Sleep Paralysis – Causes, Symptoms, Treatment, and Prevention

Jody I. Gaylord

Having nightmares is terrifying and that too with the inability to walk, speak or move around. The condition is described as SLEEP PARALYSIS, which is very common in the general population.

According to a survey, around 40% population has suffered from an episode of sleep paralysis. Sleep paralysis is a state which happens between conscious states and sleeps while you wake up or you’re dozing off. Still, after many research and studies regarding this matter, people cannot identify the fact that what is the reason behind the temporary dysfunction of the voluntary muscles.

According to a theory by Neil Kline, there is some sort of crossover with the dream sleep also termed as RAPID EYE MOVEMENT.When we are asleep in a REM stage, the muscles are atonic i.e. essentially paralyzed so that we do not hurt ourselves while dreaming.

Sleep paralysis is a condition while awake or fallen asleep during which the person is unable to speak or move but he is totally aware. Sleep paralysis results in a scary feeling as you might hear, see or feel things which are not present in reality. The episodes of paralysis might be recurrent or you may feel it for once. It usually lasts for around a few minutes. It occurs during any one of the two transitions of the sleep cycle.

It is important for the body to go in the REM and come out of this phase to avoid paralysis. When the body finds trouble making such transitions then paralysis occurs. It happens when you fall asleep i.e. hypnagogic sleep or happens when you wake up i.e. hypnopompic sleep.

Who is More Prone to Undergo Sleep Paralysis?

This condition can occur in a healthy individual, or people suffering from narcolepsy. It can also run in some families due to the specific alterations in genes. It is calculated that around 8-50% of individuals experience this condition at some point in their life. 5% of people experience regular episodes of paralysis.

There is no gender discrimination in this disorder and both male and females are equally affected. It has a strong history, it has been played in several stories, plays and in paranormal events. The prevalence rates of a lifetime are derived from around 35 aggregated studies which indicate that around 8% general population, 28% students, 32% psychiatric patients undergo an episode of sleep paralysis at some stage in their lives.

There are two types of sleep paralysis i.e. recurrent paralysis and isolated paralysis. Recurrent is not much known and it is estimated that the life history of 15-45% individuals meets the criteria of such condition. However, isolated is more common in patients who are diagnosed with a condition termed as Narcolepsy approximately around 30-50% individuals.

Common Symptoms

  • Unable to move

You cannot move while awake. People say that they are consciously awake but cannot move.
  • Imagine sounds

You might imagine sounds such as hissing, humming, zapping, static or buzzing sounds which are reported by people suffering from this condition. Other sounds can also be experienced such as whispers, voices or roars.
  • Pain

You might experience sweating, muscle pains, headaches, and paranoia.
  • Dread & fear

The symptoms linked are usually associated with panic and fear i.e. the intense emotions. People usually try to figure out the intensity of fear after the episode is over. Sometimes the feeling of fear and terror is so strong that people link it to a sense of dying or experiencing death. It results in a flight-fight response.
  • The sense of flight or being pulled

Some individuals feel a sense of flying or being dragged from the bed, electric tingling sensation or numbness. You might even feel vibrations running all over the body.
  • Real perception of the surrounding

Individuals visualize the real perception of their surrounding environment and can distinctly observe the elements in the room such as a clock or a sleeping partner.
  • Evil or malevolent presence

An individual might sense a malevolent or an evil presence in his surroundings which may be merely seen or felt.
  • Sleeping on your back

The episodes occur when an individual is sleeping in a supine position i.e. lying down on the back. However, most people do not nap in such position. The episodes of this condition last for 1-2 minutes.

Sleep Paralysis & Hallucinations

The most common symptom linked is hallucinations which might be olfactory, auditory or physical by nature. The most commonly reported hallucinations are animals growling, door opening, approaching footsteps, internal beeping or buzzing sounds, scratching, the smell of a rotten dead body, decayed, damp, flesh or a mold. You might also feel being moved, rolled, drifted, cold, heat and floating sensation.

Hallucination is a common symptom associated because the human brain is in the dreamy situation. People also report seeing demons, ghosts or strange apparitions when experiencing paralysis. People also experience hypnagogic hallucinations which include supernatural creatures terrifying or suffocating the individual. You can also feel difficulty in breathing or pressure on the chest due to an external force pressing down in the chest.

You can also feel chest pressure due to a sensual feeling. You can feel hallucination in the form of a shadow which might enter the room or lurk around the window when you are paralyzed. The interpretation, as well as the content of such hallucinations, result due to the somatic or fear sensations, REM mentation or REM-induced sexual arousal which embed in the sleeper’s traditional narrative.

Types of Hallucinations

There are many different types of hallucinations associated, for example, a belief in the presence of an intruder in your room, you can feel incubus or the sense of floating. According to the neurological hypothesis, a mechanism is involved in the coordination of body movements along with the information of the body positions during paralysis which gets activated. However, an actual movement is not performed due to which floating sensation is felt. The types of hallucinations are:

  • Intruder
  • Incubus
  • Vestibular-motor disorientation

The first two correlate with each other while the third one is termed as an out-of-body experience that involves a vigilance system which is threat-activated.

Sleep Paralysis Causes

It is believed that paralysis can occur due to some triggering factors such as psychological stress, sleep deprivation or abnormally disturbed sleep cycles. The mechanism involved in sleep paralysis is a dysfunction associated with REM. Other conditions have similar features like sleep paralysis such as atonic seizures, narcolepsy as well as hypokalemic periodic paralysis.

  • A condition which is highly common in individuals with sleep deprivation. According to Dr. Kline, the best advice to avoid paralysis is to get enough sleep at night. However, sleep deprivation has become the most significant issue in our society due to the social and working demands along with other distractions.
  • Try to avoid stressful situations as this factor also results in increased chances of sleep paralysis. You need to look for factors which help in minimizing the stress leading to less frequent episodes.
  • The condition is also associated with narcolepsy which is a sleep disorder that results in abnormally disturbed sleep cycles. During this condition, the person sleeps excessively during the daytime which might also indicate that you are suffering from periodic limb movement disorder or sleep apnea.
  • Youth is another factor which is considered as a cause of paralysis. It is stated by the Mayo Clinic that this condition occurs more often in the people aged between 10-25 years. The disorder is quite common in people suffering from panic disorder and post-traumatic stress disorder as published in a report during 2017, by National Institutes of health.
  • It can also occur due to the genetic abnormality as stated in the study conducted on 862 siblings and twins. The authors published this study in the Journal of Sleep Research which proves that there is a link of controlled circadian rhythms with the sleep paralysis.

Can You Die From Sleep Paralysis?

It is hell scary but it is not considered dangerous. Your reaction to sleep paralysis can result in problems. Some individuals consume stimulants if they suffer from recurrent sleep paralysis, while others find out methods to remain awake which is unhealthy. You don’t know what happens to you when you are asleep so you might believe all the creepy stuff such as the demons attacking you or you being kidnapped or killed by the aliens.

People start believing that they have gone crazy, especially those people who are already suffering from psychotic issues. It’s hard for them to distinguish between hallucinations and reality. Coming back to the question which is asked by most individuals, so paralysis can serve as an indirect factor leading to death but not a direct cause so it is definitely NO. You don’t need to worry about death from sleep paralysis, although the hallucinations linked with sleep paralysis are extremely terrifying so might need to fear about that.

Diagnosis, Prevention & Treatment

How to Diagnose Sleep Paralysis?

The condition is usually diagnosed after a clinical interview which helps in differentiating the potential sleep disturbance or disorders which might have resulted in paralysis. One of the main disorder associated is Narcolepsy which has a high prevalence in association with sleep paralysis. However, this disorder can be easily ruled out by a genetic test. There are many reliable tests which allow you to diagnose paralysis for example Parasomnia screening or fearful and isolated interview.

How to Prevent Sleep Paralysis?

There are many risk factors associated with an increased rate of sleep paralysis. These include sleep deprivation, insomnia, stress, physical fatigue, and erratic sleeping schedule. According to different researchers, it is also believed that the genetic component is also involved in the development of paralysis. It is because there is an increased chance of sleep paralysis in individuals who are monozygotic twins.

If you lie down in a supine position i.e. also a prominent instigator leading to paralysis. The supine position has an increased risk of resulting in paralysis because it leads to the collapse of the soft palate and the obstruction of your airway. This can happen to any individual whether you suffer or not from sleep apnea. There is an increased chance of microarousals if you sleep in supine posture as a huge amount of pressure is exerted by gravity over the lungs.

  • You can easily prevent the increased risk of paralysis by altering some changes in your lifestyle. Maintain a perfect sleep schedule.
  • Observe hygiene while asleep
  • Avoid stressful situations and decrease the uptake of stimulants.
  • Visit a psychologist or a trained professional who can advise you on how to cope up with stress.
  • However, some people undergo this condition due to some genetic mutation leading to an unavoidable condition.
  • Start practicing meditation which helps in sleeping peacefully without any disturbance. According to a research, long-term practice of meditation aids in sleeping well, reducing the nocturnal arousal leading to a reduction in paralysis.
  • Progressive relaxation of muscles.
  • Mindfulness.
  • Diaphragmatic breathing.

Treatment Options

The treatment options for this disorder have not gained attention yet, still, there is a lack of medical science solutions in this field. It is advised to people that this is not a serious condition and is very common.

However, some efforts have been put to treat this fearful condition such as cognitive behavioral therapy, sleep hygiene as well as antidepressants. According to Dr. Kushida, if the underlying sleep disorder is treated, you can reduce your chances of paralysis or even get rid of it.


Medical treatment begins with education regarding the sleep stages as well as the inability regarding the muscle movement while asleep. Individuals should be evaluated for the symptoms of narcolepsy.

The safest option for treating this condition is to advise people with healthy sleeping habits. Individuals with more serious conditions are treated with Tricyclic antidepressants or can utilize Selective Serotonin Reuptake Inhibitors. Despite, these medications are used for treatment, according to medical science there is no drug typically used for the complete treatment.

Cognitive behavior therapy

This condition can also be treated by using the cognitive behavior therapy termed as CA-CBT. This therapy focuses on the modification of catastrophic cognitions or psycho-education regarding the episodes.

Meditation-relaxation therapy

It is a direct treatment procedure. This therapy was derived from a hypothesis which suggests that the movement of muscles in this condition can result in neurological distortions regarding the body images of one’s self, triggering the hallucinations of human-like shadows. The treatment is based on four steps i.e.

  • Cognitive Appraisal
  • Emotional Regulation
  • Focused Meditation
  • Muscle Relaxation

Ways to Wake up Yourself from Sleep Paralysis

Follow these simple methods to break the cycle of this horrifying condition:

  • Avoid fighting back when you feel like being dragged or pulled. It is because fighting back increases the terror and fear, triggering the brain centers about full-blown emotions. You need to control the fear if you want to get rid of this condition.
  • Stay calm and relaxed when you observe this condition. If you sense chest pressure, go with it instead of fighting back.
  • The excellent tactic to prevent this condition is started wiggling your toe or an extremity, for example, a finger. Most people feel paralysis in the chest, throat or belly so focus yourself on the toe and move it. It aids in breaking the paralysis.
  • Another altered method which you can try for breaking paralysis is to clench or unclench the fist.
  • Start controlled breathing to avoid focusing on the nightmares linked with this condition. If you manage to control your breathing, you can control the fear linked with this condition.
  • Start focusing on a figure whom you admire. For example, any spiritual or religious belief which allows you to stay peaceful and safe.
  • If you have a sleep partner, discuss your problem with him so that you can request them for help when suffering from this fearful condition.
  • Try coughing to wake up yourself from a deep sleep.

After you break the episode of paralysis and wake up, it’s better to turn on the light, splash cold water on your face and avoid staying in bed as there is a high chance of getting another episode.


Sleep paralysis is a common issue in the general population. It is better to visit your doctor or general physician so that they can advise you on how to manage the situation. Do not fear about alien abductors or demon nightmares as they are all false.

Discuss your symptoms, medical history, and family history so that they can conclude the diagnosis and manage to provide you with the proper treatment. Keep this famous saying in mind that “PREVENTION IS BETTER THAN CURE”. So, avoid going to bed late at night and have a good bedtime nap with perfect sleep hygiene. Try different sleeping positions at bedtime and keep your life stress free.

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