Sleep paralysis is a relatively common sleep disorder characterized by temporary paralysis of the body shortly after waking up or falling asleep. During sleep paralysis, the affected individual is unable to move or speak for a few seconds to a few minutes. This experience can be frightening, but sleep paralysis is not dangerous.
Research suggests that about 8% of the general population experiences isolated episodes of sleep paralysis at some point in their lives. Sleep paralysis appears to be more common in students,shift workers, travelers, and those with mental health issues like anxiety disorders or PTSD. Understanding what triggers sleep paralysis episodes can potentially help prevent and manage them.
Understanding Sleep Paralysis
During REM (rapid eye movement) sleep, the stage of sleep when most vivid dreaming occurs, the brain paralyzes the muscles of the body to prevent individuals from acting out their dreams. In sleep paralysis, features of REM sleep persist as the individual transitions into a waking state. The brain awakens, but the body remains in a dreaming paralysis.
In addition to inability to move or speak, common symptoms of sleep paralysis include:
- A sense of being pinned down or crushed
- Difficulty breathing
- Racing thoughts
- Chest pressure
- Hallucinations or sensations of something in the room
Sleep paralysis episodes typically resolve on their own within one to two minutes as the brain fully awakens and regains muscle control. While the experience can be disturbing, episodes are not physically harmful.
Triggers and Risk Factors for Sleep Paralysis
The exact causes of sleep paralysis are not fully understood, but certain triggers and risk factors appear to play a role:
Sleep Deprivation
Not getting enough sleep is one of the most commonly reported triggers for sleep paralysis. When severely sleep deprived, people spend more time in deeper stages of non-REM sleep trying to “catch up.” This delays REM sleep, and the transition between REM and wakefulness becomes impaired. One study found students were more likely to experience sleep paralysis during exam week when sleep is often disrupted.
Inconsistent Sleep Schedules
Frequently shifting sleep schedules can also contribute to sleep paralysis. Traveling across time zones, working overnight or rotating shifts, and random sleep-wake times on weekends versus weekdays can all make it difficult to maintain regular REM-nonREM cycles.
Stress and Anxiety
High stress levels and anxiety appear closely linked to sleep paralysis episodes. In particular, PTSD and panic disorders are associated with more frequent and severe episodes of sleep paralysis. Stress and anxious thoughts may interfere with normal sleep architecture and REM-nonREM rhythms.
Genetics
A family history of sleep paralysis suggests a genetic component. Having a close relative with recurrent sleep paralysis increases your risk. Genes regulating sleep cycles, neurotransmitters, and neural pathways likely influence susceptibility.
Sleeping on the Back
Sleeping in the supine (face up) position is associated with a higher incidence of sleep paralysis compared to sleeping on the side or stomach. When lying on the back, people spend more time in REM sleep. The supine position can also contribute to breathing difficulties like sleep apnea that impair sleep.
Substance Use
Use of certain prescription medications increases the risk of sleep paralysis. These include narcotic pain medications, antidepressants, and medications that alter REM sleep like beta blockers. Alcohol, stimulants like cocaine, amphetamines, and sleep deprivation from stimulant use can also trigger episodes.
Narcolepsy
People with narcolepsy often experience chronic sleep paralysis along with excessive daytime sleepiness, cataplexy (sudden loss of muscle tone), and hallucinations. Narcolepsy impairs the normal boundaries between REM and wakefulness.
Preventing Sleep Paralysis Episodes
While occasional isolated episodes of sleep paralysis are generally nothing to worry about, recurrences can significantly impact quality of life. Preventative strategies focus on optimizing sleep quality and consistency:
- Maintain a consistent sleep schedule – go to bed and wake up at the same time daily.
- Aim for 7-9 hours of sleep nightly.
- Reduce stress through relaxation techniques, mindfulness, therapy, medication, etc.
- Avoid stimulants like caffeine, nicotine, and alcohol close to bedtime.
- Sleep on your side or stomach rather than back.
- Treat any underlying sleep disorders like sleep apnea.
- Keep the bedroom comfortable, dark, and quiet.
Lifestyle measures can decrease episodes, but medication or cognitive behavioral therapy may be warranted for chronic or severe sleep paralysis.
Stopping an Episode in Progress
Attempting to move extremities like fingers and toes can sometimes abort an episode of sleep paralysis. Other techniques to try include:
- Wiggling tongue.
- Moving eyes rapidly.
- Controlled breathing.
- Trying to speak.
- Focusing on moving one body part at a time.
Remaining calm is very important, as fear and panic tend to prolong episodes. Some people report success with meditation techniques, praying, or chanting during episodes.
When to Seek Medical Help
Occasional isolated episodes of sleep paralysis are not necessarily cause for concern. However, consult your doctor if sleep paralysis is:
- Recurrent – several episodes per week or month.
- Associated with other medical or psychiatric symptoms.
- Impacting quality of life or daytime function.
- Associated with very severe fear, panic, or hallucinations.
- Worsening or resisting self-care measures.
A sleep specialist can help diagnose any underlying conditions contributing to sleep paralysis like sleep apnea, narcolepsy, or restless legs syndrome. Treatment may involve sleep studies, cognitive behavioral therapy, medications, or equipment like CPAP for breathing problems.
Conclusion
Sleep paralysis is a common but generally benign phenomenon marked by temporary paralysis upon falling asleep or waking up. Episodes result when features of REM sleep persist into wakefulness. Known triggers include sleep deprivation, erratic sleep schedules, sleeping on the back, stress and anxiety, genetics, substance use, and sleep disorders like narcolepsy.
Addressing triggers through good sleep hygiene, lowering stress, positional avoidance, and treating medical issues can often reduce episodes. Remaining calm during an attack and using mindfulness and movement techniques can shorten duration. Seek medical advice if episodes become frequent or debilitating.