Sleep paralysis refers to the inability to move one’s muscles upon falling asleep or waking up. In most cases, the condition is short-lived and not a cause for alarm. However, a person may awaken and be unable to move because of a medical condition. Learning to recognize the early signs and taking action may prevent future episodes.

Key takeaways:
Estimates suggest that up to 8% of the population may experience sleep paralysis in their lifetime.
Sleep paralysis describes the loss of voluntary muscle movements (atonia) upon falling asleep or waking.
In addition to atonia, varying forms of hallucinations and a feeling of suffocation may occur.
Sleep paralysis may be related to medical conditions, including PTSD, panic disorders, genetic factors, and substance abuse.
For many, sleep paralysis occurs without significant underlying medical conditions. It may be preventable by recognizing signs and ensuring proper sleep health.

The body's muscles receive signals from the brain to relax during sleep. However, what happens when your muscles don't get the signal to move after waking? Being able to sense one's surroundings without being able to move can be terrifying.

Sleep paralysis symptoms
When a person with sleep paralysis (SP) wakes or falls asleep, they can’t move their legs, head, feet, hands, or body. This inability to move may last a few seconds to as long as twenty minutes, averaging about six minutes for most individuals. However, breathing and eye movements occur as normal. People have previously attributed this sensation to anything from extra-terrestrial abductions and demonic possessions to witchcraft.

In addition to the physical inability to move muscles (atonia), sleep paralysis may produce hallucinations in up to 75% of sufferers. According to the Sleep Foundation, people with SP may experience three forms of hallucinations:

These hallucinations occur outside a dream’s realm, not during the standard REM cycle where one actively dreams. As with lack of motion, hallucinations can occur upon waking or falling asleep.

Sometimes, a few individuals report experiencing euphoria or good feelings when experiencing SP. Still, SP patients generally feel anxious, scared, distressed, or panicked. This occurs because this condition blurs the classic lines between sleeping and being awake.

While distressing, SP typically causes no serious harm to the individual. Perhaps up to 10% of sufferers may experience episodes throughout their lifetime. However, this could lead to anxiety around bedtime and create an environment conducive to developing sleep disorders. Therefore, attention must be paid so that individuals avoid developing secondary ill-health effects due to disrupted sleep or poor sleep quality or duration.

Causes of sleep paralysis
Sleep paralysis is likely caused by a combination of several factors.

While this condition may occur without any underlying disease triggering it, an increased risk of SP occurs with several underlying ailments. For example, a systematic review in 2018 found that those with post-traumatic stress disorder (PTSD) were at exceptionally high risk of SP. Those with general panic disorders also develop this condition, though to a lesser degree.

Other triggers include sleep disorders, poor sleep quality, abnormal circadian rhythms, and various psychiatric conditions. A genetic link may be present but has not yet been clearly identified. High-stress levels, trauma, medications, and substance abuse were also found to be potential triggers. However, more research is necessary to characterize and comprehend SP’s potential causes.

Sleep paralysis treatment options
Unfortunately, there isn’t an exact answer to how to treat SP. Since researchers do not fully understand what triggers SP in all individuals, they can only make general recommendations to minimize episode occurrences. Recovering from an episode takes a short time. People who suffer from SP report that concentrating on trying to move one small body part, like a toe, during an attack leads to a faster recovery.

Tips to prevent sleep paralysis
While medical professionals cannot prevent SP, people with SP can take steps to minimize occurrences and lessen the impact on their lives. For example, some measures a person can take to reduce the number of episodes include the following:

Speak with a healthcare provider. Rule out any underlying medical conditions or sleep disorders.
Practice proper sleep hygiene. Ensure you get enough good quality sleep. Studies suggest that poor sleep quality increases the odds of developing SP.
Cognitive behavior therapy (CBT). Assists with reshaping negative emotions and sleep-related thoughts. This form of treatment can help treat underlying conditions such as PTSD.
Take medications that inhibit REM sleep. Taking medications that can prevent the onset of REM sleep may prevent SP. However, side effects and risks need to be weighed against the benefits.
Treat underlying health conditions. Ensure your overall health to promote good sleep habits and minimize stress.
Sleep paralysis prognosis
Most people will have their first episode of SP between the ages of 14 to 17, though it can begin at any age. This disorder occurs with varying frequency, with prevalence estimates ranging from 4% to 60%. However, a systematic review in 2011 showed nearly 8% of the population experiences SP.

Some individuals have a single episode of SP without ever experiencing it in the future. Others may have episodic periods throughout their lives. Take care to minimize stress and sleep deprivation, as episodes are more likely to occur during states of distress.

Treat yourself nicely. If you have an episode of SP, you may be more tired the next day. Don’t tax yourself, and give yourself a break. It's possible that your health issues are the result of overdoing it. Providing you maintain healthy habits and get ample sleep, thankfully, the prognosis for SP is good. While distressing, SP can be managed with proper sleep hygiene, attention to your mental health, and patience.

When to seek medical advice
Consider seeking medical advice if you have had more than one episode of SP and, as a result, have fear or anxiety associated with going to sleep. Furthermore, seek care if you have daytime sleepiness and concerns about poor sleep duration or quality that affects your daily life.

If you think you have had sleep paralysis, are scared, confused, or unsure, have daytime sleepiness, and struggle with what to do next, you aren’t alone. Talk to friends or family, or seek medical advice from a healthcare professional. You aren’t crazy; you aren’t imagining that something happened. A healthcare provider can help discern if a workup is needed and help you handle future episodes.

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