Sleep paralysis: Why you can’t move, feel being pressed when waking from sleep

Have you felt unable to move or speak when you are falling asleep or waking up from sleep? For some, these experiences also include hallucinations such as seeing a figure pressing them down, being filled with fear, or feeling a presence as well as feeling as if they ‘woke up dead’, among others.

Medical experts call this condition sleep paralysis. However, many people are unaware it is a medical condition. They view it as a very scary experience and have different beliefs about it including believing it is a spiritual attack that needs spiritual solutions. This has also led to several myths about the condition.

It is common to hear some people say ‘they were pressed by a demon or spirit the other night.’

Narrating his experience with the condition, Solomon Eyiga, (not his real names) said he woke up in the middle of the night recently and felt paralyzed. His friend who slept next to him couldn’t hear him as he tried to scream his name. After a while, he was able to move his body and get out of the bed. He said it happened twice within a week and that he was very stressed that week as he worked long hours coupled with the trauma of losing a relative weeks before then.

According to Dr Olusola Oguntolu, a sleep specialist, sleep paralysis is a transient sensation of inability to move in the wakeful state occurring right after a person awakens from asleep. “As one can imagine, it is very distressing and various causes have been attributed to the phenomenon, some of which are entrenched in folklore. The sensation is sometimes associated with a dream-like state with or without auditory and hallucinations,” he said.

The sleep specialist said the condition is due to a discordance in the transition from REM (Rapid Eye Movement) sleep phase to the wakeful state without the usual cycling through the non-REM phase.

When you sleep at night, you cycle through periods of REM and non-REM sleep.

He explained that during REM sleep, all skeletal muscles are paralyzed by design to allow repair, healing and rejuvenation from the wakeful state to occur. The eye muscles (hence rapid eye movement), heart muscles, the diaphragm and respiratory muscles are the only life sustaining muscles that are active during REM sleep.

He said: “We also dream during REM sleep. One can see how the sensations noted during sleep paralysis events are actually normal phenomena in REM sleep with the exception that they occur in the wakeful state. It is a cardinal symptom visual of obstructive sleep apnea and can occur in narcolepsy, following sleep deprivation, after alcoholic binges and some parasomnic states.”

Michael Breus, a clinical psychologist and fellow of the American Academy of Sleep Medicine explained that sleep paralysis can occur during one of two transitions in the sleep cycle. The body must go into REM sleep, and it must come out of it, he said, but sleep paralysis occurs when the body has trouble making these transitions. “If it happens when you’re falling asleep, it’s called hypnagogic sleep paralysis, whereas if it happens during waking it’s called hypnopompic,” he said.

Various cultures attribute the sensation to external forces including spiritual or paranormal activity said Dr Olusola Oguntolu, saying this includes “incubus or succubus attacks and the “old hag” in western societies; witchcraft spells and other demonic influences in indigenous cultures. “

The sleep expert said some people attribute the effect to the presence of wall geckos on the ceiling exerting motor control powers over the individual adding “These are of course all incorrect as there is a simple physiological explanation for the phenomenon.”

Dr Oguntolu who is also the Chief Circadian Officer, Sleep Consultants/ Sleep Inc. Ikoyi, Lagos, said sleep paralysis is sometimes mistaken for pathologic neurologic conditions like strokes or the effect of poisons. While some disease states can cause generalized muscle weakness, they are rarely transient and full recovery of motor function in a short period of time would be unusual in those conditions, he said.

Asked what causes sleep paralysis, the sleep expert said the transition from REM sleep to the wakeful state usually due to unplanned sleep disruptions short circuiting the normal transition through non-REM sleep results in the sensation of sleep paralysis. “Any cause of sleep disruption leading to the wakeful state (unintentional arousals, obstructive sleep apnea and some parasomnic events can cause sleep paralysis). It can also occur following sleep deprivation, overuse of some sedatives and following alcohol and illicit drug binges,” he said.

The following are some of the ways of preventing the condition, according to Dr Oguntolu:

Good sleep hygiene habit, that is sleep on your side, not your back; avoid heavy meals before sleep; drink herbal tea or a glass of milk, have a regular bedtime routine, avoid electronics, darken your bedroom.

Others include turn off sound making devices, reduce or eliminate caffeine intake, get as much sleep as possible, relieve daily stressors, avoid alcohol and overuse of sedating agents are good starting points.

He said prompt evaluation by a sleep disorders’ specialist for obstructive sleep apnea and other sleep related conditions are also important.

What should people do when they have, or have had sleep paralysis?

The sleep specialist advised people to remain calm and be reassured, saying it will pass. “However, the person must recognize that it is a potential early symptom of an underlying sleep disorder. They should seek competent help from qualified professionals as soon as practical,” he added.

On treatment, Dr Oguntolu said no specific treatment is indicated for the symptom especially since it abates fairly quickly. He said beyond reassurance, treatment of any predisposing condition is imperative. “The risk of recurrence is high if the condition (e.g. obstructive sleep apnea) is left untreated.

“Also, sleep deprivation, alcoholic binges and sedative abuse should be avoided if possible. See your doctor if sleep paralysis occurs often and/ or routinely prevents you from getting a good night’s sleep,” he advised.