Posted by Dr Sophie Bostock - Sleep Expert on 18th Jan 2024
What is Sleep Paralysis, and What Can You Do About it?
Have you ever woken up, only to find that you’re unable to move or speak?
Have you felt intense fear, or felt as though you’re being suffocated, as you’re falling asleep?
These are some of the key sleep paralysis symptoms.
Sleep paralysis happens when part of sleep intrudes into wakefulness; you are conscious and alert, and yet your body cannot move. Most people describe the feeling of being paralysed in their own body, often accompanied by an intense fear, panic, helplessness or breathlessness. You may sense a tightening in the chest or throat, someone standing over you, or have hallucinations. Some people describe an out of body experience, where they levitate or spin. Episodes can last from a few seconds to a few minutes.
Sleep paralysis can be extremely distressing, especially when it happens for the first time. It usually occurs as you’re waking up ( hypnopompic sleep paralysis ), but can also happen as you’re falling asleep (hypnagogic). It is natural to feel anxiety about sleep after experiencing sleep paralysis.
The good news is that sleep paralysis is not actually dangerous.. most people who experience sleep paralysis will do so only once, or very rarely. A minority of people experience repetitive episodes, but there is a lot you can do to prevent this.
What happens during sleep paralysis?
Sleep paralysis is an example of a parasomnia, a disorder of the switching between different sleep stages and wakefulness.
During REM, or rapid eye movement sleep, which is when we do most of our dreaming, our voluntary muscles are usually switched off. During an episode of sleep paralysis, the brain is fully conscious, but the main muscles of the limbs, the head and the trunk are temporarily stuck in REM atonia - we cannot activate them to move or speak. A sense of threat or hallucinations can also arise from the dream state invading our waking state.
How common is sleep paralysis? Who is more likely to experience it?
It depends on the population, but probably around 1 in 10 adults have experienced at least one episode of sleep paralysis.
Like all parasomnias, sleep paralysis is more common when sleep is disrupted, for example by stress, alcohol or drug misuse, insomnia, some medications, shift work, sleep deprivation or simply irregular sleep patterns.
Sleep paralysis is also more common for people experiencing mental health disorders, such as anxiety, panic disorder or social phobia. Sleep paralysis seems to be particularly common for people with post traumatic stress disorder (PTSD) ( Denis et al 2018). Some studies suggest that sleep paralysis is more common in those with a family history of the condition.
Sleep paralysis causes
We don’t really know what causes sleep paralysis, only that it’s more common when sleep is disturbed. It’s as if when we’re sleep deprived, part of the brain is still hungry for REM sleep, and wants to hang onto it, although part of the brain is ready to wake up.
For most people, there is no known cause, and sleep paralysis may only happen once. It is often linked to:
- Stress
- Sleep disruption
- A sleep disorder, such as insomnia or sleep apnoea
- Trauma
- Common mental health disorders
- Family history
In a small minority of cases, recurrent sleep paralysis can be linked to a diagnosis of narcolepsy. Narcolepsy is a rare brain condition in which it becomes very difficult to regulate the onset of sleep. People with narcolepsy often feel extremely sleepy during the day, and can have sudden attacks of daytime sleep onset with no warning, which can be associated with muscle weakness - called cataplexy.
Sleep paralysis treatment
If sleep paralysis is linked to sleep disruption, the first step is to tackle the source of poor sleep. This might mean adopting positive sleep hygiene habits, for example:
- Stick to a regular wake up time and bedtime
- Get plenty of natural daylight during the day
- Taking time out during the day for breaks
- Minimise nicotine, caffeine and alcohol, especially before bed
- Finish your evening meal at least 2 hours before you fall asleep
- Only use your bed for sleep and intimacy
- Wind down for the last 30-60 minutes before getting into bed, such as by reading, having a warm bath or listening to calming music
- Keep screens out of the bedroom
- Protect at least 7 hours for sleep at night
If sleep paralysis is linked to a period of high stress, ask yourself: what can you do to reduce the stressor, or to increase your ability to cope? This might mean talking to your manager, or a close friend, or healthcare professional for more support.
Sleep paralysis can be more likely if you sleep on your back, so try sleeping on your side to reduce the risks. Some people find it helpful to focus on moving their fingers to help bring them out of an episode of paralysis.
If fears about sleep paralysis are interfering with your ability to sleep at night, or making you want to avoid going to bed, speak to a doctor or healthcare professional. They will try to establish whether sleep paralysis is linked to any other conditions. They might be able to refer you to talking therapy or CBT (Cognitive Behavioural Therapy). Occasionally your doctor may prescribe medication to help reduce depression or anxiety, which can also help with sleep paralysis.
Does sleep paralysis mean there is something seriously wrong with me?
Sleep paralysis can feel absolutely terrifying. Although the paralysis episodes are relatively short, worrying about them can have a persistent impact. Some people experience an intense fear of dying, which can be unsettling a long time after the event.
It’s important to know that sleep paralysis is unlikely to be a sign of anything other than a faulty sleep-wake switch in the brain, usually caused by sleep deprivation or stress. You may only ever experience it once, or you might have a brief wave of events.
If you have any concerns about sleep paralysis, don’t let feeling scared interfere with getting support. Sleep paralysis itself is not dangerous, but perhaps the most harmful aspect of it is the anxiety that it can create around sleep.
