If you’ve ever woken up in the middle of the night and couldn’t move or talk, even though you were fully awake, you may have had sleep paralysis. It’s a scary thing, but what is it and why does it happen? What matters more is how you can stop it.
Let’s take a look at what sleep paralysis is, who is most likely to get it, and how to lower your chances of having an episode.
What Is Sleep Paralysis?
When you are falling asleep or waking up, sleep paralysis makes it hard to move or speak for a short time. Your body is still in a state of muscle atonia, which is when your muscles are paralyzed. This is normal during REM sleep. It can last from a few seconds to a few minutes.
What scares me the most? Hallucinations are common during these times. You might see things that aren’t there, hear things that aren’t there, or feel a weight on your chest (the “Incubus” feeling that everyone hates).
Sleep paralysis is usually not dangerous, but it can be scary, especially if you’ve never had it before. The frequency varies; some people only have it once, while others have it all the time.
II. The Main Mechanism: What Makes It Happen?
Sleep paralysis happens when the brain and body aren’t working together properly. During REM sleep, your brain is busy, but your body is almost completely still so you don’t act out your dreams. When you have sleep paralysis, the brain’s arousal systems wake up before the paralysis (which is controlled by the medulla) goes away.
The disconnect between the mind and body is what causes sleep paralysis. There is still some uncertainty about what causes this disconnect, but it is thought to be related to REM sleep instability.
III. The Main Causes of Sleep Paralysis
There are a number of things that can make it more likely that you will have sleep paralysis:
1. Not Getting Enough Sleep and Losing Sleep
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Not getting enough sleep on a regular basis, having irregular sleep schedules, or working shifts can mess up your REM sleep cycle. This can cause “REM rebound,” which is when your body tries to catch up on missed REM sleep and may cause sleep paralysis.
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If you have poor sleep quality—meaning it takes you more than 30 minutes to fall asleep or you feel tired during the day—you are more likely to get sick.
2. Sleep Problems
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Obstructive Sleep Apnea (OSA): Frequent awakenings during the night (because of breathing problems) can make REM instability worse, which makes sleep paralysis more likely.
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Insomnia: Subjective and objective insomnia (trouble falling or staying asleep) are both strongly linked to more episodes of sleep paralysis.
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Narcolepsy: People with narcolepsy often have sleep paralysis episodes as part of their cataplexy symptoms (sudden muscle weakness).
3. Mental Health Issues
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Conditions like PTSD, anxiety, panic disorder, and bipolar disorder often cause hyper-arousal and REM sleep fragmentation, both of which can lead to sleep paralysis.
4. Genetic and Familial Predisposition
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There is evidence indicating a genetic association with sleep paralysis. A twin study found that some circadian-gene variants, like PER2, make people more likely to get sick. Your chances are higher if your family members have been through it.
5. Effects of Drugs and Alcohol
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Alcohol, cannabis, and nicotine can make REM cycles less stable, which raises the risk of problems.
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Antidepressants(SSRIs, SNRIs) and stimulants(for ADHD) can change when and how long REM sleep lasts, which can cause sleep paralysis.
6. Sleep Position & Circadian Disruptors
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Sleeping on your back has been linked to more cases of sleep paralysis, which may be because it overlaps with sleep apnea.
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Jet lag, drinking caffeine late at night, and not sleeping at the same time every night all mess up your body’s natural circadian rhythms, which makes sleep paralysis more likely.
IV. Who’s in the Most Danger?
Anyone can have sleep paralysis, but some groups are more likely to have it than others:
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Age: It usually starts in childhood or adolescence and can last into adulthood.
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Sex: There is a slightly higher prevalence in individuals designated female at birth.
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Ethnicity: There are more cases among Asian and African groups, especially among college students or people who are in psychiatric care.
V. When to Get Medical Help
Most of the time, sleep paralysis isn’t harmful, but if it happens a lot or starts to get in the way of your daily life, it might be time to get help.
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Episodes that happen at least once a week and cause insomnia, tiredness during the day, or worry about sleep.
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It’s a red flag if you have cataplexy, snoring, hallucinations that happen when you’re not sleeping or waking up, or nocturnal incontinence/injury.
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Work-up: If you think you might have sleep apnea or narcolepsy, you may need a sleep history, a sleep diary, and possibly a polysomnography (a sleep study). In some cases, a psychiatric evaluation may also be needed.
VI. Prevention and Management Based on Evidence
While sleep paralysis is often harmless, there are several ways to reduce the chances of experiencing it.
A. Make Sleep More Stable(First-Line Approach)
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Set a regular sleep-wake schedule: Even on weekends, try to go to bed and wake up at the same time every day (± 30 min).
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Make sure you get 7–9 hours of sleep every night in a bedroom that is cool, dark, and quiet. Don’t look at screens for at least 30 minutes before bed.
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Don’t sleep on your back. If you tend to sleep this way, try using positional devices or a “side-sleeping backpack.”
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Don’t smoke, and cut back on caffeine and alcohol in the hours before bed.
B. Take Care of Underlying Problems
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People with sleep apnea can use a CPAP machine to help them sleep better and have fewer episodes of sleep paralysis.
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Cognitive Behavioral Therapy for Insomnia (CBT-I) works for people who can’t sleep.
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For PTSD, trauma-focused therapy is the most important thing.
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Narcolepsy: Scheduled naps, medications like sodium oxybate or modafinil, and antidepressants for cataplexy can help with symptoms.
C. Drugs for Hard-to-Treat Cases
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In very rare cases, low-dose tricyclic antidepressants or SSRIs can be used to make REM sleep less intense and stop paralysis. But this should only be done with the help of an expert.
D. Intervention in Education
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Learning about the “benign nature” of sleep paralysis and its physiological triggers can help lower the “fear” and “anxiety” that often make episodes worse.
VII. A Quick Checklist for Self-Help
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[ ] Stick to a regular sleep schedule (7–9 hours)
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[ ] Sleep on your side if you can
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[ ] Don’t drink caffeine or alcohol 4 to 6 hours before bed
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[ ] Make a relaxation routine(try deep breathing or progressive muscle relaxation)
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[ ] Get professional help if you have episodes often or if your hallucinations are scary
VIII. The Bottom Line
Sleep paralysis is usually a harmless problem with your REM sleep cycle that can happen when you don’t get enough sleep, your circadian rhythm is out of whack, or you have a health problem. It can be scary, but it’s not usually something to worry about.
Make sure you get the best sleep possible by focusing on the quality and timing of your sleep. The best way to cut down on episodes is to treat the underlying problems, such as OSA, insomnia, or mood disorders. Most of the time, you don’t need medicine. If you have sleep paralysis often or with other symptoms like cataplexy, you should see a sleep specialist for a full evaluation and treatment plan.
Don’t worry if you’ve had sleep paralysis before; you’re not the only one. To “break the cycle,” you need to understand it, deal with it, and get the right treatment. Don’t let fear keep you up at night; sleep well!
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