Too much often, different people come to me with eerie stories of being gagged at night while sleeping. They describe an intense sensation of blood-curdling fear, of nondescript creatures that strangle them to near death experiences. They cannot speak or breathe, and usually feel completely helpless. Have you ever had such an experience or a friend told you they think they are being assailed by unknown creatures while sleeping.

 Over the centuries, symptoms of sleep paralysis have been described in many ways and often attributed to an “evil” presence: unseen night demons in ancient times, the old hag in Shakespeare’s Romeo and Juliet, and alien abductors. Almost every culture throughout history has had stories of shadowy evil creatures that terrify helpless humans at night. People have long sought explanations for this mysterious sleep-time paralysis and the accompanying feelings of terror. We try to understand what sleep paralysis is and demystifying the myths associated with it. Is it treatable? 

Sleep paralysis is a feeling of being conscious but unable to move. It occurs when a person passes between stages of wakefulness and sleep. During these transitions, you may be unable to move or speak for a few seconds up to a few minutes. Some people may also feel pressure or a sense of choking. Sleep paralysis may accompany other sleep disorders such as narcolepsy. Narcolepsy is an overpowering need to sleep caused by a problem with the brain’s ability to regulate sleep.

How and when exactly does sleep paralysis occur?

Sleep paralysis usually occurs at one of two times. If it occurs while you are falling asleep, it’s called hypnagogic or predormital sleep paralysis. If it happens as you are waking up, it’s called hypnopompic or postdormital sleep paralysis. During sleep, your body alternates between REM (rapid eye movement) and NREM (non-rapid eye movement) sleep. One cycle of Rapid Eye Movement and Non Rapid Eye Movement sleep lasts about 90 minutes. Non Rapid Eye Movement sleep occurs first and takes up to 75% of your overall sleep time. During NREM sleep, your body relaxes and restores itself. At the end of NREM, your sleep shifts to REM. Your eyes move quickly and dreams occur, but the rest of your body remains very relaxed. Your muscles are “turned off” during REM sleep. If you become aware before the REM cycle has finished, you may notice that you cannot move or speak.

No matter how much you try, even if you consciously know that you’re undergoing a sleep paralysis—you can’t wake your body up. Because unlike the visuals in your dreams which occur when you’re deep in sleep and your eyes are closed, these hallucinations occur when your mind is alert and eyes are open. During sleep paralysis, your mind is conscious but you are unable to move your body. You may also think you see or hear things that aren’t really there or experience the sensation of choking or someone sitting on your chest.

What are the classical symptoms of sleep paralysis?

  • A profound inability to move the body when falling asleep or on waking, lasting for seconds or several minutes.
  • Being consciously awake.
  • Being unable to speak during the episode.
  • Having hallucinations and sensations that cause fear.
  • Feeling pressure on the chest.
  • Having difficulty breathing.
  • Feeling as if death is approaching.
  • Profuse sweating.
  • Having headaches, muscle pains, and paranoia.

What are the risk factors for sleep paralysis?

Up to as many as four out of every 10 people may have sleep paralysis. This common condition is often first noticed in the teen years. But men and women of any age can have it. Sleep paralysis may run in families. Other factors that may be linked to sleep paralysis include:

  • Lack of sleep-Sleep deprivation and stress can also result in sleep paralysis. In fact, sleep-related paralysis, as a result of being sleep deprived, is especially common among those who work varying shifts where sleeping patterns are unpredictable and change frequently.
  • Sleep schedules that change.
  • Mental conditions such as stress or bipolar disorder-Mental illness can result in a number of behavioral health problems, but sleep paralysis can also be a byproduct of certain disorders like anxiety and depression, for example. If drugs or alcohol are added to the equation, this will further complicate matters. This is especially true for those who have family members struggling with the same condition as genetics can influence one’s susceptibility to sleep paralysis.

  • Sleeping on the back-Sleep positions can trigger sleep-related paralysis while you sleep; in fact, those who favor a supine sleep position are often the same ones who struggle with the condition the most. However, it should be noted that some people who sleep on their stomach or on their side also struggle with this condition to some degree. All in all, there is no optimal sleep position when it comes to avoiding this condition, but sleeping on your stomach or side can lower your chances of enduring this otherwise unpleasant experience.

  • Other sleep problems such as narcolepsy or nighttime leg cramps.
  • Use of certain medications, such as those for ADHD. (attention deficit hyperactivity disorder)
  • Drug and substance abuse.

Waking yourself up from sleep-related paralysis

The inability to move while awake as to be one of the scariest experiences that anyone can endure, but there are ways to escape sleep-related paralysis. Here are a few helpful tips for those who need help breaking free from this sleep phenomenon:

  • Avoid the temptation to fight yourself into a wakeful state as this may intensify your condition and may cause feelings of fear to intensify. Instead, try to remain as calm as possible and slowly guide yourself awake with positive affirmations.
  • Focusing on breathing can be a great tactic for those feeling overwhelmed by sleep-related paralysis. In fact, controlled breathing exercises can go a long way toward lessening chest pain, which is one of the many byproducts of this condition. While struggling with sleep-related paralysis, many people forget to breathe, often because they’re in a state of panic. So avoid fighting and breathe, understanding this terrifying moment will eventually run its course.
  • Coughing is another tactic that can be used to guide yourself awake; this autonomic/conscious act forces the body to become alert even if you’re firmly in the grips of sleep-related paralysis. At the very least, it can also alert others in the household of your struggles

Things you can do to help prevent sleep paralysis

Sleep paralysis is not normally considered a medical diagnosis, but if symptoms are of concern, it may be a good idea to see a doctor. Medical attention may help when:

  • Sleep paralysis happens regularly.
  • There is anxiety about going to sleep or difficulty falling asleep.
  • The individual falls asleep suddenly or feels unusually sleepy during the day.

Suddenly falling asleep during the day could be a sign of narcolepsy, a rare brain disorder that causes a person to fall asleep or lose muscle control at unexpected or inappropriate times. If stress and or anxiety are present, addressing these may help relieve symptoms. The following additional measures may help:

  1. Managing any depression or anxiety disorder.
  2. Reducing intake of stimulants before bedtime such as caffeine.
  3. Practicing meditation or regular prayer.
  4. Avoid sleeping on your back.

Understanding the physiology of sleep and the mechanism for sleep paralysis is an important step to overcoming it. Ongoing stress and disruption in the sleep cycle can have serious health implications. Healthy sleep habits are not just necessary for sleep paralysis management, but for overall health and wellness. I hope you have found a few tips on how to cope with sleep paralysis. You are fortunate enough if you have not experienced it, and I hope that you do not any time soon.

Sleep paralysis is a really broad topic. Do let us know if you have any questions concerning the same. As always, stay well and healthy.