What is sleep paralysis and can you prevent it from happening?

The first time it happens, you won’t know what’s going on, but you’ll sure as hell think that something absolutely terrifying is gripping you, holding you down, and stopping your breath.

And in a way, it is.

This is sleep paralysis, one of the least understood (and least pleasant to endure) sleep conditions you’ll find going. Its origins are mysterious, its causes unknown, and just to add to the fun of living with it: there’s no known cure.

And though this may be the first time you’ve heard of it, it’s estimated that nearly 8% of the world’s population suffers from sleep paralysis at least at some point in their lives [1].

Anglo-swiss artist Henry Fuseli’s 1781 oil painting The Nightmare is thought to depict sleep paralysis [2]. It was seriously misunderstood way back then and it’s seriously misunderstood now.

Describing an attack is hard, as the true terror of being awake, convinced that bad things are happening to you while your body remains paralysed, can only be grasped by those who have experienced it. It’s also different for everybody.

Sleep paralysis is thought to be the source of many alien abduction stories, as well as other paranormal events, due to the insidious way it plays tricks on the unsuspecting mind [3].

Without a proper name and a set of medically recognised symptoms, one could be forgiven for thinking that a devil was indeed literally sitting atop their chest while they slept.

What is sleep paralysis?

In short, sleep paralysis happens when you are technically awake, but your body is not. An attack usually occurs when a sufferer is waking up or falling asleep, and the brain is active while the body is still asleep.

During rapid eye movement (REM) sleep, which is the stage of sleep where you have dreams, your body becomes paralysed [4]. While sleep is still one of the least understood medical sciences, it’s presumed that this is so that you don’t act out your dreams.

Sleep paralysis is a type of disruption to this REM sleep, which happens when somebody is going to sleep or waking up, as well as at other points during the night.

Short of this, and a few highly technical theories that use big words and offer little light, not much is actually known [5]. Sufferers report varying symptoms and degrees of severity, and reports of the sort of hallucinations one might experience differ between patients [6].

Types of sleep paralysis

There are 2 types of sleep paralysis:

• Recurrent sleep paralysis, which consists of multiple sleep paralysis episodes that can be linked to narcolepsy.
• Isolated sleep paralysis, which consists of one-off episodes of sleep paralysis that aren't linked to narcolepsy (or other sleep disorders).

It's also possible for both types to occur together. This is called recurrent isolated sleep paralysis and it refers to multiple episodes not linked to narcolepsy.

What causes sleep paralysis?

This is very easy to answer. We dunno [7].

Sleep scientists do have a few theories, though, and certain conditions appear to be linked to a higher prevalence of sleep paralysis.

Practising Psychologist and Director of the North Queensland Insomnia Clinic, Dr Andrew Mair tells Co-Pilot that there are numerous factors that studies have shown to be linked to sleep paralysis, including disrupted and poor sleep, shift work, stress and trauma, substance use, anxiety and even certain personality types.

According to Dr. Mair, it is also more common in people suffering from post-traumatic stress disorder.

But as any scientist will tell you, correlation does not necessarily amount to causation, and the mystique of sleep paralysis seems to be a part of its very nature.

It’s also not understood whether sleep paralysis is a good indicator of any major underlying issues, though Dr Mair does add: “Sleep paralysis seems to be commonly associated with co-occurring sleep issues and anxiety conditions.”

What do I do if I’m suffering a sleep paralysis attack?

For most sufferers, the first attack will be the worst as you won’t know what’s going on.

As time goes by and attacks become more common, your conscious state makes you aware that you are having a sleep paralysis attack, which makes it easier to talk yourself down from the proverbial ledge.

One of the hardest parts to overcome, however, is the median state in which it occurs, where you are still technically dreaming but your mind is lucid.

You will be aware that the things happening around you aren’t real, but the part of your brain that controls your “fight or flight” reactions — the amygdala — doesn’t discriminate between real and perceived threats, meaning the feeling of terror is still there [8].

“Managing 'catastrophic' thoughts is the key to de-escalating your distress rather than having it mushroom out of control”, says Dr. Mair.

“If we believe we’re in serious danger then our nervous systems respond accordingly. Noticing and challenging irrational thoughts like 'I’m going crazy' or 'I’m going to die' acts as a circuit-breaker in the positive feedback loop of anxiety when you are paralysed.”

What’s probably most important to remember during an attack is that it is only temporary.

An episode of sleep paralysis generally lasts no longer than a couple of minutes, so staying calm and waiting for it to pass is an effective way to manage ongoing symptoms.

Can you prevent sleep paralysis?

The old adage that prevention is always better than a cure may ring true for many a medical condition, but as so little is known about sleep paralysis, it’s hard to know if that is at all possible.

The condition's prevalence can be linked to poor sleep, irregular sleeping patterns, stress, trauma, substance use, and anxiety, though this is not to say that a lifestyle change is a guaranteed fix for living with sleep paralysis.

“Unfortunately, there is no hard scientific evidence that changing lifestyle factors will benefit sleep paralysis”, says Dr Mair. “However, unsatisfactory sleep, stress and poor mental and general health are regarded as risk factors for sleep paralysis.

“If you experience sleep paralysis and are having trouble with any of these other issues, then getting some professional help from your GP or a sleep psychologist might be worthwhile.”

Is there a cure for sleep paralysis?

While there’s no silver bullet cure, Dr Mair does note that Cognitive Behaviour Therapy can help to treat sleep paralysis.

“Training with a psychologist skilled in this treatment will help you develop and hone your skills so you can tackle sleep paralysis head-on.”

Other than this, the treatment for sleep paralysis is largely a mystery.

Some medications have been used in the instance of managing other sleep disorders like narcolepsy, but, as Dr Mair points out: “There haven’t been any controlled clinical studies to date that indicate a cure is in sight.

“Cognitive behavioural treatment (CBT) is currently regarded in the clinical literature as the first choice for the management of sleep paralysis.”

Living with sleep paralysis can be a really tough time.

From the first terrifying attack that leaves the sufferer lying in bed in a state of bewilderment to the ongoing, often daily, trauma of managing the symptoms each morning, it can feel like an uphill battle.

It leaves you feeling like you’ve had a bad night’s sleep and makes the idea of going to bed for a decent night’s shut-eye less than appealing for those who suffer the worst.

But while there’s no known “cure”, there is comfort in knowing how many sufferers there are, globally, and that by opening up a conversation with your GP and being open to CBT, help is available that might just kick your sleep paralysis for good.

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