Sleep paralysis is a relatively common experience, estimated to occur in about 8% of the general population at least once in their lifetime. It happens when someone wakes up during REM sleep, but their body remains partly in the REM atonia state, unable to move. This experience can be scary, but there are usually signs that someone is having an episode of sleep paralysis.
What is sleep paralysis?
During REM (rapid eye movement) sleep, your body is essentially paralyzed, so that you don’t act out your dreams. This temporary paralysis is called REM atonia. Sleep paralysis happens when you wake up before REM atonia has stopped. You may awake to find yourself unable to move or speak for a short time.
An episode of sleep paralysis can last from a few seconds to several minutes. Though you can’t move or speak, you remain aware of your surroundings. Some people also experience hallucinations during sleep paralysis, sometimes accompanied by a sense of pressure on the chest, difficulty breathing, and a feeling of fear or dread.
What are the signs someone is experiencing sleep paralysis?
Since a person experiencing sleep paralysis is awake but unable to move or speak, some of the signs include:
- Appearing wide awake but unable to move or respond
- Unable to talk, aside from slight moans or mumbles
- Rapid eye movements or twitching
- Intermittent, irregular breathing
- Look of fear, anxiety, or struggle on their face
In mild cases, the episode may resolve on its own after a minute or two. In more severe cases, the person may continue trying unsuccessfully to move or cry out.
What are some other symptoms that may accompany sleep paralysis?
In addition to paralysis and inability to speak, some other symptoms can happen along with sleep paralysis episodes:
- Hallucinations: Up to 75% of people with sleep paralysis report visual, auditory, or tactile hallucinations. These hallucinations often involve a sense of an evil presence, like an intruder in the room. People may also hallucinate a pressure on their chest, being touched or grabbed, out-of-body experiences, or flashing lights.
- Fear and anxiety: The inability to move paired with hallucinations commonly produces a sense of fear or panic in those experiencing sleep paralysis. They may feel afraid someone is watching them or feel a sense of doom.
- Difficulty breathing: Some people report sensations of chest pressure, choking, or difficulty breathing during episodes. However, sleep paralysis does not actually obstruct breathing.
- Racing heartbeat: The fear and anxiety caused by sleep paralysis can also trigger a faster heartbeat.
How long does sleep paralysis last?
Sleep paralysis episodes typically last only a few seconds to several minutes. In rare cases, they may persist for up to an hour. The average duration is estimated to be around 2-6 minutes.
Even though an episode may seem to last a long time to the person experiencing it, it will eventually end as the REM atonia wears off and normal muscle movement returns.
Are there any risk factors for sleep paralysis?
Certain factors can increase someone’s risk of experiencing sleep paralysis:
- Sleep deprivation – Lack of sleep can trigger episodes.
- Inconsistent sleep schedule – Frequent changes in sleep timing interrupts the sleep cycle.
- Sleeping on the back – Sleeping in the supine position makes sleep paralysis more likely.
- Substance use – Alcohol, sleep aids, and other drugs can increase episodes.
- Mental health conditions – Anxiety, depression, bipolar disorder, and PTSD are associated with more sleep paralysis.
- Family history – Sleep paralysis seems to have a genetic component and run in families.
How is sleep paralysis diagnosed?
Sleep paralysis is mainly diagnosed based on the person’s description of their episodes. There are no blood tests or imaging that can diagnose sleep paralysis. However, a doctor may order a sleep study or overnight polysomnography if other sleep disorders are suspected.
Criteria doctors use to diagnose sleep paralysis include:
- Inability to move or speak when waking up or falling asleep
- Awareness of surroundings during the episode
- Duration less than one hour, often just minutes
- No seizure-like movements
The doctor will want to rule out other conditions like generalized seizures or narcolepsy that can have similar symptoms.
Are there ways to stop or prevent sleep paralysis?
While there’s no foolproof way to completely prevent sleep paralysis, some strategies that may help reduce episodes include:
- Getting enough sleep on a regular schedule
- Avoiding alcohol and stimulant drugs around bedtime
- Managing stress through relaxation techniques
- Using behavioral therapies for anxiety or PTSD if present
- Trying mindfulness meditation before bed
- Avoiding sleeping only on your back
For some people, merely learning about sleep paralysis and its temporary, harmless nature can help reduce anxiety and frequency of episodes. During an attack, trying to wiggle your toes or fingers or focusing on moving just one small body part sometimes helps end the paralysis.
When should you seek emergency care for sleep paralysis?
Sleep paralysis itself is not physically dangerous, even though the experience can be very disturbing. There are a few circumstances when someone experiencing sleep paralysis should seek prompt medical care:
- Episodes are increasing dramatically or happening multiple times per night
- Sleep paralysis occurs with other worrisome symptoms like recurrent panic attacks or disordered thinking
- Paralysis episodes persist for more than 1 hour
- They begin causing significant distress or disrupting daily functioning
- The person experiences suicidal thoughts related to the episodes
Rarely, dramatic increases in sleep paralysis could signify an underlying neurological condition. Urgent medical help may also be needed if the episodes trigger mental health issues like anxiety, depression, or trauma.
Conclusion
Sleep paralysis can be an unsettling experience, but it is relatively harmless for most people. Paying attention to symptoms like inability to move, irregular breathing, and hallucinations allows recognition of an episode occurring. While not always preventable, sleep paralysis can often be minimized with sleep hygiene and stress reduction techniques. If episodes become severe or distressing, seeking medical advice is recommended to check for any underlying conditions or mental health impacts needing treatment.