Recurrent sleep paralysis: why it happens and how to reduce it

The NHS describes sleep paralysis as being unable to move or speak as you are waking up or falling asleep. During an episode you may feel awake but unable to move, speak or open your eyes, feel as though someone is in your room, or feel something pushing you down, and be frightened. These feelings can last up to several minutes, and the NHS says it can be scary but is harmless.

NHS Borders guidance explains the normal basis: it is normal for the body to be paralysed during sleep, which stops people acting out their dreams and putting themselves in danger. Sleep paralysis occurs when, during the transition between sleep and wake, the body remains paralysed while the mind awakens, giving the frightening sensation of not being able to move or speak despite trying. It is often accompanied by sensory hallucinations or vivid dreams. The guidance notes it is a normal phenomenon that most people will experience on occasion, usually beginning in adolescence.

It is not clear exactly why sleep paralysis happens in some people, but the NHS says it has been linked with insomnia, disrupted sleeping patterns such as shift work or jet lag, narcolepsy (a long-term condition that causes a person to suddenly fall asleep), post-traumatic stress disorder (PTSD), generalised anxiety disorder, panic disorder and a family history of sleep paralysis. The Sleep Charity notes that hypnagogic hallucinations and sleep paralysis are common features of narcolepsy.

NHS Borders guidance says sleep paralysis seems to happen more frequently when lying face up and that avoiding sleep deprivation helps. The NHS likewise says not to sleep on your back, which can make it more likely.

• Insomnia, short sleep or an irregular sleep schedule.

• Shift work and jet lag.

• Anxiety disorders, panic disorder and PTSD.

• Narcolepsy.

• Sleeping on your back, and a family history.

The NHS says you may be able to prevent sleep paralysis by changing your sleep habits: try to regularly get 7 to 9 hours of sleep a day, go to bed at roughly the same time each night and get up at the same time each morning, and get regular exercise, but not in the last hour before bed. It advises not eating a big meal, smoking, or drinking alcohol or caffeine shortly before bed, and not sleeping on your back.

NHS Borders guidance suggests that people who experience it regularly may benefit from having strategies to wake up, such as relaxation with attempts to move small muscles first, or asking a partner to wake them if they see them trying to speak or move.

The NHS says you do not normally need medical help for sleep paralysis unless it is affecting your mental health or your sleep. See a GP if you often have it and you feel very anxious or scared to go to sleep, or tired all the time due to lack of sleep. A GP may treat an underlying condition that could be triggering it, such as insomnia or PTSD, and if that does not help may refer you to a doctor who specialises in sleep conditions.

NHS Borders guidance says that if sleep paralysis is accompanied by other related problems, particularly daytime sleepiness or losing muscle strength (cataplexy), the person should be referred to neurology because that pattern suggests narcolepsy. The Sleep Charity says that if hallucinations stop you sleeping well or cause distress it is important to see a GP, who may prescribe medication.

From a specialist, the NHS says you might be given a medicine usually used to treat depression, which at a lower dose can also help with sleep paralysis, and you might be referred for cognitive behavioural therapy (CBT). Such decisions are individual, and the benefits and side effects should be discussed with the prescriber.

Treating the contributors, such as improving sleep habits, managing anxiety and addressing PTSD or sleep apnoea if present, is often more effective than treating the episodes themselves. A sleep diary noting bedtime, sleep duration, alcohol, caffeine, stress and episodes helps clinicians see patterns.

In the NHS, a GP appointment is the starting point, with referral to sleep services or neurology only when other features are present. Talking therapies for anxiety, insomnia or PTSD may be accessed by self-referral in many areas.

Private sleep clinics and psychologists can offer faster assessment, sleep studies and CBT for insomnia, but the majority of people with isolated sleep paralysis need only reassurance and habit changes. If you are told you need an overnight study, ask what it is meant to rule out.