What is sleep paralysis?

Recurrent isolated sleep paralysis is a parasomnia. A parasomnia involves undesired events that occur while you are falling asleep, during sleep, or as you are waking up. A REM parasomnia is one that happens during a transition into or out of REM sleep. Sleep paralysis is a REM parasomnia. It causes you to be unable to move your body at either of the two following times:

When falling asleep (hypnagogic or predormital form)
When waking up from sleep (hypnopompic or postdormital form)

Normally your brain causes your muscles to relax and be still in REM sleep. This is called “REM atonia.” This happens to keep you from acting out your dreams. Sleep paralysis occurs when REM atonia happens while you are falling asleep or waking up. Sleep paralysis is “isolated” when it appears without any other signs of narcolepsy or other sleep disorders.

An episode of paralysis may cause you to be unable to speak. It can also make you unable to move your arms and legs, body, and head. You are still able to breathe normally. You are also fully aware of what is happening. An episode can last for seconds or minutes. The episode usually ends on its own. It may also end when someone touches you or speaks to you. Making an intense effort to move can also end an episode. Sleep paralysis may occur only once in your life. It may also happen many times in a year.

It can be very scary when you are unable to move. You may feel anxious and afraid. Some people also hallucinate during an episode. They may see, hear or feel things that are not there. They may even think that another person is in the room with them. These hallucinations may also appear without the sleep paralysis.

Sleep paralysis tends to first appear in the teen years. It then occurs most often when you are in your 20s and 30s. It may continue into your later years. Although the paralysis event may be frightening, it is not a serious medical risk on its own and does not keep you from getting the sleep you need.

Sleep paralysis can be one sign of narcolepsy. Other signs include excessive daytime sleepiness, fragmented sleep, sleep-related hallucinations, and cataplexy. If you are experiencing these symptoms along with sleep paralysis, you should talk to a sleep doctor. Narcolepsy is a serious disorder that requires treatment, and a sleep doctor is best suited to diagnose and treat narcolepsy.

What are symptoms of sleep paralysis?

People with sleep paralysis may:

Be unable to move their arms and legs, body, and head when falling asleep or waking up
Have episodes that last from only seconds to a few minutes

It is also important to know if there is something else that is causing your sleep problems. They may be a result of one of the following:

Another sleep disorder such as narcolepsy
A medical condition
Medication use
A mental health disorder
Substance abuse

What are risk factors for sleep paralysis?

Sleep paralysis can affect men and women of any age group. The average age when it first occurs is 14 to 17 years. It is a fairly common sleep problem. Estimates of how many people have it vary widely from 5% to 40%. You may be more likely to have it if a relative also has it.

A lack of sleep can make you more likely to have sleep paralysis. It is also more likely if you have a sleep schedule that often changes. Mental stress may also be a factor. It seems to occur more often when you sleep on your back. It may also be related to any of the following factors:

Bipolar disorder
The use of certain medications
Sleep-related leg cramps

How to diagnose sleep paralysis?

Recurrent isolated sleep paralysis is fairly common. In most cases, it does not affect your sleep or overall health. Talk to your doctor if episodes of sleep paralysis make you anxious. You should see a sleep doctor if the episodes keep you up at night or make you very tired during the day.

The doctor will need to know when the sleep paralysis started. She will want to know how often it occurs and how long it lasts. The doctor will need to know your complete medical history. Be sure to inform her of any past or present drug and medication use.

Also, tell your doctor if you have ever had any other sleep disorder. Find out if you have any family members with sleep problems. It will also be helpful if you fill out a sleep diary for two weeks. The sleep diary will help the doctor see your sleeping patterns. This data gives the doctor clues about what is causing your problem and how to correct it.

Doctors do not need any tests to treat most patients with recurrent isolated sleep paralysis. Your doctor may have you do a sleep study if your problem is disturbing your sleep or they suspect an additional sleep disorder. This study is called polysomnography. It charts your brain waves, heartbeat, and breathing while you sleep. It also records how your arms and legs move. An electromyogram (EMG) recording will show the level of electrical activity in your muscles. This level will be very low during an episode of sleep paralysis.

If you tend to be very sleepy during the day, then your doctor may also have you do a daytime nap study. This is called a Multiple Sleep Latency Test (MSLT). The MSLT will measure how fast you fall asleep during the day. It will also show what kind of sleep you have when you take a nap. It will help to show if your sleep paralysis is a sign of narcolepsy.

How to treat sleep paralysis?

Treatment of sleep paralysis is aimed at whatever causes it to occur. Sleep deprivation may trigger sleep paralysis. In this case, try to get 7 to 9 hours of sleep per night on a regular basis.

People with psychiatric problems may have sleep paralysis. An example is someone who has bipolar disorder. This person would need ongoing treatment with medication. This would be overseen by a physician or psychiatrist. You may notice sleep paralysis occurring with leg cramps. It may also happen after a change in your medicine. Discuss these issues with your doctor.

People with narcolepsy often have sleep paralysis. If you are diagnosed with narcolepsy, a sleep doctor will work with you to find a treatment plan for your narcolepsy.

When sleep paralysis is not associated with other disorders there are few treatment options. Many times it does not require treatment. A regular sleep schedule can help as well as maintaining good sleep hygiene. Cognitive behavioral therapy to address anxiety and stress may be helpful.