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Sleep Paralysis: Definition, Causes, Treatments

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What Is Sleep Paralysis?

Woman with insomnia can not sleep at nightThroughout the ages, sleep paralysis has been attributed to the likes of demons, aliens and even the devil himself. Before the advent of modern medicine and the creation of research tools that have allowed us a scientific understanding of brain function, it’s not hard to see why this was the case.

Sleep paralysis is one of the most disconcerting, terrifying experiences a sleeper can have. In its strange blend of sleep and wakefulness, people feel powerless and scared, unable to physically control their own bodies. Even with a 21st century understanding of why and how this phenomenon affects certain individuals, sleep paralysis can still feel like the work of a mystical force.

So what is really going on when we wake up unable to move or sense danger? What causes sleep paralysis? Can anything be done to prevent it? Is sleep paralysis a symptom of a more serious underlying condition?

There are two main kinds of sleep paralysis

Sleep paralysis can be broken down into two distinct types: predormital and postdormital. Predormital paralysis occurs a person is falling asleep and slowly relaxes, and postdormital paralysis occurs as one is waking up.

Both forms of the disorder are characterized by the same symptoms. According to the UK’s National Health Services, during an episode of sleep paralysis you may feel:

  • awake but unable to move, speak or open your eyes
  • like someone is in your room
  • like something is pushing you down
  • intense fear

These episodes can last for several minutes. Some studies suggest that this disorder is very rare, with just over 6% of people reporting that they have experienced the phenom in their lifetime. While less than 1% of people reporting having episodes once a week. However, other studies have estimated that up to one-third of adults have experienced sleep paralysis at least once.

Sleep paralysis is a form of parasomnia

woman with sleep paralysis and panic while lying down under the blanket in bedroomLike sleepwalking, night terrors, confusional arousal, hallucinations, and others, sleep paralysis belongs to a broad category of disorders known as parasomnias.

These conditions are characterized by unwanted physical activities and behaviors that occur when our bodies and minds enter an abnormal state somewhere between sleep and wakefulness.

During the course of a normal night in bed, our body cycles through discrete stages, marked by slightly different brain and body functions. This is known as the sleep cycle. Though the term parasomnia summarizes a broad category of different behaviors, all of them take place when people get “caught” in between discrete stages of the cycle and become partially awake.

How it is linked to REM

Without getting too deep into the specifics of the different stages of sleep, there are broadly two categories known as rapid eye movement (REM) and non-rapid eye movement (NREM). Sleep paralysis is a REM type of parasomnia, meaning that it affects individuals as they enter into, or are already in, the REM stage.

During this time, dreams are more common and more vivid. Because of this, the body naturally “paralyzes” its muscles so that sleepers cannot act out their dreams in the middle of the night. This freezing of the muscles is responsible for the immobile sensation associated with paralysis.

Causes of sleep paralysis

While there is no clear cut “cause” of sleep paralysis, sleep researchers have linked this parasomnia with certain triggers and other conditions. Significant factors that can contribute to SP include:

  • Unhealthy or irregular sleep patterns: Not getting enough sleep, or getting it in irregular intervals can lead to SP. Generally speaking, the less routine your nighttime patterns are, the more susceptible to certain disorders you become.
  • Excess stress: High levels of stress can lead to insomnia, which in turn has been linked to episodes of SP.
  • Mental health disorders: Some studies have shown that the prevalence of SP is higher among populations that suffer from mental health disorders.
  • Other sleep disorders: Sleep paralysis has been linked to several other disorders, including narcolepsy, insomnia, and restless legs syndrome (RLS), among others.
  • Certain medications: Some medications might lead to episodes of paralysis, especially those taken for the treatment of ADHD.
  • Substance abuse: Along with many other sleep disorders, there seems to be a link between substance abuse and sleep paralysis, though more research is needed to establish a clear causal link between the two.

This phenomenon can happen to any person regardless of age or gender, though the first experiences with the disorder typically occur during the teenage years.

A young woman doing yoga exercise in morning in a bedroom

 

Treatment Options

Often times, this paralysis occurs so infrequently that it does not require a formal diagnosis and treatment by medical professionals. However, if episodes become frequent, or especially upsetting, there are some treatment options available to combat the episodes.

  • Improve your sleep hygiene: Try to get six-to-eight hours of rest every night. As best you can, try to go to bed and wake at the same time to set a routine your body will naturally adjust to. Avoid alcohol, caffeine, and nicotine in the evenings, as well as electronics with blue light-emitting displays.
  • Treat underlying conditions: The most important thing you can do is seek treatment for any conditions that might underpin sleep paralysis. Talk to your doctor if you suffer from other sleep disorders like insomnia or narcolepsy, or if you suspect you may have untreated mental health disorders like depression or bipolar disorder.
  • Relieve stress before bedtime: Anything you can do that makes the journey into sleepless fraught will improve your chances of healthy uninterrupted rest. Try practicing meditation or yoga in the evening, or wind down with a bath and a good book. Avoid things like social media or checking emails.
  • Talk to your doctor about medication and therapy options: If you take medication for any other condition, speak with your physician about possible side effects that may cause or exacerbate sleep paralysis. They might recommend that you change your prescription. In severe cases, some doctors might recommend cognitive behavioral therapy as treatment.

 

Depression and How it Affects Your Sleep

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Depression is one of the most commonly diagnosed mental health conditions in the U.S. In 2017, the National Institute of Health reported that over 7% of all Americans over the age of 18 had at least one major depressive episode.

Depressed Woman Lying on Mattress

Your mind and sleep are deeply intertwined. Experts say one of the most common symptoms of clinical depression is trouble during the night. Those diagnosed with it are likely to suffer from insomnia and trouble staying asleep throughout the night. Patients are likely to have problems with oversleeping. All of these symptoms negatively affect other aspects of wellness and intensify symptoms of depression.

It is therefore very important to understand the relationship between this disorder and sleep from both a diagnostic perspective as well as a treatment.

What depression looks like

Depression is a mental health mood disorder that comes in many varieties and severities. Common types of it include postpartum depression (PPD), seasonal affective disorder (SAD), Persistent depressive disorder (Dysthymia), Psychosis, bipolar disorder and more. Changes to mood and behavior are characteristic of all forms of the disorder.

According to the NIH, some of the most common psychological symptoms of depression are:

  • Prolonged feelings of sadness, anxiety, or emptiness
  • Extreme pessimism or hopelessness
  • Feeling guilt, worthlessness, and helplessness
  • Loss of interest in hobbies and previously pleasurable activities
  • Problems with memory, decision making, and concentration
  • Suicidal thoughts

Depression also inflicts significant physical changes to the body, including:

  • Loss of energy, and a continual feeling of fatigue
  • Sluggishness in movement and speech
  • Various aches, pains, and cramps with no apparent causes
  • Restlessness and trouble staying still
  • Changes in appetite and weight

Depressed young woman lying in bed and feeling lostAs mentioned above, trouble sleeping is another important sign of depression that doctors use as a diagnostic tool. For a patient to receive a formal diagnosis of clinical depression, they must experience a combination of these symptoms for no less than two weeks.

The roots of depression

Depression is an extremely complex mental illness which occurs under certain conditions of genetics and environmental interaction. As noted by Harvard Health Publishing, the often-used description of depression as simply a “chemical imbalance” is no longer accepted in the medical community. Instead, experts believe that a list of factors affect whether, and how, any individual person might feel the disorder. Genetics play a role in this, but so do personality traits, stress, traumatic life events, and medications.

Scientists are starting to paint a picture of depression at the neurological level, however, noting that it is associated with problems in certain parts of the brain, including the thalamus, amygdala, and hippocampus. There appears to be an imbalance of neurotransmitters (specifically serotonin) in diagnosed patients, as well as misfirings in the fight-or-flight response system responsible for certain hormone production.
Depressed woman with Insomnia
Depression often runs in families; having any family member with this type of mental health disorder increases the chance that someone else may develop it. Genetics are also a risk factor in setting the sensitivities patients have to stress and trauma, which can cause short- or long-term depression in many people.

Depression changes sleeping patterns, and poor sleep exacerbates symptoms

Problems sleeping are extremely common in patients with depression. A 2008 literature review of scientific studies on sleep and depression concluded the following:

  • Insomnia is very common among patients and is often the main reason they seek treatment for their illness
  • Sleep architecture is altered in patients and antidepressants can reverse that alteration
  • Sleep disturbances in patients can be used to predict the effectiveness of different treatments
  • Sleep manipulation affects mood

These shifts in your nighttime patterns, especially when prolonged for more than two weeks, can be an important symptom. More specific descriptions of the sleep disruptions include:

  • Insomnia: Insomnia is the most common sleep disorder associated with depression, affecting up to three-quarters of all diagnosed patients. This includes extreme difficulty in getting to sleep, maintaining sleep throughout the night and the problem of waking up too early in the morning. Some patients find that negative thoughts keep them up at night, and fear of not being able to get adequate sleep can lead to sleep anxiety.
  • Hypersomnia: This term refers to sleeping too much, and it affects about 40% of younger depressed patients and about 10% of older patients.
  • Abnormal Sleep Architecture: Studies have shown that patients typically have less sleep latency in the REM stage of the sleep cycle, get less slow-wave sleep, and have periods of abnormal awakening than a non-depressed patient.
  • Obstructive Sleep Apnea (OSA): Evidence suggests a link between depression and OSA, with over 50% of OSA patients claiming a dual diagnosis for both.

Sad woman suffering from insomnia in her bedAll of these changes to nighttime patterns decrease the quality and amount that depressed patients receive. This adds to an increase in the severity of other symptoms of depression, especially mood changes, fatigue, and problems with focus and memory. The result is a dangerous cycle where the lack of sleep causes more intense depression that, itself, may lead to your nighttime routine becoming less healthy.

Treatment for sleep disorders linked to mental health

Mending control of healthy sleeping patterns is an important step in treating depression. Experts recommend the following steps to help those patients with depression, sleep better:

  • Talk with your doctor about medication: There are a number of medications that have shown promise in treating sleep problems for patients. Many of them work by addressing the other symptoms of depression that make sleep difficult. SSRIs, antidepressants, sleep medications, and other hypnotics might be recommended by your doctor, depending on the severity of your symptoms and medical history.
    • Do not seek medication without speaking to your doctor about the entirety of your depression symptoms. They will often recommend medications in tandem with some sort of therapy.
  • Maintain a healthy diet and exercise routine: Keeping your body healthy by eating well and getting enough exercise will increase your chances of getting through the night better. Learn how your immune system can affect your sleep. Make sure to not eat too much, exercise, or drink caffeine too close to your bedtime, as these things can stimulate you and make nighttime rest more difficult.
  • Establish relaxing bedtime routines: If you find that negative thoughts are keeping you up at night, try finding ways to clear your head by meditating, listening to music, or otherwise calming yourself as you prepare to sleep.
  • Dedicate your sleep space to sleeping: Make sure your bed is used only for sex and sleep. Keep your room cool, dark and quiet. Above all else, do not use electronics in bed, and if you have trouble falling asleep, get up and do something until you are tired rather than tossing and turning.

Anxiety: Guide and Tips for Better Sleep

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Depressed man suffering from anxiety lying in bed

Anxiety has an especially insidious relationship to sleep. Sleeplessness, caused by symptoms of anxiety, will inevitably lead to more trouble falling asleep. The two feed off of each other in a downward spiral that can make life miserable.

Sleep is an important tool to manage anxiety; therefore, it is extremely important to understand how the two relate, and how to manage a healthy sleep cycle even when suffering from symptoms of anxiety.

The Anxiety and Depression Association of America is a leading nonprofit dedicated to raising awareness of mental health issues. According to them, anxiety disorder is the single most common mental illness in the United States. Over 40 million U.S adults suffer from the disorder, constituting a massive 18% of the population.

How anxiety affects the body

The relationship between sleep and anxiety is embedded in the symptoms of mental illness. Having a basic understanding of how anxiety works can help in creating strategies to manage it, especially when it comes to sleep.

There are several types of anxiety disorders, ranging from generalized anxiety to specific phobias. The Mayo Clinic lists the following symptoms for generalized anxiety:

  • Constant worrying about things in a way that is “out of proportion”
  • Overthinking everything
  • Feeling threatened in unthreatening situations
  • Fear or discomfort with uncertainty
  • Extreme hesitancy and fear of making bad choices
  • Inability to relax or set aside worries
  • Difficulty concentrating, accompanied by the feeling of a blank mind

The Mayo Clinic also lists the following physical symptoms:

  • Tiredness (fatigue)
  • Muscle tension and soreness
  • Twitching and trembling
  • Frightens easily
  • Increased sweating
  • Stomach problems including nausea, diarrhea, and even irritable bowel syndrome
  • Irritability

Stressed business woman with anxiety disorder

The severity of any and all of these symptoms fluctuates depending on a number of stress factors, and the patterns of symptoms present can be different in every individual case of anxiety.

Scientists are still unsure about the neurological root causes of anxiety disorders. A 2017 review found that due to its overlap with other mood and affective disorders, scientists had yet to specify with certainty the biological mechanics of how anxiety affects the brain of people. Scientists hypothesize that it might be related to a chemical imbalance affecting our “fight or flight” response, which defines how we physiologically and psychologically react to different situations. The amygdala is necessary for this process and remains a target of study.

How anxiety affects sleep patterns

It is important to reiterate here that there are several specific disorders associated with anxiety. PTSD, panic disorder, generalized anxiety disorder, and OCD are but a few that rest within the spectrum. Each of these has been associated with its own effect on sleep, some of which are discussed below.

  • Panic Disorder: Patients with panic disorder have been found to have reduced sleep efficiency, the ratio between the time they spend in bed and the actual amount of time they sleep. Patients typically find it difficult to fall asleep and stay asleep as well. Often they are interrupted by night time panic attacks and suffer from insomnia as a result.
  • Generalized Anxiety Disorder: Studies have found that up to 70% of patients who suffer from GAD also suffer from chronic insomnia. It has been speculated that people with insomnia, usually at the hands of racing thoughts and worry, might even be recognized as a symptom of GAD. Regardless of which one causes the other, lack of sleep can exacerbate other symptoms of GAD.
  • Obsessive-Compulsive Disorder: Results of studies aimed at identifying the exact relationship between OCD and sleep have been mixed. Many of them report links between insomnia and OCD, though no conclusive data suggests there is a significant impairment in the quality of sleep for people with OCD.
  • Post Traumatic Stress Disorder: Evidence has also been mixed on whether PTSD patients suffer significant sleep disturbances as a result of their disorder. Some studies have found that there is an increased REM density (more active eye movements) in PTSD patients, suggesting more intense dreams. This could be a result of their inability to stop reliving traumatic events, which might follow them in their dreams.

Overall, anxiety seems to be linked to difficulty in falling asleep (insomnia), and in some cases an increase in sleep disturbances throughout the night.

Tips for maintaining healthy sleep

young woman has insomnia due to anxietyTo address the main sleep problems associated with anxiety, try the following tips and tricks to manage symptoms during bedtime:

  • Seek treatment for your anxiety disorder: This might be the most effective way to get a good night’s sleep if you have anxiety. Visit a specialist to determine which type of treatment is right for you, be it therapy, medication, or a combination of the two. Treating the root causes of the problem is the best way to ensure that sleep problems are reduced as well.
  • If you are on medication, note side effects: Some medications can keep you up at night, even if they are not prescribed directly for anxiety. Talk to your doctor about your trouble sleeping, and work together to determine if medication might be the cause.
  • Eat healthily, and exercise regularly: A good diet and routine exercise can go a long way in defeating sleep problems, as well as symptoms of anxiety. Make sure not to eat heavily or exercise too close to bedtime.
  • Avoid stimulating or depressing substances: Caffeine, nicotine, alcohol and other drugs can complicate your sleep cycle and increase symptoms of anxiety. If you suffer from panic disorder, you might want to consider excluding caffeine from your diet entirely.
  • Avoid electronics and bright lights before bed: Exposing yourself to artificial light in the evening will interrupt the body’s natural process of growing drowsy and inducing sleep. Consuming stimulating information close to bed can also contribute to racing thoughts and worrying thought patterns that might keep you up.
  • Find your own way to relax: Whether it’s with music, a hot bath or meditation. Finding personalized tools and techniques that allow you to calm your mind before bed will improve your chances of falling asleep quickly. That will help you to sleep soundly throughout the night.