Sleep paralysis

To understand what sleep paralysis is, it helps to know a bit about sleep. During rapid eye movement (REM) sleep, when most vivid dreams happen, your brain temporarily relaxes most of your muscles to stop you from acting out dreams. Sleep paralysis happens when you become conscious while this muscle relaxation is still in effect.

The result is a strange in-between state: your mind is partly awake, but your body hasn't caught up. You may be able to move your eyes, but not your arms, legs or voice.

Episodes can occur as you drift off or as you wake up. Many people experience sleep paralysis at least once in their lives, and for some it happens repeatedly. Isolated episodes are common and usually harmless. When it happens often, causes significant fear of going to sleep or occurs alongside sudden daytime sleep attacks, it's worth talking to a doctor, as it can be linked to sleep disorders like narcolepsy.

The main symptom is being unable to move or speak while awake. Other common experiences include:

• Feeling pressure on the chest or difficulty breathing
• Feeling that someone or something is in the room
• Hypnagogic hallucinations (when falling asleep) or hypnopompic hallucinations (when waking), which can involve seeing, hearing or feeling things that aren't there
• Sensations of floating, falling or being pulled
• Intense fear or a sense of dread

Many people describe seeing a shadowy figure, an intruder or a menacing presence, often called the sleep paralysis demon. Across cultures and history, people have explained these experiences with folklore about spirits, witches or visitors. Today, they're understood as dream imagery blending with waking awareness, intensified by the brain's threat response.

Knowing this doesn't always make episodes less scary in the moment, but understanding that you can't move because you're still partly in REM sleep, and that it will pass, can reduce the fear.

Sleep paralysis causes are linked to disruptions in sleep, particularly around REM. Factors that can increase the risk include:

• Sleep deprivation or irregular sleep schedules
• Shift work and jet lag
• Sleeping on your back
• Stress and anxiety
• Panic disorder, PTSD and other mental health conditions
• Insomnia or other sleep disorders, such as narcolepsy or sleep apnea
• Some medications and substances, including alcohol
• Family history, as it may run in families

Stress and poor sleep often go hand in hand, and both make episodes more likely. For some people, anxiety about having another episode, sometimes called sleep anxiety, makes it harder to fall asleep, which then raises the risk again. Addressing that cycle is often part of treatment.

If you can't move when waking up, it can help to have a plan:

• Remind yourself that this is sleep paralysis, it is temporary and it will pass
• Focus on slow, steady breathing rather than fighting for breath
• Try to move a small part of your body, such as a finger, toe or facial muscle
• Let any frightening images or sensations come and go without engaging with them
• After the episode, get up briefly, turn on a light or have a drink of water before returning to sleep

Some people find it helpful to mentally rehearse these steps during the day so they come more easily during an episode. Struggling against the paralysis can increase panic, so calm acceptance often works better.

Occasional sleep paralysis usually doesn't need treatment beyond better sleep habits. If episodes are frequent, very distressing or affect your sleep and daily life, professional help can make a difference.

A doctor may first check for underlying sleep disorders, such as narcolepsy or sleep apnea, and review medications or substances. A psychologist or clinical psychologist can help when anxiety, stress, trauma or fear of sleep plays a role. Cognitive behavioral therapy approaches, including CBT for insomnia, relaxation training and techniques to reduce fear around episodes, can be useful. Some specialized approaches teach people to reinterpret and calm their reactions during episodes.

When sleep paralysis occurs alongside PTSD, panic disorder or depression, treating those conditions often helps. A psychiatrist may consider medication in specific cases, especially if there is an underlying sleep disorder.

At a first appointment, expect questions about your sleep routine, how often episodes happen, what you experience, and your stress levels and mental health. Keeping a sleep diary beforehand can help.

Many people reduce episodes by improving their sleep:

• Aim for enough sleep on a regular schedule, including weekends
• Create a calm bedtime routine and keep your bedroom dark, quiet and cool
• Limit caffeine, especially in the afternoon and evening
• Avoid heavy alcohol use, which disrupts REM sleep
• Try sleeping on your side if episodes happen when you're on your back
• Manage stress during the day with exercise, relaxation or mindfulness
• Avoid screens and stimulating activities right before bed

If fear of sleep paralysis is keeping you awake, or episodes come with other symptoms like nightmares, sudden muscle weakness during the day or excessive daytime sleepiness, talk to a doctor or mental health professional.