What Is Sleep Paralysis?

Medically reviewed by Jane Kim, MD

Sleep paralysis is the inability to move even though you feel awake and conscious. It can happen as you fall asleep or as you wake up. This physically harmless but often frightening phenomenon happens when one part of your brain wakes up from sleep but the part that inhibits movement during sleep does not.

Sleep paralysis is fairly common. It affects about 7% of the population. Most people don’t have more than one or two episodes in their lifetime unless their sleep paralysis is caused by another condition.

If needed, treatment focuses on reducing episodes and helping you cope with anxiety and stress caused by episodes. It also addresses any underlying causes of sleep paralysis.

Types

Experts usually group sleep paralysis into two categories based on how often it occurs. Both types are considered “isolated” as long as they appear without any symptoms of other sleep disorders, such as narcolepsy. Narcolepsy is a chronic neurological disorder that disrupts the brain's sleep-wake cycle.

Isolated sleep paralysis (ISP): A singular episode of sleep paralysis. Episodes are generally brief, lasting from several seconds to several minutes. You may experience more than one episode in your lifetime, but episodes don’t occur frequently or follow any particular pattern.

Recurrent isolated sleep paralysis (RISP): Repeated episodes of sleep paralysis that cause distress, including anxiety or fear. RISP can affect your overall quality of life.

Sleep paralysis is also categorized based on when episodes occur:

• Hypnagogic, or predormital sleep paralysis: Happens as you fall asleep

• Hypnopompic, or postdormital sleep paralysis: Happens as you wake up

Sleep Paralysis Symptoms

Sleep paralysis often first appears in your teenage years. Episodes most often occur in your 20s and 30s.

Episodes of sleep paralysis can last for several seconds to several minutes, during which you're fully alert and aware of your surroundings. However, you’re also locked in something called REM atonia: your muscles, including those that allow you to speak, are paralyzed because they're still set to “sleep mode."

ISP and RISP share the same symptoms. The only difference, diagnostically, is their frequency. During a sleep paralysis episode, you might notice symptoms like:

• An inability to move any part of your body

• An inability to speak or make sounds

• Full awareness or alertness to your surroundings

• Feeling heaviness or compression on your chest

• Feeling like you're suffocating

• Hallucinations, which can be extremely frightening or disturbing in nature

• A sense that someone is in the room with you

Many people experience an intense dream-like state during a sleep paralysis episode. These waking nightmares can be unpleasant and disorienting.

What Causes Sleep Paralysis?

Sleep paralysis is known as a REM sleep disorder because it occurs during the part of your sleep cycle called rapid eye movement (REM) sleep. During REM sleep, your eyes move quickly, your body relaxes, and your muscles don't move. REM sleep is also when you dream. However, your brain temporarily puts you in a state of atonia, or paralysis, because it's not safe for you to “act out” your dreams while you sleep.

During sleep paralysis, your mind wakes up but your body stays in atonia. As a result, you can't move or speak even though you’re no longer sleeping.

Sleep paralysis usually doesn’t last long. The average episode lasts about six minutes. It can often be disrupted by someone touching you or talking to you, and it eventually ends on its own.

Though sleep paralysis can happen without any known cause, certain things can trigger episodes.

ISP and RISP triggers include:

• Other sleep disorders, like narcolepsy or insomnia (a sleep disorder that can make it difficult to fall asleep, stay asleep, or both)

• Medications

• Substance use disorder

• Disrupted sleep patterns, such as jet lag or working the night shift

• Anxiety disorders like social anxiety disorder (intense fear of being judged by others), obsessive-compulsive disorder, or OCD (uncontrollable, intrusive, and continuous thoughts that lead to repetitive activities and behaviors), and generalized anxiety disorder (excessive worry and concern)

• Trauma or post-traumatic stress disorder (PTSD), a condition that can occur if you've experienced or witnessed a traumatic event, series of events, or circumstances

Risk Factors

Many people experience an episode of sleep paralysis for no apparent reason, and it can occur at any age. However, certain factors can increase your risk of experiencing sleep paralysis.

Risk factors include:

• Poor sleep quality

• High stress levels

• Mental health conditions such as panic disorder (recurrent panic attacks, often for no apparent reason) and bipolar disorder (a mental health condition that can cause mood swings and changes in energy levels)

• A family history of sleep paralysis

• Excessive use of alcohol, especially near bedtime

• Use of certain medications, such as stimulants for attention deficit hyperactivity disorder (ADHD) or beta-blockers (a class of medications used to reduce blood pressure), like Inderal LA (propranolol)

Diagnosis

Testing won't confirm a sleep paralysis diagnosis. A healthcare provider will ask you about your sleep habits, discuss your symptoms and history of sleep paralysis episodes, and rule out other conditions or parasomnias that might be causing your symptoms.

Parasomnias are conditions that disrupt your sleep. They include:

• Nightmare disorder: Frequent nightmares that cause significant distress or affect daytime functioning

• Night terrors: Also known as sleep terrors, these are episodes of intense fear while partially awake. They're commonly seen in children, but adults can also experience them. Symptoms include screaming, crying, and thrashing. The person might appear awake but will not respond if you try to wake them.

• Hallucinations: Sensing things that seem real but are not

Your healthcare provider will assess how much the episodes affect your quality of life. While any episode of sleep paralysis can be scary, recurrent episodes can create a more intense sense of fear leading to what experts call “clinical distress." This includes excessive worry about your sleep paralysis, avoidance of sleep, and daytime shame or embarrassment.

Your healthcare provider may also suggest you participate in a sleep study. For example, polysomnography tracks your heartbeat, breathing, brain activity, and arm and leg movement while you sleep. An electromyogram (EMG) tracks the electrical activity in your muscles, which would be low during a sleep paralysis episode.

Treatment

In general, sleep paralysis doesn’t require treatment, especially if it’s non-recurrent. It usually doesn't pose a risk on its own. However, RISP can affect your overall sleep quality, as well as your emotional and physical health. Therefore, you may want to seek treatment if you have recurrent episodes.

Treatment focuses on reducing your number of episodes by targeting the root cause of sleep paralysis. You might also work on coping strategies to help you manage the negative effects of sleep paralysis.

Therapy

Several types of therapy can help address underlying causes of sleep paralysis (such as anxiety) and help you develop strategies to cope with anxiety and stress during and after episodes.

Therapy might include:

• Cognitive behavioral therapy (CBT): A therapeutic approach that focuses on helping you change your thought and behavioral patterns. CBT might help address anxiety and stress caused by RISP.

• Meditation-relaxation (MR) therapy: A four-step approach that includes reassuring yourself that sleep paralysis is physically harmless and temporary and that the hallucinations aren't real, focusing inwardly on a positive thought, and relaxing your muscles. MR therapy is being explored as a potential treatment for sleep paralysis as it's happening.

Sleep Hygiene

Practicing good sleep hygiene is often part of treatment because poor or disrupted sleep is a common cause of sleep paralysis. Sleep hygiene is also a treatment for narcolepsy, as well as part of treatment for insomnia, both of which can cause or exacerbate sleep paralysis.

Recommendations for improving your quality of sleep may include:

• Go to bed and wake up at the same time every day

• Aim for seven to nine hours of sleep each night

• Keep your bedroom quiet, dark, and cool

• Get regular exercise during the day, but not too close to bedtime

• Limit your use of electronic devices 30 minutes before bed

• Avoid drinking caffeine late in the afternoon

• Avoid drinking alcohol or eating large meals at night

Medications

Medications that treat the causes of sleep paralysis including bipolar disorder and narcolepsy, can also reduce the number of sleep paralysis episodes.

Tricyclic antidepressants and selective serotonin reuptake inhibitors, or SSRIs (classes of medications used to treat depression), may also be helpful in treating RISP, but more research is needed.

Prevention

You may experience sleep paralysis at some point in your life. It's a fairly common phenomenon that affects many people at least once. It also might have a genetic component, meaning it runs in families.

Managing co-existing conditions, practicing good sleep hygiene, reducing stress, and limiting or avoiding the use of substances that can trigger sleep paralysis may help you prevent having an episode or reduce the frequency of episodes.

Related Conditions

Sleep paralysis is more common in people who have a pre-existing mental or physical health condition. Conditions related to sleep paralysis include sleep disorders like narcolepsy and mental health disorders, including PTSD.

While sleep paralysis doesn't cause other conditions, repeated episodes can contribute to poorer sleep quality, which can affect overall health. Hallucinations can also contribute to conditions like anxiety.

Living With Sleep Paralysis

Sleep paralysis itself, whether recurrent or non-recurrent, doesn’t negatively affect your health. However, repeated episodes can be very distressing and can affect your sleep quality as well as your overall quality of life.

If you have recurrent sleep paralysis, talk to a healthcare provider about reducing the frequency of episodes and learning coping tools. In general, the best approach to living with sleep paralysis is to combine prevention and treatment strategies: address any underlying health conditions, practice good sleep hygiene, and find therapies that reduce your fear, stress, and anxiety.

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