Sleep Paralysis: Causes, Symptoms, and Treatment

What is sleep paralysis?

Sleep paralysis is a temporary but very frightening feeling of being unable to move or speak as you transition between wakefulness and sleep. The condition is categorized as a parasomnia, alongside issues such as sleep terrors and sleepwalking.

A sleep paralysis episode can begin with you stirring in bed, not quite fully awake. You may be able to see the edges of your mattress, for example, your closet, a lamp, and the windows. But there’s also an intense fear growing inside you. You may hear voices whispering, see shadows moving just beyond the bed, or feel that something or someone is holding you down and restricting your breathing. When you try to turn your head or sit up, you realize you’re unable to move. And if you try to call out for help, you can’t open your mouth or find your voice.

Then the experience suddenly ends and you’re able to move again. The voices, shadows, or demonic figures disappear. But you’re left shaken, with residual feelings of fear, confusion, and unease.

An episode of sleep paralysis can last anywhere from several seconds to several minutes, but in the moment, it may feel much longer. In addition, the sense of anxiety and terror can continue to haunt you long after the experience is over. You might even hesitate to go to bed the following night through fear of another terrifying episode.

Of course, avoiding sleep isn’t a healthy or sustainable solution. Sleep is vital to both your mental and physical health. Without sufficient sleep, your mood, energy, focus, and memory will all suffer. It can also lead to physical issues, such as increased blood pressure and reduced immunity from illnesses.

So, instead of avoiding sleep, you can better understand sleep paralysis and learn how to cope with it in the future.

What’s really happening during sleep paralysis?

Sleep paralysis can occur when you’re either transitioning into or out of rapid eye movement (REM) sleep, the phase of sleep in which you dream. As the name implies, your eyes move around during REM. Your breathing and heart rate also increase.

REM sleep also comes with muscle atonia, a state of temporary paralysis that keeps you from physically thrashing around as you dream. Sleep paralysis episodes occur when muscle atonia is maintained even as you shift out of REM sleep and begin to wake. In other words, the temporary paralysis is completely normal and natural. You’re just typically unaware of it.

If you suffer from bouts of sleep paralysis, know that you’re not alone. Research shows that about eight percent of the population has experienced at least one instance of sleep paralysis in their lifetime.

More importantly, you’re not in any danger. Although the experience can leave you feeling rattled, current research indicates that sleep paralysis is not harmful. While your breathing may feel restricted, for example, you’re not actually suffocating. However, sleep paralysis can be a symptom of another sleep disorder that you do need to address.

Sleep paralysis vs. lucid dreaming

Lucid dreaming is when you become aware of the fact that you’re dreaming. This sense of awareness allows you to control the narrative of your dream, as if you’re engaging in a vivid daydream.

Lucid dreaming might be related to sleep paralysis in some way, since both involve REM sleep. Some people have also claimed to move from one state to the next, so lucid dreaming and sleep paralysis may co-occur.

One major difference between the two experiences is your sense of control. During lucid dreaming, you feel in control of what’s happening, so it tends to be a positive experience. Sleep paralysis, however, is often the exact opposite. You feel trapped and unable to respond to perceived threats in your room. That sense of helplessness makes for a terrifying experience.

Another key difference is that lucid dreaming is primarily an internal experience. You’re engaging with your thoughts and imagination. During sleep paralysis, on the other hand, you have more awareness of your real-life, external surroundings. When mixed with the vividness of your imagination, this results in frightening, unpleasant hallucinations in your bedroom.

What causes sleep paralysis?

In past centuries, people who experienced sleep paralysis often attributed it to supernatural causes. For example, some blamed the phenomenon on an incubus, a demon that would sit on your chest or hold you down. These kinds of cultural narratives developed as explanations for the unusual symptoms—the hallucinations, sense of terror, and loss of bodily control.

Today, researchers have a better, but still imperfect, understanding of what causes the condition. Sleep paralysis can be a symptom of narcolepsy or another sleep disorder. When it’s not related to a medical issue, it’s known as isolated sleep paralysis. If you experience at least two of these episodes in a six-month period, you may have recurrent isolated sleep paralysis (RISP).

The following factors may increase your risk of sleep paralysis:

Sleep quality. Not sleeping well increases the likelihood of you experiencing sleep paralysis. Your episodes might coincide with bouts of insomnia or nightmares, for example.

Substance abuse or medication. Alcohol use, as well as withdrawal, can affect REM sleep, increasing the risk of parasomnia conditions like sleep paralysis. Substances such as nicotine and some prescribed medication can also sometimes interfere with sleep and lead to episodes.

Sleep disorders. As mentioned before, sleep paralysis can be a symptom of a broader sleep disorder, especially narcolepsy. Sleep paralysis that is associated with narcolepsy often occurs just as you’re falling asleep, while isolated episodes that aren’t due to narcolepsy tend to occur when you’re waking up.

[Read: Sleep Disorders and Problems]

Stress. There’s a correlation between stress and sleep paralysis. High stress can exacerbate sleep paralysis episodes, while sleep paralysis can disrupt your sleep and add to your stress. If you spend your day worrying about whether you’ll have another sleep paralysis episode at night, for example, the stress will only make it harder for you to sleep.

Anxiety disorders or PTSD. If you’re suffering from post-traumatic stress disorder (PTSD) or an anxiety disorder you may be more likely to experience sleep paralysis. It’s currently uncertain if these disorders actually cause sleep paralysis. However, the sleep disruptions and sense of terror you experience may exacerbate other anxiety symptoms.

Irregular sleep schedule. Disruptions to your typical sleep patterns can increase your risk of temporary sleep paralysis episodes. Jet lag or shift work can cause you to fall asleep at unusual or irregular times and trigger sleep paralysis.

Sleep position. Some studies indicate that sleep paralysis is more likely to occur when you sleep in a supine position (on your back). This could be related to sleep apnea, which is also worsened by sleeping on your back. Using an adjustable bed may help improve your sleep position.

Family history. It’s possible that genetics may affect your risk for sleep paralysis. Limited research hints at sleep paralysis running in families. However, it’s possible that shared environmental factors rather than genetics are the cause. Members of a family can share the same supernatural beliefs or develop similar habits that reduce sleep quality.

Your personality and personal beliefs. Are you an imaginative person? There appears to be a link between people with vivid imaginations and the likelihood of sleep paralysis. Paranormal beliefs also seem to go hand-in-hand with the problem. It's possible that supernatural beliefs increase episodes or that the hallucinations that come with sleep paralysis feed your beliefs.

Symptoms

Not everyone experiences the exact same symptoms of sleep paralysis. Your episodes might come with all or some of the following symptoms:

Fear. Most sleep paralysis episodes involve feelings of terror and distress. Panic can develop from the sense of helplessness you experience.

Restricted breathing. You might feel pressure on your chest or tightness around your throat. Breathing is difficult, and you might believe you’re being suffocated.

Inability to move. During an episode, you’ll try move your body but feel strapped in place or weighed down as an intruder or “demon” presses down on you. You may panic as you realize you can't move or call for help.

Inability to open your eyes. You may find you can’t force your eyes open. Or if your eyes are open, you can’t shift your gaze or turn your head.

Hallucinations. You may hear strange voices or sounds around you. Dark figures could seem to creep around the room or bear down on you. Or perhaps you simply “sense” the presence of an intruder in the room.

Formal diagnosis of RISP

If sleep paralysis is a frequent problem that interferes with your life, a sleep specialist may diagnosis you with recurrent isolated sleep paralysis (RISP). RISP appears as a formal diagnosis in the International Classification of Sleep Disorders (ICSD). In the Diagnostic and Statistical Manual of Mental Disorders (DSM), it can fall under the category of “unspecified sleep–wake disorder.”

Before receiving a formal diagnosis, a clinician will interview you about the severity of your symptoms and frequency of the episodes. They’ll also need to rule out the possibility that the paralysis is a result of a sleep disorder, a neurological disorder, or a side effect of medication.

How to treat sleep paralysis

If you’re feeling hesitant to go to bed tonight, remember that skipping out on sleep will only make things worse. There are healthier and more effective ways to cope with the problem.

Firstly, it’s important to seek treatment for any underlying sleep disorder, such as narcolepsy, sleep deprivation, or any other condition that may be causing the sleep paralysis episodes, such as trauma or anxiety.

[Read: Narcolepsy: Causes, Symptoms, and Treatment]

Cognitive behavioral therapy (CBT) or “talk therapy” may offer a path to reducing stress and improving sleep, thus minimizing the symptoms of sleep-related disorders. CBT for sleep paralysis might involve working with a therapist to:

• Monitor and record reoccurring episodes through journaling.
• Develop a personalized sleep hygiene plan.
• Rehearse ways to escape or cope with paralysis when it’s happening.
• Practice relaxation techniques that reduce overall stress and help you sleep.

Even without the aid of a therapist, there are steps you can take to reduce your risk of sleep paralysis.

Sleep paralysis treatment tip 1: Be mindful of your internal clock

Your body has an internal clock that pushes you to wake up and fall asleep at regular times. Having a consistent sleep-wake cycle can improve your sleep quality. But, when that cycle is thrown off, sleep quality dips and events like sleep paralysis are more likely.

[Read: How to Fall Asleep Fast and Sleep Better]

Stick to a regular bedtime. Don’t try to force it. Just plan to go to bed around the time you typically feel tired.

Get up every day at the same time. If you feel reliant on an alarm clock to wake you up, consider switching to an earlier bedtime.

Be consistent. Try to avoid staying up too late and sleeping in during weekends.

Nap when needed. If you had a late night out, plan to take a short nap during the day to make up for the lost sleep. Brief naps—naps that last less than 20 minutes—can boost your alertness without disrupting the following night’s sleep.

Tip 2: Calm your mind before bed

Whether you have deadlines to hit, unfinished chores to complete, or financial or health concerns, the stress of daily life can leave you feeling restless before bed, interfering with your sleep. Use the following tips to relax:

Write down your worries. Keep some paper and a pencil on your nightstand and jot down whatever is worrying you, so you can deal with it the next day. This helps you break out of those worry cycles, during which your fears seem to be playing out in an endless loop.

Experiment with relaxation techniques such as progressive muscle relaxation, breathing exercises, or meditation to help you unwind at night.

Avoid stressors before bed. Stimulating activities such as scrolling through social media or chatting about work can make it harder to relax at night. Replace these habits with a more relaxing pre-bed routine, such as listening to an audiobook or taking a warm bath.

Tip 3: Set the scene for quality sleep

Your bedroom atmosphere can make the difference between deep, quality sleep and a night of tossing and turning.

Create a space that’s dark and quiet. Avoid bright screens, such as the TV or computer, as you wind down. If shiftwork forces you to keep an unusual schedule, consider using blackout shades to minimize light when you sleep during the day. If loud noises are an issue, try a sound machine.

Check the thermostat. If the room is too hot or too cold, your sleep quality will suffer. The right temperature can vary from person to person, but somewhere around 60 to 67 degrees Fahrenheit is often best.

Keep it tidy and cozy. Cleaning up clutter around your room can help put your mind at ease. Use your nightstand to display comfort items, like pictures of loved ones.

Avoid sleeping on your back

Sleeping on your back increases the odds of a sleep paralysis episode. But it’s not always easy to maintain a certain sleeping position throughout the night. Even if you fall asleep on your side, you may find yourself on your back by morning.

To train yourself not to sleep on your back, consider sewing a sock to the back of your sleeping shirt and putting a tennis ball inside. Even when you’re asleep, if you roll onto your back the discomfort of the tennis ball will make you return to a side sleeping position.

Tip 4: Adopt new habits during the day

Getting quality sleep and avoiding a sleep paralysis episode at night isn’t just about your pre-bed routine. What you do throughout the day is also important.

Make time for exercise. Physical activity can relieve stress and improve your sleep quality. Find an exercise routine that you enjoy and can stick with, whether that includes biking, weightlifting, or a team sport. Be careful though. Vigorous exercise within one hour of bedtime may make it harder to fall asleep.

[Read: The Mental Health Benefits of Exercise]

Consider how eating habits affect your sleep. Alcohol and excessive caffeine consumption can lead to sleep disruptions. Be mindful of how much you consume, especially later in the day. Eating a heavy meal right before bed can also reduce sleep quality.

How to stop sleep paralysis in the moment

There doesn’t seem to be a single, surefire way to escape sleep paralysis when it’s occurring. However, you can try a few strategies that have reportedly worked for other people.

You’ll have some degree of conscious awareness as you enter a sleep paralysis episode. So, when you notice its onset, keep your eyes closed and try the following:

Remind yourself that it’s a harmless experience. Any hallucinations are just in your mind, and the discomforting sensations are temporary. If you’ve previously experienced sleep paralysis episodes, remember that they came and went without affecting your physical health.

Meditate on a positive thought. Think about the comfort of a loved one or a pleasant memory. Or, if you’re a spiritual person, a prayer might be helpful. This can help shift your attention away from the fear and panic that typically comes with an episode.

Relax your body. Avoid attempts to flex your muscles or control your breathing. Doing so may simply trigger more fear when you realize you can’t control your body. Instead, try to accept the physical symptoms for what they are—completely harmless and part of your sleep cycle.

Focus on moving individual body parts. Try to wiggle your fingers, for example, or twitch your toes. This might help pull you out of paralysis.

Helping someone who is experiencing sleep paralysis

If you have a loved one who suffers from sleep paralysis, you probably want to do everything you can to spare them the fearful experiences. Because they’re already in the process of waking up, all you might need to do is give them a gentle nudge to push them out of the episode.

Unfortunately, you may have a hard time telling if a child or partner is experiencing sleep paralysis in the moment. Episodes may only last a few seconds or minutes, so they’re easy to miss. If someone’s stuck in paralysis, you might notice their eyes are open and moving or their breathing is loud. Or you may notice their feet or hands twitch. If they seem to be having a bad dream, it's okay to gently nudge them awake.

Whether your loved one is a child or an adult, it’s important to communicate that sleep paralysis is not harmful. If you’re explaining the concept to a child, you can compare it to a nightmare—a product of the imagination. If you’re explaining it to an adult, you can educate them on REM sleep and how it influences paralysis. Knowing the science behind the experience might help calm their fears and reduce the intensity or frequency of sleep paralysis episodes.

Last updated or reviewed on November 8, 2023