By: Catherine Joachin
What is sleep paralysis?
Sleep paralysis is the inability to move or speak while falling asleep or waking up (Cleveland Clinic, 2024). This phenomenon is common during rapid eye movement (or REM) sleep, a period in which the body enters a state of relaxation and temporary paralysis (atonia) to prevent muscle movement while dreaming (Mount Sinai, 2025). Sleep paralysis occurs when the body transitions between stages of sleep and wakefulness, so a sudden awakening from REM sleep will leave the body immobilized (Mount Sinai, 2025).
Symptoms and Causes
Sleep paralysis is harmless; most people experience it at least once in their lifetime. (Mount Sinai, n.d.). However, the distressing nature of this experience can cause intense fear and anxiety, leading to more frequent episodes (Farooq & Anjum, 2023).
Episodes of sleep paralysis are often accompanied by hypnagogic hallucinations, which can become a source of panic and fear (Mount Sinai, 2025; Farooq, M., & Anjum, F. (2023)). Other symptoms include:
- Daytime sleepiness
- Inability to speak or move
- Hallucinations
- Sensations of chest pressure akin to suffocation
(Cleveland Clinic, 2024).
Sleep paralysis co-occurs with various disorders including narcolepsy, insomnia, obstructive sleep apnea, and psychological conditions, namely panic disorder, post-traumatic stress disorder (PTSD), or bipolar disorder (Cleveland Clinic, 2024; Farooq & Anjum, 2023). Sleep paralysis is also associated with sleep deprivation, substance use, disturbances in regular sleep schedules, and the use of certain medications, such as those prescribed to treat ADHD (Cleveland Clinic, 2024; Mount Sinai, 2025).
Diagnosis
Overnight sleep studies, known as polysomnograms, and multiple sleep latency tests (MSLTs) are used to diagnose sleep paralysis (Cleveland Clinic, 2024). These exams detect sleep-related issues by tracking metrics, such as breathing, heartbeat, and brain activity (polysomnograms), and measuring how rapidly a person falls asleep and enters REM during naps (MSLT) (Cleveland Clinic, 2024). An accurate diagnosis is essential to isolate treatment options intended for sleep paralysis from the pharmacological and psychological interventions designed to treat similar conditions (Farooq & Anjum, 2023).
Sleep paralysis and Epilepsy
Sleep paralysis occurs in around 7.6% of the general population, but has a prevalence of 11.7% in genetic generalized epilepsy patients (Sharpless & Barbe, 2011.; Cornejo-Sanchez et al., 2019). This higher prevalence in the epilepsy population suggests the existence of shared heritability or underlying pathology between these two conditions (Cornejo-Sanchez et al., 2019).
Research has also identified a case of focal epileptic seizures mirroring sleep paralysis. The case report revealed that focal seizures share significant clinical similarities with recurrent isolated sleep paralysis (RISP) (Galimberti et al., 2009.). This study also highlighted the use of polysomnography as a tool for differential diagnosis, allowing for the delineation of these two conditions (Galimberti et al., 2009).
Treatment
Sleep paralysis is rare. Furthermore, episodes either end on their own or when someone touches or moves the person, meaning that treatment is hardly needed (Mount Sinai, 2025). Since not much can be done during an episode, treatment mainly focuses on managing any underlying factors that may trigger sleep paralysis (Farooq & Anjum, 2023). Considering the link between sleep paralysis and other sleep disorders, implementing good sleep habits may prevent sleep paralysis (Farooq & Anjum, 2023). Some of the changes that can help improve sleep quality include:
- Avoiding the use of electronic devices (including cell phones, laptops, and televisions) before bed
- Adopting a fixed sleep schedule
- Reducing or abstaining from caffeine and alcohol consumption, especially in the evening
- Setting a pre-bed routine
- Making the bedroom as comfortable and distraction-free as possible
(Farooq & Anjum, 2023)
Conclusion
Sleep paralysis is a harmless but distressing parasomnia in which muscle movement is inhibited by sudden awakening from REM sleep. This experience occurs together with dreamlike hallucinations, heightening anxiety and panic levels. While rare, certain epileptic seizures can mimic sleep paralysis, drawing attention to the importance of differential diagnosis in distinguishing conditions with similar clinical characteristics.
References
Cleveland Clinic. (2024, July 9). Sleep paralysis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21974-sleep-paralysis#prevention
Cornejo-Sanchez, D. M., Carrizosa-Moog, J., Cabrera-Hemer, D., Solarte-Mila, R., Gomez-Castillo, C., Thomas, R., Leal, S. M., Cornejo-Ochoa, W., & Pineda-Trujillo, N. (2019). Sleepwalking and Sleep Paralysis: Prevalence in Colombian Families With Genetic Generalized Epilepsy. Journal of Child Neurology, 34(9), 491–498. https://doi.org/10.1177/0883073819842422
Farooq, M., & Anjum, F. (2023). Sleep paralysis. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK562322/#:~:text=Sleep%20paralysis%20refers%20to%20the,any%20part%20of%20their%20body.
Galimberti, C. A., Ossola, M., Colnaghi, S., & Arbasino, C. (2009). Focal epileptic seizures mimicking sleep paralysis. Epilepsy & Behavior, 14(3), 562–564. https://doi.org/10.1016/j.yebeh.2008.12.018
Mount Sinai. (2025). Isolated sleep paralysis. Mount Sinai Health System. https://www.mountsinai.org/health-library/diseases-conditions/isolated-sleep-paralysis
Sharpless, B. A., & Barber, J. P. (2011). Lifetime prevalence rates of sleep paralysis: A systematic review. Sleep Medicine Reviews, 15(5), 311–315. https://doi.org/10.1016/j.smrv.2011.01.007
