Sleep paralysis is scary. Here's what to do

Few things are more frustrating than a disruptive night’s sleep.

Whether it’s due to stress, screen time before bed, caffeine, an inconsistent sleep schedule, or an underlying health condition, many factors can interfere with getting the rest your body needs. And while tossing and turning is common, some disturbances are more unsettling.

One of the most alarming of these is sleep paralysis, a condition that occurs more than many realize.

"About 10% of the general population deals with it," says Dr. Chad Ruoff, medical director at the Mayo Clinic Center for Sleep Medicine, "though this figure can greatly vary across published studies."

Here’s what sleep paralysis is, what causes it, and how it’s typically treated.

What is sleep paralysis?

Sleep paralysis is a brief but often frightening experience defined by "a brief inability to move the entire body or talk as you're falling asleep or waking up," Ruoff explained. Despite being conscious and aware of their surroundings, individuals experiencing it are essentially "stuck" in place for a short period of time.

Common symptoms include "feeling awake but unable to move or speak, a sensation of pressure on the chest or difficulty taking a deep breath or even the perception that someone else is in the room," noted Michelle Drerup, director of behavioral sleep medicine at Cleveland Clinic. She added that many people also report vivid hallucinations or an overwhelming sense of fear or panic during an episode.

Some individuals may also experience auditory or visual distortions that feel real. Such sensations can be especially unsettling, and because time perception is distorted, Ruoff said that "it may feel like forever in duration even if it might actually be seconds."

What causes sleep paralysis?

While the idea of being paralyzed can sound alarming, the underlying mechanism is actually a normal part of sleep for nearly everyone.

"During REM or dream sleep, most individuals are essentially paralyzed except for key muscles such as the diaphragm," Ruoff said.

This natural state of paralysis prevents the body from physically acting out dreams, which could otherwise lead to injury, Drerup explained. But sleep paralysis occurs when this REM-related paralysis overlaps with wakefulness.

In other words, "it is a result of the select feature of paralysis from REM sleep pervading into wakefulness," Ruoff says. Put another way, “sleep paralysis happens when the mind wakes up before the body fully regains muscle control,” says Drerup.

At the same time, certain factors can increase the likelihood of this mismatch between mind and body.

"Sleep paralysis occurs more frequently in individuals with psychiatric comorbidities such as those with anxiety and panic disorders," Ruoff said.

And poor sleep habits, such as irregular sleep schedules or chronic sleep deprivation, can also trigger episodes. Other well-established triggers for sleep paralysis are "sleeping on one’s back or fragmented REM sleep due to various factors such as obstructive sleep apnea," Drerup said.

She added that emerging research is exploring additional contributors like trauma exposure, post-traumatic stress disorder (PTSD), and a potential genetic predisposition.

How is sleep paralysis treated?

Treatment for sleep paralysis typically focuses on addressing its root causes and "decreasing triggers,” Drerup said.

One of the first steps is to identify and manage any underlying sleep disorders, particularly obstructive sleep apnea or narcolepsy, which are commonly associated with disrupted REM sleep.

"And when episodes are frequent or highly distressing, physicians may prescribe medications that suppress REM sleep," says Drerup. These may include "certain antidepressants such as selective serotonin reuptake inhibitors (SSRIs)," explains Ruoff.

For many people, lifestyle changes can also make a significant difference.

"Strategies that individuals can implement on their own include making sure to get an adequate amount of sleep per night on a regular basis, keeping a consistent sleep schedule, avoiding sleeping on their back and decreasing stressors, especially in the evening and around bedtime," Drerup noted. 

She added that if sleep paralysis does occur, it's important to stay calm and remind yourself that the episode is temporary and not dangerous. Also, focusing on slow, controlled breathing while attempting small movements, like wiggling fingers or toes, can help the body regain control more quickly.

Knowing when to seek medical advice is also important.

"If the frequency or intensity of these events is significantly impacting quality of life, then an individual should seek medical evaluation," Ruoff recommended. Additionally, if sleep paralysis occurs alongside excessive daytime sleepiness or symptoms such as sudden muscle weakness (cataplexy), he says, "it may indicate an underlying sleep disorder that requires evaluation by a board-certified sleep physician."