Sleep Paralysis – Symptoms, Causes, Why It Occurs And Treatments.

Imagine that you wake up to find that you cannot move a muscle, everything is dark, but you are sure that you feel a presence in the room, floating near your bed, or perhaps sitting on your chest, pinching your breath. This strange phenomenon is known as sleep paralysis , and a new study finds that understanding why it happens helps people feel less distressed after an episode. Believing that it is caused by the supernatural, on the other hand, makes people feel more nervous.

Sleep paralysis occurs when the brain and the body are not entirely in agreement when it comes to sleeping. During rapid eye movement (REM) sleep, dreaming is common, but the muscles of the body are relaxed to the point of paralysis, perhaps to prevent people from acting on their dreams. The researchers discovered that two brain chemicals, glycine and GABA, are responsible for this muscle paralysis.

What is sleep paralysis?

It is a terrifying phenomenon in which a person wakes up from their sleep but feels completely paralyzed, unable to move or speak, the experience is usually accompanied by extreme fear and terrifying hallucinations, which can be visual, tactile and / or auditory. Many patients have reported feeling as if there is a malignant presence in the room. It generally occurs during a transitional stage of sleep, most of the time upon awakening, but occasionally while sleeping, which can last from a few seconds to several minutes.

One hypothesis is that sleep paralysis is related to a disruption in REM sleep , which occurs in conjunction with muscle atony, a state of complete muscle relaxation, or paralysis. This lack of muscle control is intended to prevent people from putting their dreams into practice. In this hypothesis, the sleeping person becomes conscious before the brain signals the body to move again, this can lead to terror and other negative emotions , leading to hallucinations of fear and dreams.

Sleep paralysis is a common condition with up to four out of ten people experiencing it at least once in their lives, those most at risk of suffering from it are sleep deprived, those under extreme stress, or those who abuse stimulants. People who practice lucid dreaming techniques are also more likely to experience this phenomenon.

The condition occurs most often in people who sleep on their backs, adjusting the body to sleep in other positions, such as on the side or stomach, appears to decrease the risk.

Symptoms of sleep paralysis

For an episode to be considered sleep paralysis, only symptoms 1-3 may occur , 4-9 may or may not be present, in varying degrees of severity.

1. Being awake:  Those affected report feeling consciously awake during experiences of sleep paralysis, it is experienced as part of waking consciousness, not as a dream.

2. Realistic perception of the environment: The immediate environment surrounding the bed is clearly perceived, distinctive elements are observed in the room (for example, a sleeping partner or a clock).

3. Inability to move: The sensation of paralysis is one of the first elements of the experience noticed by the individual, sometimes, this paralysis is attributed to an external force.

4. Overwhelming fear and dread: A sense of overwhelming fear can accompany the experience, this can be felt so strongly that those who experience it may then struggle to articulate its intensity. Sometimes the feelings progress from a hunch to outright terror and can include feelings related to death or dying.

5. Detected Presence: Individuals can sense a malevolent or “evil presence” in the room with them, this presence can be seen or simply felt.

6. Pressure on the chest: The sensation of a physical weight pressed against the chest, this can be purely sensual or it can seem the result of an external presence or force, literally pushing down.

7. Shortness of breath: This can occur along with pressure in the chest.

8. Supine position: Most attacks of sleep paralysis occur while the individual is lying on their back, although studies have shown that, in general, people tend not to fall asleep in this position.

9. Additional unusual sensations: In addition to visual hallucinations, episodes of sleep paralysis may be accompanied by hallucinations of an auditory, olfactory and / or physical nature. Commonly reported hallucinations include door opening, animal grunting, approaching footsteps, scratches, internal buzzing / beeping, malevolent whispers and rotten meat odors, “death”, decay, dampness, mold and sensation of moving, adrift , rolling, floating, hot or cold. Out-of-body experiences are also sometimes reported.

Causes of sleep paralysis

The causes are surprisingly mundane , despite the elaborate explanations given by some people. During sleep, the body’s motor functions are suspended, which prevents people from putting their dreams into practice or participating in potentially harmful actions, during sleep atony, the suspension of motor activity continues even after the person wake up.

REM disturbance

In particular, it is believed that sleep paralysis is related to a problem that regulates REM sleep, since it is during this that our body is paralyzed and we cannot make dreams come true. This muscle relaxation, called atony, can sometimes occur while you are awake. As such, you will not be able to move, even if you are conscious, this is one of the common characteristics.

There are clearly certain triggers, often occurring during periods of stress and sleep deprivation. Many people experience it when their sleep schedule is disrupted, regardless of the reason. Those with work shift sleep disorder may be at higher risk, if you try to sleep during the day, sleep disruptions are more likely to occur.

Additionally, sleep paralysis can be triggered experimentally by disrupting REM. In a controlled setting (such as a sleep study), this could be attempted, and has been shown to incite the phenomenon.

Psychiatric disorders

There also appears to be a strong association with psychiatric disorders such as anxiety and depression , the use of alcohol or other drugs can also lead to an attack and for some people, a family history is evident, although a genetic cause of the disease is not known. .

Sleeping position

Most people with sleep paralysis report that it occurs when they are sleeping on their backs (supine sleeping position). However, less frequently, others have reported that it occurs when they sleep on their stomachs or sides.


The vast majority of people suggest that it occurs while sleeping (a hypnagogic phenomenon), but it can also occur upon waking from sleep. It usually occurs at night, but it has also been known to occur during daytime naps.

Other sleep disorders

It can occur in association with other sleep disorders , including obstructive sleep apnea and narcolepsy . The apnea sleep worsens to be back and in REM sleep, so other symptoms such as snoring and waking to urinate, may suggest the need for testing.

With symptoms such as drowsiness, hallucinations, and cataplexy, it could suggest a sleep disorder called narcolepsy . Treating these conditions can reduce the frequency of episodes.

How common is sleep paralysis?

As strange as waking up to hallucinations, experts say it is more common than you think , an estimated 8 percent of the world’s population has experienced it and that’s a conservative estimate, the number rises to 28 percent for college students and 32 percent for psychiatric patients.

Just depriving yourself of sleep can cause someone to experience it. In fact, researchers induce sleep paralysis in labs all the time, wait until a person has fallen asleep and gone into REM, then lightly touch them, and sometimes that’s all it takes.

Although many have not heard of the term “sleep paralysis,” people knew about the disorder long before there were sleep labs or even modern countries. After all, people who suffer from it feel as if a monster, be it a Greek god, a female spirit, or an alien, is sitting on their breasts.

How do hallucinations work in sleep paralysis?

Hallucinations seem to happen in stages, first you wake up with the feeling that you are not alone, it is like when you are walking down a lonely street at night, your eyes are open and you feel this uncomfortable sensation.

As your brain tries to make sense of what is happening, create something to explain why you feel so uncomfortable, you could whip a threatening figure to look at you, one that fits your worldview.

Here you don’t stop seeing imaginary things and you can feel them too, just as the brain can create imaginary images and sounds, it can also create imaginary physical sensations. People say that the monster in their room sits on them, and they can feel the pressure on their chest, note that the anxiety of seeing monsters can create or increase this feeling, as anxiety can cause chest pain.

Sometimes people who experience sleep paralysis cannot breathe for a few seconds. In really scary cases, people feel like something is attacking or sexually assaulting them.

Are some people more likely to have sleep paralysis than others?

Anyone who dissociates easily, that is, enters a kind of trance in which they lose consciousness of the world around them, is more likely to have sleep paralysis, that could evoke images of prophets or fortune-tellers, but dissociation is usually quite mundane.

How is sleep paralysis diagnosed?

Isolated recurrent sleep paralysis is quite common, in most cases it does not affect your sleep or your overall health. Talk to your doctor if the episodes make you anxious, you should see a specialist if the episodes keep you awake at night or make you feel very tired during the day.

The doctor will need to know when the sleep paralysis started. he or she will want to know how often it occurs and how long it lasts, you will need to know your complete medical history. Be sure to inform him about past or present drug and medication use.

Also tell your doctor if you have ever had any other sleep disorders, find out if you have any family members with trouble sleeping, it will also help if you complete a sleep diary for two weeks as this will help the doctor to see your sleep patterns, this data gives clues about what is causing the problem and how to correct it.

Doctors do not need any tests to treat most patients with paralysis , you may have to do a study at night if your problem is disturbing your sleep. This study is called a polysomnogram, which records your brain waves, heartbeat, and breathing while you sleep and records how your arms and legs move. An electromyogram recording will show the level of electrical activity in your muscles, this level will be very low during an episode of sleep paralysis.

If you tend to be very sleepy during the day, then your doctor may also ask you to do a nap study during the day, this is called a multiple sleep latency test, the one that will measure how quickly you fall asleep and show what kind of sleep. sleep when you take a nap, it will help show if your sleep paralysis is a sign of narcolepsy.

Treatment for sleep paralysis

Medical treatment begins with education about the stages of sleep and the inability to move muscles during REM sleep, people should be evaluated for narcolepsy if symptoms persist. The safest treatment is for people to adopt healthier sleeping habits, however in more severe cases, tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) can be used. Despite the fact that these treatments are prescribed, currently no drug has been found to completely interrupt episodes.

Cognitive behavior therapy

Some of the earliest work in treating sleep paralysis was done using a culturally sensitive cognitive behavior therapy called CA-CBT. The work focuses on psychoeducation and the modification of catastrophic cognitions about the attack, this approach was previously used to treat it in Egypt, although clinical trials are lacking.

The first published psychosocial treatment was cognitive-behavioral therapy for isolated sleep paralysis (CBT-ISP), it is manualized, has an adherence manual for research purposes and is intended to prevent and alter episodes, begins with self-monitoring of symptoms, cognitive restructuring of maladaptive thoughts and psychoeducation on the nature of sleep paralysis.

Prevention techniques include sleep hygiene and preparatory use of various relaxation techniques (eg, diaphragmatic breathing, mindfulness, progressive muscle relaxation, meditation). Episode interruption techniques are practiced first in session and then applied during actual attacks, no controlled testing of CBT-ISP has been performed to demonstrate their effectiveness.

Meditation and relaxation therapy

It is a published direct treatment, which was derived in part from the neuroscientific hypothesis suggesting that attempting movement during sleep paralysis, for example due to panic reactions, may lead to neurological distortions of ‘body image’, possibly triggering hallucinations of shadowy human-like figures.

The therapy is based on four steps applied during sleep paralysis: (1) reevaluation of the meaning of the attack (cognitive reevaluation); which involves closing your eyes, avoiding panic, and re-evaluating the meaning of the attack as benign. (2) psychological and emotional distancing (regulation of emotions); the sleeper reminds himself that catastrophizing the event (ie fear and worry) will make it worse and possibly prolong it; (3) inward focused attention meditation; focusing attention inward on an emotionally prominent positive object; 4) muscle relaxation; avoid breath control and avoid movement.

There are preliminary case reports supporting this treatment, although there are no randomized clinical trials yet to demonstrate its effectiveness.

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Hello, how are you? My name is Georgia Tarrant, and I am a clinical psychologist. In everyday life, professional obligations seem to predominate over our personal life. It's as if work takes up more and more of the time we'd love to devote to our love life, our family, or even a moment of leisure.