Symptoms and Causes of Sleep Paralysis

Table of Contents
View All
Table of Contents

Sleep paralysis occurs when you're temporarily unable to move or speak as you transition from sleep to wakefulness, or vice versa. You may feel like someone is holding you down in your sleep or like you're touching, hearing, smelling, or seeing people or things that aren't really there. It can last seconds to minutes.

You may feel anxious, scared, or even like you're going to die (or that you're already dead). You are aware of the experience, but unable to do anything to control it. Fortunately, most people who experience sleep paralysis don't typically have it often. When they do, the cause is usually relatively harmless with no serious risks. However, some conditions that can affect your health may also cause sleep paralysis, so it may be worth seeing a healthcare provider.

Here's everything you need to know about sleep paralysis, including what causes it and what to do if it happens to you.

Woman lying in bed with arm over her face
Blend Images - JGI / Jamie Grill / Brand X Pictures / Getty Images

Sleep Paralysis Symptoms

Sleep paralysis can occur when you're waking up, which is called a hypnopompic state. It can also happen when you're falling asleep, which is called a hypnagogic state. The latter is more common in people with narcolepsy, a sleep disorder that makes you sleep too much.

You're more likely to experience sleep paralysis closer to the morning. That's when rapid eye movement (REM), the sleep stage associated with vivid dreaming, occurs. Sleep paralysis also happens more often when you sleep on your back.

Common features of sleep paralysis include:

  • Limited eye movement
  • Sense of an evil presence or impending doom
  • Hallucinations: For example, you may have a feeling of being touched, hearing voices in the room, or seeing people or faces by the bed.
  • Feeling short of breath or pressure on your chest: It may seem like someone is standing or sitting on your chest, though your breathing is not truly affected.

You may feel like someone is standing over you, for example. You may not be able to move any of your body parts, including your head. Or you may feel like someone (or something) is holding you down. You might panic, or even fear that your life is in danger.

While many people have scary sensations during sleep paralysis, it's also possible to have pleasant ones.

Prevalence

Sleep paralysis occurs most often among people who are in their 20s and 30s, but some have their first episode as teenagers.

People with certain medical or mental health conditions—like narcolepsy or sleep apnea—are more likely to have sleep paralysis. The condition also has a genetic component and may run in families.

Sleep paralysis is relatively common, with a lifetime prevalence of about 8%. People who are younger or who have conditions such as chronic pain or major depression are at higher risk for having sleep paralysis incidents.


A 2018 study found that student-athletes regularly reported sleep paralysis. The study also found students with depression had higher instances of sleep paralysis.

Causes

Sleep deprivation, stress, and a disrupted sleep schedule can trigger sleep paralysis. Anxiety disorders also have a strong link, possibly because they lead to insomnia or lighter, fragmented sleep.

A 2016 review found that sleep paralysis occurs with disruption of rapid eye movement (REM), or dream sleep. Although specific triggers play a role, some people believe sleep paralysis is related to a problem with REM regulation. During this phase of sleep, your body relaxes so that it doesn't physically act out dreams.

This type of relaxation can cause temporary paralysis if it happens while a person is awake. Other elements of vivid dream sleep can continue as you wake up and also occur with disrupted REM.

Obstructive sleep apnea can disrupt your breathing. This causes you to wake up throughout the night. Studies have found that people who experience obstructive sleep apnea have a higher incidence of sleep paralysis. This could be because apnea often occurs during REM sleep, causing a sudden awakening that can lead to sleep paralysis.

Your condition may have an underlying cause, such as sleep apnea, if you have symptoms like:

  • Snoring
  • Teeth grinding (bruxism)
  • Pauses in breathing
  • Gasping or choking
  • Daytime sleepiness
  • Frequently waking to urinate at night (nocturia)

In rare cases, another disorder mimics sleep paralysis. One example is a focal epileptic seizure. A video electroencephalogram (EEG) can help differentiate between the two. An EEG is a test that records your brain's electrical activity.

Treatment

Sleep paralysis ends within a few minutes, either when you go back to sleep or fully wake up. Treatment is not typically needed and most people feel like they can cope after they know they're not actually in danger.

If you're prone to episodes of sleep paralysis, improving your sleep hygiene can often help. Sleep hygiene refers to healthy habits that help you fall into a deep sleep:

  • Get enough sleep.
  • Avoid alcohol and caffeine before bed.
  • Manage your stress.

In rare cases, people suffer from repeated episodes and feel like they can't handle the psychological distress.

Medicine that suppresses the REM cycle of sleep sometimes helps. This includes selective serotonin receptor inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Ask your healthcare provider to evaluate you to address any sleep, mental health, or other medical disorders that can disrupt sleep, like sleep apnea or narcolepsy.

If you have multiple or recurring episodes of sleep paralysis and these strategies don't help, your healthcare provider might refer you to a board-certified sleep specialist for an evaluation that will likely include a sleep study.

Coping

Some people find that mindfulness meditation and muscle relaxation exercises help them cope with sleep paralysis.

When you experience sleep paralysis, focus on relaxing your mind. Tell yourself that:

  • You know what's happening.
  • It's not real.
  • You're not in any danger.
  • The sleep paralysis will end soon.

Some people even like to engage in the experience. For instance, they'll pretend they're an actor in a scary movie. This gives them a sense of control over something that otherwise makes them feel powerless.

If you can reassure and distract yourself enough to fall back asleep, the experience will quickly end.

Summary

Sleep paralysis is somewhat common in adults but especially affects students and people with panic disorders. It happens when the transition to sleep or awakening is disrupted, and there's an interruption in your REM sleep.

Many times people experience hallucinations that they can see, hear, smell, or feel. Most people don't like the experience and often feel scared. But usually, sleep paralysis is harmless.

If it's bothering you or if you have other symptoms of sleep disorders, see your healthcare provider or a sleep specialist.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Sleep Medicine. Sleep Education. What is sleep paralysis?

  2. Stanford Medicine Healthcare. Sleep paralysis.

  3. Denis D, French CC, Rowe R, et al. A twin and molecular genetics study of sleep paralysis and associated factors. J Sleep Res. 2015;24(4):438-46. doi:10.1111/jsr.12282

  4. Denis D, French CC, Gregory AM. A systematic review of variables associated with sleep paralysis. Sleep Med Rev. 2018;38:141-157. doi:10.1016/j.smrv.2017.05.005

  5. Liu S, Athey A, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. Sleep paralysis and hypnogogic/hypnopompic hallucinations: prevalence in student athletes and relationship to depressive symptomsSleep. 2018;41(suppl_1):A358-A358. doi:10.1093/sleep/zsy061.963

  6. Sharpless B. A clinician’s guide to recurrent isolated sleep paralysisNeuropsychiatr Dis Treat. 2016;12:1761-1767. doi:10.2147/NDT.S100307

  7. National Heart, Lung, and Blood Institute. Sleep phases and stages.

  8. Tale S, Kumar A, Saini LK, Meitei SP, Gupta R. Sleepwalking and prolonged partial sleep paralysis in a case of obstructive sleep apnea. Sleep Sci. 2021;14(2):186-189. doi:10.5935/1984-0063.20200053

  9. Jalal B. How to make the ghosts in my bedroom disappear? Focused-attention meditation combined with muscle relaxation (MR therapy)—a direct treatment intervention for sleep paralysisFront Psychol. 2016;7. doi:10.3389/fpsyg.2016.00028

Additional Reading

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.