What do we know about sleep paralysis?

Open access


Introduction: Sleep paralysis (SP) is a condition that widely occurs among people all over the world. It has been known for thousands of years and is rooted in the culture of many countries. It arouses strong emotions, though still little is known about it. The clinical picture of the disorder can be very diverse. It is often accompanied by hypnopompic and hypnagogic hallucinations, somatic complaints and the feeling of intense anxiety. A feeling of paralysis in the body with inhibited consciousness is always observed with the experience. SP pathophysiology is not fully understood, however, most theories explaining this phenomenon are based on the assumption that it results from dysfunctional overlap of REM sleep and wakefulness. It is experienced by healthy people, but it is more often associated with somatic and mental disorders, which is why it is becoming an object of interest for researchers.

Aim: The aim of this work is to present the most important information about the disorder known as sleep paralysis - its history, cultural context, pathophysiology, prevalence, symptomatology, coexistence with other somatic and mental disorders as well as diagnostics and available forms of prevention and treatment.

Materials and methodology: The available literature was reviewed using the Google Scholar bibliographic databases searching the following keywords: sleep paralysis, REM sleep parasomnias, sleep disorder, night terrors and time descriptors: 1980-2018.

Results 1. Sleep paralysis has already been described in antiquity, and interpretations related to its occurrence are largely dependent on culture and beliefs.

2. Symptomatology of the disorder is very diverse: both mental and somatic symptoms are present.

3. The pathophysiology of the disorder has not been fully explained. The basis of most theories regarding sleep paralysis is the assumption that it results from the dysfunctional overlap of REM sleep and wakefulness.

4. The prevalence of SP at least once in a lifetime is 7.6% in the general population, although it is estimated that it is much more frequent in people with various mental and somatic disorders.

5. Treatment of SP is associated with a change in lifestyle and the use of pharmacotherapy and psychotherapy.

1. de Sá JF, Mota-Rolim SA. Sleep paralysis in Brazilian folklore and other cultures: a brief review. Front Psychol. 2016 7;7:1294.

2. Kompanje EJ. ‘The devil lay upon her and held her down’ Hypnagogic hallucinations and sleep paralysis described by the Dutch physician Isbrand van Diemerbroeck (1609–1674) in 1664. J Sleep Res. 2008;17(4):464-7.

3. Ropper, A. H. (2016). Adams and Victor’s principles of neurology. New York: McGraw-Hill Medical Pub. Division.

4. American Academy of Sleep Medicine. “International classification of sleep disorders–third edition (ICSD-3).” Darien, IL: American Academy of Sleep Medicine 2014.

5. Gangdev P, Dua V, Desjardins NIsolated sleep paralysis and hypnic hallucinations in schizophrenia. Indian J Psychiatry. 2015;57(4):383-5.

6. Cheyne J.A, Newby-Clark IR, Rueffer SD. Relations among hypnagogic and hypnopompic experiences associated with sleep paralysis. J Sleep Res. 1999; 8(4):313-7.

7. Denis D, French CC, Rowe R, Zavos HM, Nolan PM, Parsons MJ et al. A twin and molecular genetics study of sleep paralysis and associated factors. J Sleep Res. 2015;24(4):438-46

8. Sharpless BA. A clinician’s guide to recurrent isolated sleep paralysis. Neuropsychiatr Dis Treat. 2016;12:1761-7.

9. Jalal B, Simons-Rudolph J, Hinton DE.Explanations of sleep paralysis among Egyptian college students and the general population in Egypt and Denmark. Transcult Psychiatry. 2014;51(2):158-75.

10. Fukuda K, Miyasita A, Inugami M, Ishihara K.High prevalence of isolated sleep paralysis: Kanashibari phenomenon in Japan. Sleep. 1987;10(3):279-86.

11. Wing YK, Lee ST, Chen CN.Sleep paralysis in Chinese: ghost oppression phenomenon in Hong Kong Sleep. 1994;17(7):609-13.

12. Jalal B, Romanelli A, Hinton DECultural Explanations of sleep paralysis in Italy: the pandafeche attack and associated supernatural beliefs. Cult Med Psychiatry. 2015;39(4):651-64.

13. McNally RJ, Clancy SA.Sleep paralysis, sexual abuse, and space alien abduction. Transcult Psychiatry. 2005;42(1):113-22.

14. Brooks PL, Peever JH. Identification of the transmitter and receptor mechanisms responsible for REM sleep paralysis. J Neurosci. 2012;32(29):9785-95.

15. Björn WW., Schulz H. Recurrent isolated sleep paralysis: Polysomnographic and clinical findings. Somnologie-Schlafforschung und Schlafmedizin. 2004;8(2):53-60.

16. Torontali ZA, Grace KP, Horner RL, Peever JH. Cholinergic involvement in control of REM sleep paralysis. J Physiol. 2014; 592(7):1425-6.

17. Jalal B, Ramachandran VS. Sleep paralysis and “the bedroom intruder”: The role of the right superior parietal, phantom pain and body image projection. Med Hypotheses. 2014;83(6):755-7.

18. Sharpless BA1, Barber JP. Lifetime prevalence rates of sleep paralysis: a systematic review. Sleep Med Rev. 2011;15(5):311-5.

19. Dahmen N, Kasten M, Müller MJ, Mittag K. Frequency and dependence on body posture of hallucinations and sleep paralysis in a community sample. J Sleep Res. 2002;11(2):179-80.

20. Alfonso Suárez S. Isolated sleep paralysis in patients with disorders due to anxiety crisis. Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1991;19(1):58-61.

21. Jalal B, Hinton DE. Rates and characteristics of sleep paralysis in the general population of Denmark and Egypt. Cult Med Psychiatry. 2013;37(3):534-48.

22. O’Hanlon J, Murphy M, Di Blasi Z. Experiences of sleep paralysis in a sample of Irish university students. Ir J Med Sci. 2011;180(4):917-9.

23. American Sleep Disorders Association. International classification of sleep disorders. Revised: Diagnostic and coding manual; 1994. [cytowana 20 lipca 2018]. Dostępna z: http://www.absm.org/PDF/ICSD.pdf.

24. Otto MW, Simon NM, Powers M, Hinton D, Zalta AK, Pollack MH. Rates of isolated sleep paralysis in outpatients with anxiety disorders. J Anxiety Disord. 2006;20(5):687-93.

25. Hinton DE, Pich V, Chhean D, Pollack MH, McNally RJ.Sleep paralysis among Cambodian refugees: association with PTSD diagnosis and severity. Depress Anxiety. 2005;22(2):47-51.

26. Abrams MP, Mulligan AD, Carleton RN, Asmundson GJ. Prevalence and correlates of sleep paralysis in adults reporting childhood sexual abuse. J Anxiety Disord. 2008;22(8):1535-41.

27. Golzari SE, Ghabili K. Alcohol-mediated sleep paralysis: the earliest known description. Sleep Med. 2013;14(3):298

28. Bell CC, Hildreth CJ, Jenkins EJ, Carter C. The relationship of isolated sleep paralysis and panic disorder to hypertension.” J Natl Med Assoc. 1988;80(3):289-94.

29. Ohayon MM, Zulley J, Guilleminault C, Smirne S. Prevalence and pathologic associations of sleep paralysis in the general population. Neurology. 1999 12;52(6):1194-200.

30. Hsieh SW, Lai CL, Liu CK, Lan SH, Hsu CY. Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea. Qual Life Res. 2010;19(9):1265-72

31. Amann VC, Maru NK, Jain V.Hypersomnolence in Wilson disease.” J Clin Sleep Med. 2015 15;11(11):1341-3.

32. Nevsimalova S, Buskova J, Bruha R, Kemlink D, Sonka K, Vitek L, et al. Sleep disorders in Wilson’s disease. Eur J Neurol. 2011;18(1):184-90.

33. Anderson KN, Pilsworth S, Sharples LD, Smith IE, Shneerson JM. Idiopathic hypersomnia: a study of 77 cases. Sleep. 2007;30(10):1274-81.

34. Karacan I, Thornby JI, Anch M, Booth GH, Williams RL, Salis PJ. Dose-related sleep disturbances induced by coffee and caffeine. Clin Pharmacol Ther. 1976;20(6):682-9

35. Phillips BA,Danner FJ Cigarette smoking and sleep disturbance.” Arch Intern Med. 1995 Jul;155: 740-737.

36. https://icd.who.int [strona domowa w Internecine] [cytowana 22 lipca 2018].

37. https://dsm.psychiatryonline.org [strona domowa w Internecine] [cytowana 22 lipca 2018].

38. Sharpless BA, McCarthy KS, Chambless DL, Milrod BL, Khalsa SR, Barber JP. Isolated sleep paralysis and fearful isolated sleep paralysis in outpatients with panic attacks. J Clin Psychol. 2010;66(12):1292-306.

39. Paradis C, Friedman S, Hinton DE, McNally RJ, Solomon LZ, Lyons KA.The assessment of the phenomenology of sleep paralysis: the Unusual Sleep Experiences Questionnaire (USEQ). CNS Neurosci Ther. 2009;15(3):220-6

40. Fulda S, Hornyak M, Müller K, Cerny L, Beitinger PA, Wetter TC. Development and validation of the Munich Parasomnia Screening (MUPS). Somnologie - Schlafforschung und Schlafmedizin. 2008;12:56-65.

41. Cheyne JA. Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects.J Sleep Res. 2002;11(2):169-77.

42. Stores G. Medication for sleep - wake disorders. Arch Dis Child. 2003;88: 899-903.

43. Hishikawa Y, Ida H, Nakai K, Kaneko Z. Treatment of narcolepsy with imipramine (tofranil) and desmethylimipramine (pertofran). J Neurol Sci. 1966;3(5):453-61.

44. Koran LM, Raghavan S.Fluoxetine for isolated sleep paralysis. Psychosomatics. 1993;34(2):184-7.

45. Schrader H, Kayed K, Bendixen Markset AC, Treidene HE. The treatment of accessory symptoms in narcolepsy: a double-blind cross-over study of a selective serotonin re-uptake inhibitor (femoxetine) versus placebo. Acta Neurol Scand. 1986;74(4):297-303.

46. Jalal B.How to make the ghosts in my bedroom disappear? Focused-attention meditation combined with muscle relaxation (MR therapy) - a direct treatment intervention for sleep paralysis. Front

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 718 718 75
PDF Downloads 539 539 55