What causes sleep paralysis and how to reduce your risk

insider@insider.com (Kelly Burch)
Sleep paralysis isn't harmful, but it can be frightening.
Sleep paralysis isn't harmful, but it can be frightening.

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Sleep paralysis is the feeling of being unable to move when you're falling asleep or waking up. That's because people experiencing sleep paralysis are awake and alert, but unable to move their muscles. 

The condition is relatively common, says Gonzalo Laje, MD, director of Washington Behavioral Medicine Associates in Chevy Chase, Maryland. Roughly 8% of people in the U.S. will experience sleep paralysis at least once in their lives. 

Although the experience can be scary, it is not harmful and most episodes resolve on their own within minutes. "For the most part it is something that is benign and knowing more about it helps a lot," Laje says. 

What causes sleep paralysis? 

During REM sleep, your body stops most muscle movement. This is called REM sleep atonia and it's meant to keep you safe while you dream. 

"The body paralyzes itself during REM sleep, so we don't act out our dreams and hurt ourselves or our bedpartners," says Nate Watson, MD, co-director of the University of Washington Medicine Sleep Center. 

Sleep paralysis occurs when you enter antonia without being in REM sleep — while the mind is still conscious — and is often the result of an irregular sleep-wake cycle. 

Sleep paralysis can occur at two points, says Patricia Celan, MD, a psychiatry resident at Dalhousie University in Nova Scotia, Canada.

  • Hypnagogic or predormital type. This occurs when falling asleep.

  • Hypnopompic or postdormital type. This occurs when waking up. 

Risk factors 

Sleep paralysis is most common for people with these medical conditions or risk factors: 

  • Narcolepsy. This condition affects the regulation of the sleep-wake cycle, and often occurs with sleep paralysis.  

  • Sleep apnea. Sleep disorders like sleep apnea can increase your risk for sleep paralysis. 

  • Irregular sleep schedules. This commonly includes night-shift workers who don't have a regular sleeping routine. 

  • Post-traumatic stress disorder. PTSD, as well as high levels of stress, fatigue, or trauma can increase your risk for sleep paralysis. 

  • Genetic factors. A twin study published in the Journal of Sleep Research in 2015 found evidence that there is likely a genetic component involved in sleep paralysis. 

Treatment 

Sleep paralysis itself is not harmful and the episodes often resolve on their own, so you don't necessarily need to seek any special treatment. 

However, many people with sleep paralysis develop anxiety because the episodes can be frightening. In some cases, this can even cause insomnia if people feel afraid to sleep, Laje says. If that happens or if episodes become more frequent, it's time to seek professional help. 

"There is no definitive cure for sleep paralysis, but if someone is bothered by it, there are actions that can be taken to reduce its risk of occurring," Celan says. 

Practicing good sleep hygiene

Going to bed and waking up at the same time each day can promote a regular sleep schedule and help prevent episodes of sleep paralysis. 

In fact, people who say they have good sleep quality are less likely than those who have bad sleep quality to experience sleep paralysis.

"Treating sleep paralysis involves optimizing sleep habits," Celan says. "That means improving sleep hygiene so you can fall asleep more easily and get a full night's rest." 

Specifically, Celan recommends that you: 

  • Exercise early in the day 

  • Avoid drinking coffee and alcohol a few hours before bed 

  • Put all screens away an hour before bed

  • Wind down at bedtime with relaxing activities such as a hot bath or meditation

Address underlying health concerns 

Underlying sleep disorders or mental health conditions often contribute to sleep paralysis. 

If that's the case, it's most important to treat those conditions, like sleep apnea or depression, as it can help prevent sleep paralysis and improve your overall health. 

"We have the patient address their medical and sleep issues, and the sleep paralysis gets better," Watson says. 

Educate yourself

Knowing more about sleep paralysis — like the fact that it's common and not actually harmful — can make occurrences easier to deal with and help reduce anxiety about the condition. 

"When patients experience it for the first time they're freaked out, but as you learn more it's less scary," Laje says. 

Cognitive behavioral therapy 

Cognitive behavioral therapy (CBT) can help address any stress or trauma that may be contributing to sleep paralysis. 

Some types of CBT — like CBT-I, which is used to treat insomnia — also teach relaxation techniques that are useful for improving your sleep hygiene and getting better sleep. 

Medication

There is some early research that selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, can help treat sleep paralysis. 

However, Celan says that more research is needed to prove that medication can be an effective treatment. 

The bottom line

If you experience sleep paralysis once, it's not an immediate cause for concern, but you should focus on improving your quality of sleep. 

"Although scary when it occurs, sleep paralysis is generally brief, self-limited, and does not indicate the presence of narcolepsy," Watson says. "When it occurs, it is a sign that your sleep may not be healthy."

If sleep paralysis begins interfering with your life, it's time to seek medical guidance, starting with your primary care physician. 

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