Understanding the Terrors of Sleep Paralysis

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Sleep paralysis sounds unbelievable. You wake from sleep. As you lie in bed, you feel like someone is standing over you in the darkness. You try to move your head only slightly to take a subtle glance, but you can't. Someone -- something -- is surely holding you down. You attempt to struggle, to thrash your arms and legs, but you are frozen in place. Sheer panic washes over you as your paralysis lingers.

Though this may sound all too unreal, sleep paralysis is indeed a very real experience.

What Exactly Is Sleep Paralysis?

If you have experienced something similar while awakening, you are familiar with the unforgettable horrors of sleep paralysis. Sleep paralysis is a transient inability to move or speak as one goes from sleep to wakefulness, without other findings characteristic of narcolepsy. In sleep paralysis, this often occurs while awakening (hypnopompic) as opposed to falling asleep (hypnagogic), which is more common in narcolepsy.

Features of Sleep Paralysis

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

  • Eye movements are typically preserved.
  • It more often occurs while sleeping on one’s back.
  • Visual and auditory hallucinations often occur and may include a sense of an evil presence, of being touched, or hearing voices or noises in the room.
  • Occasionally faces or people may be seen at the bedside.
  • A sense of breathlessness (or chest pressure, even someone standing on one’s chest) may exist.

How Often Does Sleep Paralysis Occur?

It is common and may be experienced by 20% to 60% of people, depending on the population examined. In a study of college students, 21% were found to have had at least one episode of sleep paralysis, but only 4% had 5 or more episodes.

It is believed to be precipitated by sleep deprivation, stress, and sleep schedule disruption. In experiments, it has been shown to occur with disruption of rapid eye movement (REM), or dream sleep. It also is associated with anxiety disorders.

Continue reading to learn about the causes and treatment of sleep paralysis.

What Causes Sleep Paralysis?

Although there may be certain triggers, ultimately 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 acted out. If this relaxation, or atonia, occurs while the person is awake, it can cause temporary paralysis. This may be experienced when a REM period is disrupted.

Treatment of Sleep Paralysis

Though these episodes may be frightening, the disorder itself is not harmful and will generally resolve on its own.

No treatment is needed, but avoiding sleep deprivation, stress, and other precipitants may be helpful. These are summarized in the sleep hygiene guidelines.

For those who suffer from multiple episodes and who are unable to tolerate the psychological distress, a selective serotonin receptor inhibitor (or SSRI) may be prescribed. In addition, evaluation by a physician may be important to address sleep, mental health, or other medical disorders that can disrupt sleep.

Sources:

Koran, L.M. et al. "Fluoxetine for isolated sleep paralysis." Psychosomatics. 1993;34:184-7.

McCarty, D.E. et al. "A case of sleep paralysis with hypnopompic hallucinations." Journal of Clinical Sleep Medicine. 2009;5(1):83-84.

Morton, K. "Paralyzed at Night: Is Sleep Paralysis Normal?" Stanford Sleep & Dreams. 2010.

Spanos, N.P. et al. "The frequency and correlates of sleep paralysis in a university sample." J Res Pers. 1995;29:285-305.

Takeuchi, T. et al. "Isolated sleep paralysis elicited by sleep interruption." Sleep. 1992;15:217-225.

Takeuchi, T. et al. "Factors related to the occurrence of isolated sleep paralysis elicited during a multiphasic sleep-wake schedule." Sleep 2002;25:89-96.

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