Sleep Paralysis

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is sleep paralysis?

If you have ever woken up feeling like you can’t move your limbs for a few minutes and you can’t even call out, you might have experienced sleep paralysis. Sleep paralysis occurs usually just as you are falling asleep or just as you wake up. As uncomfortable and scary as this may be, it’s actually not rare. No one knows for sure, but various studies estimate that from 8 to 40% of adults in the United States experience at least one episode at some point.

While we sleep, we enter a sleep phase called rapid eye movement, or REM. This is when we dream. Some of our dreams can be quite intense, with us running, jumping and moving through a dream setting. To protect ourselves from injury—actually acting out what is happening while we are in REM sleep—our brain protects us by relaxing our muscles so we don’t move. With sleep paralysis, for unknown reasons, we are in REM mode as we doze off or still in it when we wake up, causing that paralyzing feeling.

Anyone can experience sleep paralysis, but the first episode most often occurs when you’re a child or young adult.

Sleep paralysis is usually not serious; and, other than making some lifestyle changes, doesn’t need active treatment. But if the episodes occur frequently or are disturbing, your doctor may have some suggestions to help you have a more peaceful night’s sleep. Sleep paralysis treatments may include sleep medication and individual therapy with a counselor.

What are the symptoms of sleep paralysis?

The only major symptom of sleep paralysis is exactly that—feeling paralyzed for a minute or two just as you doze off and reawaken, or upon waking during the night or in the morning.

Some people who experience sleep paralysis also have:

  • Dream-like sensations

  • Hallucinations

  • Feelings that you’re being pushed down onto the bed

What causes sleep paralysis?

Doctors do not know exactly why some people experience sleep paralysis, but there are some possible triggers that could cause or worsen it.

Causes and risk factors for sleep paralysis include:

  • Anxiety and stress

  • Disorders like narcolepsy, post-traumatic stress disorder (PTSD), bipolar disorder, and others

  • Exhaustion, either from interrupted sleep or insomnia

  • Family history of sleep paralysis

  • Irregular sleep patterns, as with people who work shifts

  • Medications to treat conditions like attention-deficit hyperactivity disorder (ADHD)

  • Sleeping on your back

  • Substance abuse

Can you prevent sleep paralysis?

It is difficult to prevent a condition like sleep paralysis because the cause is not known. You may be able to reduce your risk of sleep paralysis by controlling known risk factors, such as substance abuse and irregular sleep patterns, but not all risk factors can be prevented, such as a family history of sleep paralysis.

To reduce the risk of sleep paralysis, start with these strategies:

  • Avoid sleeping on your back.

  • Get enough sleep so you are not totally exhausted when you go to bed. If you have insomnia, speak with your doctor about treatment options.

  • Get regular exercise early in the day (not before bed).

  • If you take medications, review the side effects with your pharmacist. If the medications may be interfering with your sleep, talk with your doctor about alternatives, if necessary. It may be best to take the drugs at certain times of day so they are less likely to bother your sleep.

  • Practice good sleep hygiene: The bedroom is for sleeping and sexual activity only; do not use electronic devices in your bedroom; do not eat heavy meals a few hours before bed; avoid smoking, alcohol and caffeine before bed; and adjust your bedroom so it is quiet, dark and cool (60 to 67°F)—the best conditions for sleep.

  • Practice stress reduction techniques like yoga, meditation, reading, or a warm bath before bed.

Regardless of how often you experience sleep paralysis, talk with your doctor about it. There may be an easy solution to the problem.

What are some conditions related to sleep paralysis?

Sleep paralysis may be a sign of narcolepsy. If you have any other symptoms, such as excessive daytime sleepiness, cataplexy, and night hallucinations, speak with your doctor about the possibility of narcolepsy.

How do doctors diagnose sleep paralysis?

A doctor or other healthcare provider may diagnose sleep paralysis by reviewing your medical history and answers to general questions about your sleep patterns and behavior. Your doctor will ask what you experience as you are falling asleep and waking up from sleep, and how often you notice sleep paralysis. You may be asked to keep a sleep journal for a few weeks, to see if there are any patterns to your sleep paralysis.

Generally, sleep studies are not indicated unless your doctor suspects you may have narcolepsy.

Your primary care doctor may make an initial diagnosis of sleep paralysis. Or, they may refer you to a sleep medicine doctor to confirm the diagnosis, investigate the possible underlying cause or triggers, and work with you to develop a treatment plan if necessary.

How is sleep paralysis treated?

Treatment for sleep paralysis focuses on reducing your risk factors and increasing sleep hygiene. If sleep paralysis is frequent or affecting your quality of life, your doctor may prescribe medication that prevents you from going into REM sleep cycle.

If stress or anxiety are triggers, seeing a therapist may help reduce the stress, resulting in better sleep. If possible, work with a therapist who has experience helping people with sleep disorders. When searching for a sleep therapist, ask them about their specific expertise, the types of therapy (such as cognitive behavioral therapy) they offer to clients with sleep paralysis and other sleep symptoms, and the success rate of the technique.

In addition to sleep therapy, these healthy habits may help reduce the risk or frequency of sleep paralysis:

  • Avoid alcoholic, caffeinated or sugary liquids within a few hours of bedtime. 

  • Eat a nutritious, low-sugar snack at least an hour before bed. Examples include eggs; hummus or nut butter with crackers or veggies; and nuts or seeds. 

  • Exercise most days of the week, at the beginning of your day.  

  • Go to sleep and wake on a consistent schedule, even on days when you could “sleep in.”

  • Minimize sleep time distractions as much as possible. 

  • Practice stress reduction techniques like deep breathing and mindfulness, even if you do not feel stressed.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 2
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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