How to Handle a Strange Sleep Condition

Did you ever wake up and find that you were briefly unable to move? It's scary, but actually pretty common. Dr. Saltz tells how to take care of the situation.

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Episode Transcript

Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm Dr
Gale Salts. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,

(00:26):
hopefully with understanding, insight and advice. Have you ever woken
up but found yourself unable to move at all, as
if you were frozen. This phenomenon is called sleep paralysis.
Sleep paralysis is a feeling of being conscious but unable

(00:49):
to move. It occurs when a person passes between stages
of wakefulness and sleep. During these transitions, you may be
able to move or speak for a few seconds up
to a few minutes. Some people may also feel pressure
on their chest or a sense of choking. This feeling

(01:12):
can make you panicky or fearful. So today I have
a question from a listener who is wondering what is
happening to her when she wakes up in the morning.
Recurrent isolated sleep paralysis is called a paras omnia. Paras
Omnias are undesired events that occur when you're falling asleep

(01:35):
or during sleep, or as you're waking up. A REM
paras omnia or rapid eye movement parasomnia is one that
happens during a transition into or out of REM sleep.
REM sleep is the time when we dream is a
deep state of sleep. Sleep paralysis is a REM parasomnia.

(01:58):
It causes you to be unable to move your body
at either of two times, either when falling asleep called hypnogogic,
or when waking up from sleep called hypnopumpet. Normally, your
brain causes your muscles to relax and be quiet in
REM sleep, such that you don't act out your dreams,

(02:19):
which would of course be a real problem. This is
called rem a tonia. Sleep paralysis occurs when rem atonia
happens while you are falling asleep or waking up. Sleep
paralysis is called isolated when it happens without any other
signs of for example, narcolepsy or another sleep disorder. An

(02:43):
episode of paralysis may cause you to be unable to speak.
It can also make you unable to move your arms
and legs and body and head. You are still able
to breathe normally. You are also fully aware of what
is happening, and as I said, this episode can last

(03:03):
for seconds four minutes. The episode, however, usually ends on
its own. It can also end when someone touches you
or someone speaks to you. Making an intense effort to
move can also end an episode. Sleep paralysis may occur
only once in your life, but it also can happen

(03:25):
many times in a year. It can be very scary
when you are unable to move, you could feel anxious
or afraid. In addition, some people hallucinate during an episode,
meaning they could see or hear or feel things that
are not there. For example, they may think that another

(03:46):
person is in the room with them who is not.
And these hallucinations can also appear without the sleep paralysis.
That's another form of a parasomnia. Again, it's going to
be hypnogogic or hypnopompic, either falling asleep or waking up,
depending on when it happens. Sleep paralysis tends to first

(04:11):
appear in teenage years. It then occurs most often when
you're in your twenties and thirties. It can continue in
your later years, but usually less so. Although the paralysis
event may be frightening, it is actually not a serious
medical risk on its own and does not keep you
from getting the sleep you need. However, sleep paralysis can

(04:36):
be one sign of something called an ec eilepsy. Other
signs of an ec eilepsy include excessive daytime sleepiness, fragmented sleep,
sleep related hallucinations during the day, and something called cataplexy,
where experiencing a strong emotion or laughter causes a person

(04:58):
to suffer sudden physical collapse though remaining conscious. If you
are experiencing these symptoms along with sleep paralysis, you should
talk to a sleep doctor because narcolepsy is a serious
disorder that requires treatment. It is also important to know
if there is something else that is causing your sleep problems.

(05:19):
They may be a result of one of the following.
In fact, parasomnias in general can be benign and just
standalone phenomenon, or they can be part of something like narcolepsy,
a medical condition, medication use, a mental health disorder, or
substance abuse. Sleep paralysis can affect men and women of

(05:40):
any age group. The average age when it first occurs, however,
is fourteen to seventeen. It's a fairly common sleep problem.
Estimates of how many people have it very widely from
five percent to It does tend to run in families
like all asomnius, and so you may be more likely

(06:02):
to have it if a close relative has it too.
A lack of sleep can make you more likely to
have sleep paralysis. It is also more likely if you
have a sleep schedule that often changes. Mental stress can
be a factor in producing more often episodes. It seems
to occur more so when you sleep on your back.

(06:25):
Recurrent isolated sleep paralysis is fairly common, and in most
cases it does not affect your sleep or overall health. However,
you should see a sleep doctor if the episodes are
keeping you up at night or make you so fearful
of going to sleep. Find out if you have any
family members with sleep problems, because that will be an

(06:46):
important clue for your doctor. It would be also helpful
if you're going to see a doctor to fill out
a sleep diary for two weeks in advance, so that
you can give him or her that information about your
sleep patterns. Doctors do not need any tests to treat
most patients with recurrent isolated sleep paralysis. Your doctor, on

(07:07):
the other hand, may do a sleep study if your
problem is really disturbing your sleep, or they're concerned about
an additional sleep disorder. The study they usually use is
called a polysomnography. It charts your brain waves, your heart beat,
and breathing while you sleep. It also records how your

(07:29):
arms and legs move. Something called an electro myogram. Recording
will show the level of electoral activity in your muscles.
This level will be very low during an episode of
sleep paralysis, because, of course, as I've been explaining, your
muscles are paralyzed. If you tend to be very sleepy

(07:50):
during the day, then your doctor may also have you
do a daytime nap study. This is called a multiple
sleep latency test, which will measure how fast you fall
asleep during the day. It will also show what kind
of sleep you have when you take a nap. It
will help to show if your sleep paralysis is actually

(08:13):
a sign of narcilepsy. When we come back, I'll get
to my listeners question. Let's get to my listeners question

(08:33):
and see how can I help dear doctor Suns. It
has been a stressful few months for me. I find
myself very nervous returning to work in the office, and
my rent is increasing to a level I find hard
to manage, but I'm not sure I have any other
good options now. A few times this past month I

(08:56):
have woken up in the morning but found that I
can't move at all. All. I know that I'm awake,
but I feel paralyzed. It lasts for a few minutes,
though to be honest, it feels like forever because it's
really terrifying. I now find myself dreading it might happen again,

(09:17):
and I don't know what it is. Is this some
mental illness? Is something physically wrong with me? Is there
a way for me to get this to stop? As
you can hear from earlier in this episode, this does
sound like sleep paralysis, which is a type of paras omnia,
a sleep disorder that involves unusual and undesirable physical events

(09:39):
or experiences that disrupt your sleep. For example, sleep walking
and sleep talking are also types of parasomnias. Actually, sleep
paralysis is not even one of the more unusual ones.
As many as four out of ten people have it.
It can occur when you are falling asleep or as

(10:00):
you have experienced just waking up. It can be accompanied
by feelings of chest pressure or high anxiety, and even
seeing strange things in your room. What is happening is
during sleep, your body is alternating between REM and non
REM sleep. One cycle of REM and non REM sleeps

(10:22):
lasts about ninety minutes. Non REM sleep, or the non dreaming,
non rapid eye movement sleep, occurs first and takes up
to of your overall sleep time. During non REM sleep,
your body relaxes and restores itself, and then at the
end of non REM your sleep shifts to REM. Your

(10:43):
eyes move quickly back and forth, and dreams occur, but
the rest of your body remains very relaxed. Your muscles
are essentially turned off during REM sleep. If you become
aware and conscious before the REM cycle has finished, you
may notice that you cannot move or speak as would

(11:03):
be normal during REM sleep. But what's not normal is
you are aware. Because that feels weird, and because it
seems you can't move, it can feel scary. But just
knowing what it is and that it will go away
in it most a few minutes can really help with
the panicky part. Sometimes just making an extreme effort to move,

(11:27):
say a finger, can break the spell and allow you
to come out of it, or allowed sound like an
alarm clock can end it. This could be happening to
you for any number of reasons. I mean, first and foremost,
you mention you're highly stressed right now, and being highly
stressed can bring on more parasomnias like sleep paralysis. But

(11:47):
I also ask you to investigate did you start a
new medication? A number of psychiatric medications, like antidepressants or
those used for attention deficit hyperactivity disorder can increasely paralysis
and paras omnias in general. Other medications can as well,
and I advise you if you've added any to discuss

(12:09):
this with your doctor. You might want to discuss switching
medications or lowering dosages with your doctor. I also asked,
is there a history in your family of paras omnias.
These things do tend to run in families, but maybe
your family hasn't spoken of it. If this started in
your teens and has continued through your twenties and thirties,

(12:29):
this is likely classic familial paras omnias. Other things that
can contribute to having sleep paralysis are lack of sleep.
So if your sleep schedule has really been disrupted, if
your schedule keeps changing so you're going to bed at
one time and then at a different time, and sleeping
late at different times that can increase the likelihood, so

(12:53):
you might want to set yourself on a better schedule.
Mental conditions that have to do with straight us or
for example, bipolar disorder, sleeping on your back, other sleep
problems such as narcolepsy, or even nighttime leg cramps can
increase the incidence of sleep paralysis. I mentioned the use

(13:14):
of certain medications, like for depression or attentional issues, and
substance abuse, which has become a real issue for many
people during the pandemic. Drinking too much alcohol or using
other substances can increase sleep paralysis. If it's happening to
you from time to time and you don't have any
other issues, then it's likely just that and there is

(13:35):
nothing to really do or to be concerned about. You
might try to have a more regular and predictable sleep
schedule to decrease how often it's happening. You might change
positions of sleep if you're sleeping on your back, and
you could consider avoiding substances like alcohol or any other drugs,
because that could make a real difference. If, however, you

(13:57):
have other symptoms to such as importantly, something called cataplexy,
which is estimated to occur inasmuch as three quarters of
all people with an eclepsy, so it's a real sign
of an ecilepsy. It is basically the sudden loss of
muscle tone while staying conscious, but it's being triggered by

(14:20):
a strong emotion like laughing a lot, surprise, or even
being angry. So you're awake, but you go to the
floor hallucinations which can occur upon going to sleep or
waking up, and it can affect also lots of people
with an ecilepsy. So these hallucinations are vivid dreamlike experiences

(14:43):
that occur while falling asleep or while waking up, and
they can occur with sleep paralysis. If you have excessive
daytime sleepiness, this is a really important thing to consider
because it affects all patients with narcilepsy. So it's the
inability to stay awake and alert during the day, resulting

(15:06):
in periods of an irrepressible need for sleep or unintended
lapses into drowsiness or sleep, like suddenly you're napping when
you didn't say I'm going to take a nap. Excessive
daytime sleepiness is the cardinal symptom of an ecilepsy, and
it is the most disabling, which is why you do

(15:26):
need to see a doctor. And of course we've talked
about sleep paralysis, which does occur in as much as
half of people with narcilepsy, but again, many people with
sleep paralysis do not have an eclepsy and sleep disruption.
So many patients with narcilepsy have sleep disruption which was
basically frequent awakenings resulting in poor quality sleep. Because narcilepsy

(15:51):
is a disorder of the sleep wake state, it's an
instability of it, and many patients who report this disruption
of nighttime sleep understandably have excessive daytime sleepiness. You don't
report any of these other symptoms, and so it's possible
that this is really just sleep paralysis for you. If

(16:14):
you did have any of these symptoms and simply didn't
mention them, then I think you should see a doctor
because it's important to be treated if you have an ecilepsy.
It's not safe to drive with narcilepsy, and there are
various things that one can do for treatment. I hope
that was helpful. Sometimes people with sleep paralysis also have

(16:36):
these hallucinations of strange things in their room. But even
with this, there is no need to fear nighttime demons
or alien abductors. If you just have occasional sleep paralysis,
you can take steps at home to control this to sort.
So start by trying to make sure you get enough
sleep that's seven to nine hours of sleep. Do what

(16:59):
you end develop some coping tools to relieve some of
the stress in your life, especially before bedtime. So for example,
it's not necessarily great to watch the news or look
at your phone and emails for the hour before bed,
and consider new sleeping positions if you can. Sleeping on

(17:20):
your back is the one most likely to produce paralysis,
so on your side or on your belly. But be
sure to see your doctor if sleep paralysis routinely prevents
you from getting a good night's sleep. Do you have
a problem I can help with? If so, email me
yet how can I help? At Seneca women dot com,

(17:42):
All centers remain anonymous and listen every Friday too. How
can I help with me? Doctor Gail's Salts