.

Some evidence shows that daydreamers (or people who otherwise frequently disassociate from their environment) are more likely to experience sleep paralysis. ‘I find that sufferers are often highly sensitive creative individuals who are imaginative and need an outlet for their creativity, says Dr Ramlakhan.

What triggers sleep paralysis?

Children and adults of all ages can experience sleep paralysis. While there are no confirmed triggers, sleep paralysis is sometimes associated with:

  • Symptoms of insomnia, such as lack of sleep

  • Disrupted sleep schedules, such as jet lag and shift workers

  • Withdrawal from alcohol or antidepressants

  • Sleeping on your back

  • High stress levels and anxiety

  • Substance abuse

Sleep paralysis is merely a sign that your body is not transitioning smoothly through the stages of sleep. It’s rarely linked to an underlying psychiatric problem. ‘Sleep involves lots of complicated work from our brain and we pass through the different sleep stages and even into wakefulness numerous times during the night,’ says Wilson. During this process sometimes we get "stuck" and one of the effects of this is sleep paralysis.’

What does sleep paralysis feel like?

Sleep paralysis can be terrifying for sufferers. During an episode, everyday sounds, sensations and visions become disproportionately important and often feel threatening. The most common signs and symptoms of sleep paralysis include:

  • An inability to move that can last seconds or minutes

  • Being unable to speak

  • Feeling awake and conscious

  • Experiencing hallucinations

  • A sensation of fear

  • Pressure on the chest

  • Difficulty breathing

  • Sweating

  • Headache

  • Muscle pain

  • Paranoia

  • A feeling that death is coming

The visual, auditory, and sensory hallucinations that are experienced during a bout of sleep paralysis are reported as being distinct from usual dreams. They typically fall into three categories:

  • Intruder: a feeling of sensing that a dangerous person or presence is in the room.

  • Incubus: a feeling of suffocation, or being smothered or sexually assaulted.

  • Vestibular-motor: a feeling of spinning, floating, flying, or some other out-of-body experience.

While the majority of sleep paralysis episodes are associated with fear, this isn’t always the case – some people experience pleasant and even euphoric hallucinations. Either way, the episode usually comes to an end naturally on its own, as a result of interruption by another person’s touch or voice, or occasionally as the result of extreme effort to move.

How common is sleep paralysis?

While it can be a frightening experience, it’s likely you’ll experience sleep paralysis only once or twice in your life, says Gallagher. ‘Around one in 10 people have at least one episode of sleep paralysis during their lifetime,’ she says. ‘Sleep paralysis can occur at any age, but episodes can happen more frequently in your twenties and thirties.’

While rare, some people do experience recurrent episodes of sleep paralysis. This can cause anxiety about going to sleep, which often compounds the issue. ‘People fall into a cycle of having episodes,’ Wilson explains. ‘They start to avoid sleep to avoid the episodes, which makes the sleep paralysis more frequent. Addressing underlying sleep issues is often the first step to living with sleep paralysis.’

Sleep paralysis treatment

Can you treat sleep paralysis? For most people, sleep paralysis occurs infrequently enough that it doesn’t cause an issue or require treatment. However, if it becomes a regular occurrence – or you have anxiety about going to sleep, or difficulty falling asleep – it’s worth speaking to a healthcare professional.

‘In the first instance, you should speak to your doctor about your experiences with sleep paralysis,’ advises Gallagher. ‘They’ll be able to check if there’s anything underlying that’s causing these episodes, for example a sleep disorder,’ she says. ‘If your sleep paralysis is frequent, your doctor may prescribe you medication to help, or refer you to a sleep clinic.’

Can you prevent sleep paralysis?

Improving your sleep hygiene – that is, optimising your sleep habits and environment for quality rest – is the best way to keep sleep paralysis at bay. ‘In my experience of working with people who suffer from this distressing condition, symptoms can be significantly alleviated by following good sleep routines and self-care,’ says Dr Ramlakhan.

Here are a handful of ways you can catch consistent Zzz’s:

✔️ Maintain a sleep routine

Going to bed and getting up at the same time each day – even on days off and weekends – can help you to keep a regular sleep routine, says Gallagher. Unless you’re a shift worker, you should aim to be asleep by midnight, says Dr Ramlakhan. This will optimise your circadian rhythm, which is the system responsible for regulating the sleep-wake cycle.

✔️ Get comfortable

Ensure that the bedroom and sleep space is restful, safety-inducing, and peaceful, says Dr Ramlakhan, taking sights, sounds and smells into account. ‘Make sure your room is as dark as possible, quiet and a comfortable temperature,’ advises Gallagher.

✔️ Remove distractions

Avoid using your digital devices in your bedroom – leave any laptops, tablets or phones in another room, says Gallagher, and don’t panic if you’re unable to drift off. ‘A good tip is to turn your alarm clock away from you so you can’t see it,’ she adds. ‘It can be quite stressful to see the minutes ticking by.’

✔️ Try a relaxation exercise

Mindful activities can calm a racing mind, says Gallagher. ‘Mindfulness is all about being really connected to, and aware of, what’s going on right now in our minds and in our bodies,’ she says. 'As you’re laying down in bed, familiarise yourself with your surroundings and any sensations you feel in your body.’

✔️ Foster a creative outlet

Practice positive psychology-based techniques such as gratitude, compassion and self-love exercises before going to bed to soothe and calm the nervous system and create feelings of inner safety, Dr Ramlakhan suggests. ‘Give space to creativity – write, journal, paint, dance – whatever the outlet needs to be,’ she says. ‘ It is important that this energy is channelled constructively.’

✔️ Lead a healthy lifestyle

Your physical health is just as important as your mental health, so it’s crucial to practise healthy habits that can aid a good night’s sleep, says Gallagher. ‘Reduce consumption of alcohol and caffeine – as a general guide, avoid consuming these after 3pm each day,’ she says. ‘Regular exercise that gets your heart rate up can help too but avoid exercising in the four hours leading up to bed.’

Last updated: 13-11-20

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