The Mind Awake and the Body Bound: Looking into the Inner Nature of Sleep Paralysis
Sleep paralysis is a frightening experience where the body feels as if it is surrounded, or encased, in concrete, and it prevents one from moving or speaking or screaming. Sleep paralysis is common. In fact, many people will experience sleep paralysis in their lifetime. Knowing the complexities of sleep paralysis, including what it is, the different symptoms, possible triggers, and ways to manage and move past it, can help to make a frightening experience less scary and allow one to return to calming nights of sleep.
What is Sleep Paralysis?
Sleep paralysis refers to a temporary inability to move or to speak and occurs while sleeping or waking, in which normal transitions between wakefulness and different stages of sleep, particularly Rapid Eye Movement (REM) sleep, are disrupted. During REM sleep, our brains are remarkably active when viewed on an EEG (electroencephalogram) and similar to waking activity. In order to prevent the body from harm, our brains send signals to temporarily paralyze our skeletal muscles, a phenomenon known as atonia. In sleep paralysis, atonia remains, maybe momentarily, after the individual wakes up or is concurrently conscious in their mind. The dissociation between a conscious mind and a non-responsive body is the essence of sleep paralysis. A sleep paralysis episode can last from a few seconds to many minutes. Although sleep paralysis is often frightening, it is generally harmless from a physical standpoint, but from a psychological perspective, the consequences of sleep paralysis, especially for repeaters, can be immense.
Sleep Paralysis Symptoms
The core characteristic of sleep paralysis is the inability to move or speak while being completely or partially aware. However, the experience can be compounded with other very distressing symptoms. The following symptoms can make the episode even more frightening:
- Inability to Move : This symptom is the hallmark. One may try to move their arms, legs, fingers, toes, or even their eyelids, but they realize that they cannot move at all.
- Inability to Speak : One may try to call for help or tell the other person about their distress, but they realize that they cannot make a sound.
- Sense of Awareness : Regardless of the body being paralyzed, usually one is aware of their surroundings; one might hear, see, and feel the sensations.
- Inability to Breathe: Another common and frightening symptom is the sensation of an inability to take a deep breath or feeling as if something is weighing down the chest; this can result in panic and the feeling of suffocation.
- Sense of Dread or Fear : In addition to the above, sleep paralysis is usually attached to an overwhelming sense of fear, anxiety, or impending doom; if this sensation is compounded by an inability to move or speak and visual and/or auditory hallucination, the dread can become unbearable.
- Sweating : One might find themselves sweating profusely while in an episode.
- Rapid Heartbeat : One may have an increased heart rate due to the fear and anxiety in the situation.
- Visual Hallucinations : These can be vivid (and often unpleasant) or disturbing sensory experiences that can happen while paralyzed. Visual hallucinations can be something as innocuous as seeing shadowy figures or indistinct shapes in their periphery, or they can be far more elaborate and terrifying scenarios of intruders, animals, or monsters.
- Auditory Hallucination : One might hear nonexistent sounds such as hissing, buzzing, voices whispering, footsteps, or a feeling of someone being in the room.
- Tactile Hallucinations : These involve non-existent sensations such as feeling touched, pulled on, or a feeling of something crawling on their skin.
- Vestibular Hallucinations : These can give a sensation of floating, flying, or spinning.
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Types of Sleep Paralysis
Even though the fundamental experience of existing paralyzed while conscious is the same, sleep paralysis can be generally understood in relationship to frequency and the presence of comorbid sleep disorders and is categorized into
- Isolated Sleep Paralysis (ISP): ISP refers to episodes of sleep paralysis occurring in the absence of other established disorders like narcolepsy. Sleep paralysis may occur on occasion throughout a person’s lifetime. ISP is often precipitated by conditions such as sleep deprivation or stress.
- Recurrent Sleep Paralysis (RSP): RSP describes the regular experience of sleep paralysis over time. RSP may be more concerning.
- Sleep Paralysis Due to Narcolepsy: As noted, sleep paralysis is one of the classic tetrad symptoms of narcolepsy (excessive daytime sleepiness, cataplexy, and hypnagogic/hypnopompic hallucinations). People with narcolepsy generally experience, more frequently and intensely, episodes of sleep paralysis.
These distinctions between types of sleep paralysis are helpful to define more intermittent experiences of paralysis versus more sustained problems, which may need consideration for clinical management.
Reasons for Sleep Paralysis
While exactly how sleep paralysis happens is still under investigation, there are a number of things that might cause sleep paralysis. Sleep paralysis is almost never thought of as occurring for a single reason; instead, sleep paralysis appears to happen as the result of a combination of predisposing factors or triggers. Anyway, some of the common causes of sleep paralysis are described below:
- Disrupted Sleep Schedules : Sleeping irregularly, like when one is a shift worker or has jet lag, greatly increases the likelihood of having sleep paralysis.
- Sleep Deprivation : Being insufficiently sleep-deprived over a sufficient amount of time may disrupt the cycle required to suppress sleep paralysis during REM sleep.
- Stress and Anxiety : Also, the more stress and anxiety one has in general appears to be a higher correlated frequency in sleep paralysis.
- Certain Sleep Disorders : For example, people with narcolepsy—a neurological disorder caused by excessive daytime sleepiness and also cataplexy (sudden weakness in muscles)—are extremely more likely to also experience sleep paralysis. Narcolepsy is not the only disorder or psychological phenomenon that relates sleep paralysis to it. Sleep paralysis is also connected to other sleep disorders such as insomnia and obstructive sleep apnea, as well as other psychological disorders.
- Mental Health Conditions : Anxiety disorders, panic disorder, post-traumatic stress disorder (PTSD), and depression appear to show a higher prevalence of sleep paralysis occurrence.
- Sleep Position : Studies have shown that sleeping on one’s back (supine position) is associated with a greater chance of sleep paralysis.
- Substance Use : Use of alcohol or drugs can change the patterns of sleep and lead to sleep paralysis.
- Genetics : There is evidence that suggests one may inherit the likelihood of sleep paralysis through family history of it.
- Some Medications : Some drugs, while not a direct cause, might still be associated with sleep abnormalities that might predispose to sleep paralysis.
- Underlying Medical Conditions : It is less common, but some underlying medical conditions could affect sleep regulation and also relate indirectly to sleep paralysis.
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The Mind’s Eye Deception: Sleep Paralysis Hallucinations Explained
There are generally three main types of sleep paralysis hallucinations :
- Intruder Hallucinations : The horrifying feeling that a person or presence is right there in the room is usually interpreted as malevolent or unsettling. People describe seeing shadows or figures, feeling that someone is standing over them, or feeling an evil presence.
- Incubus Hallucinations : This is the sensation of having a burden on the chest or abdomen or feeling as if one can’t breathe or is being suffocated. Historically, the mind would describe this feeling as an entity sitting on the chest (thus the name incubus).
- Vestibular-Motor Hallucinations : This is the sensation of flying, spinning, floating, or even like the body is being moved. When compared to other types, vestibular-motor events are often frightening but can feel less threatening but just as disorienting.
The different sensations and intensity experienced during these attacks can be influenced by cultural beliefs, personal experiences, and the degree to which the individual experiences fear and anxiety during the episode.
Sleep Paralysis Treatment & Management
In the case of people with infrequent and nontroublesome episodes of sleep paralysis, no treatment may be necessary. For individuals whose episodes are impacting both their sleep and quality of life, a few recommendations may be made to help reduce/manage their episodes:
- Sleep Hygiene : This includes keeping the same time to bed and the same time to wake up every day, creating a relaxing bedtime routine, and avoiding stimulants such as caffeine and nicotine.
- Stress and Anxiety Management : One can utilize one or more methods to calm the nervous system and promote sleep, including mindfulness, meditation, yoga, deep breathing techniques, and progressive muscle relaxation.
- Sleep Disorders : If one experiences sleep paralysis due to an identified sleep disorder, such as narcolepsy or obstructive sleep apnea, seek appropriate medical treatment.
- Mental Health Disorders : Management of any anxiety or depression may include a combination of therapy/medication or simply therapy.
- Sleep Position : If one is a frequent sufferer of sleep paralysis, then they might want to try sleeping on their comfort side.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) : Awareness and modification of negative thoughts and behaviors regarding sleep can help improve sleep functionality.
- Hypnosis and Relaxation Techniques : A couple of people have described hypnosis and other relaxation techniques/methods as helpful too.
- Medications : On rare occasions, medication may be prescribed to regulate sleep or assist with any anxiety associated with sleep paralysis.
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Can Sleep Paralysis Cause Death?
Despite the frightening sensations that sleep paralysis can provoke, it does not directly cause death. Eventually the body will overcome the temporary paralysis and resume automatic breathing; one cannot “stop breathing” or die during an episode. However, the significant fear and anxiety that one may feel or experience as a result of sleep paralysis can affect mental health, potentially creating anxiety disorders, sleep deprivation, and an overall decreased quality of life. In a few instances, extreme stress and panic may worsen a previously underlying respiratory condition or cardiac event, but it is not causal. Sleep paralysis is solely a temporary and harmless physiologic event, and knowing this can be helpful in reducing some of the fear that comes along with it.
Sleep Paralysis Remedies & Coping Strategies
While there is no definitive “cure” for sleep paralysis, there are various treatments and techniques that may be used to help lower the incidence of sleep paralysis and decrease it from becoming a scary event:
- Be Relaxed: If experiencing a sleep paralysis episode, be calm and try to be relaxed with the muscles (even if one cannot physically relax them).
- Try Small Movements: Full movement may not be possible, but one can concentrate on making small movements, such as wiggling the fingers or toes or moving the eyes. Sometimes this can help one to “break” the paralysis.
- Control Breathing: Focus on the breathing and slow, deep breaths. This will help one to fight against the suffocating feeling and prevent the panic from kicking in.
- Remind Yourself That You Are Hallucinating: If you are hallucinating, remind yourself that these are dream-like images and sensations that are not real.
- Switch the Focus: Concentrate to shift the mental focus off the scary sensations that one may be experiencing to a neutral or calming focus away from the scary sensations.
- Talk to Others: Talk to trusted friends, family, or a therapist about the experiences. Talking about them is likely to lower the fear and isolation that accompany the experiences.
- Know What To Expect: Knowing the physical basis of sleep paralysis can diminish the fear factor and can help one to normalize it, even though it might feel unpleasant.
- Practice Good Sleep Hygiene: Again, it has already been mentioned that it is important to sleep well in terms of staying healthy, but it can also help limit sleep paralysis episodes.
- Monitor Any Underlying Issues: Getting treatment for sleep disorders or mental health issues or addressing any source of stress can eliminate the number of sleep paralysis episodes.
When to Seek a Doctor’s Help?
Sleep paralysis – the experience of being temporarily unable to move or speak when waking up or falling asleep—may be a very distressing experience. Occasional sleep paralysis episodes are usually harmless; however, you should see a healthcare professional if:
- Your episodes are happening frequently or getting more frequent
- Your episodes are causing significant distress, anxiety, or fear
- You have symptoms such as excessive daytime sleepiness, daytime hallucinations, or episodes of sudden muscle weakness (cataplexy) that may suggest narcolepsy
- Your episodes are affecting your sleep quality or daily functioning
Conclusion
Sleep paralysis is a horrifying experience where one loses their ability to move and speak while having hallucinations. Nonetheless, knowing the factors that lead to sleep paralysis and how to deal with it can help some people take back their peaceful nights. The first step is to understand that it’s just for a short period of time and is harmless. A good sleep routine, limiting stress, treating any existing health issues, and utilizing coping strategies can help lower the frequency and the fear around sleep paralysis and therefore give a better night’s sleep. One can deal with sleep paralysis, but it takes knowledge, self-care, and taking back control of the night.
Yashoda Hospitals in Hyderabad provides comprehensive neurological care, including the diagnosis and management of sleep disorders like sleep paralysis. Our neurology departments, located in Secunderabad, Somajiguda, Malakpet, and Hitec City, are staffed by experienced neurologists who can identify underlying causes and recommend appropriate management strategies. We can help individuals experiencing frequent or distressing episodes by assessing for associated conditions like narcolepsy, anxiety disorders, or other sleep disturbances and tailoring a management plan that may include lifestyle modifications, stress management techniques, or treatment for coexisting conditions.
Have any questions or concerns about your health? We’re here to help! Call us at +918929967127 for expert advice and support.
About Author –
Dr. G. V. Subbaiah Chowdhary is a Senior Consultant Neurologist and Clinical Director
About Author
Dr. G. V. Subbaiah Chowdhary
MD, DM (Neurology)Senior Consultant Neurologist & Clinical Director
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