The Connection Between Sleep Paralysis and Mental Health Conditions

Sleep paralysis is generally harmless, but it can be emotionally distressing. Sleep paralysis and mental health are closely connected. However, certain mental health conditions increase the likelihood of experiencing sleep paralysis. On the other hand, sleep paralysis can induce symptoms of anxiety and stress in some people.

Sleep paralysis overview

Sleep paralysis is a phenomenon that occurs in the transition between sleep and wake. In a sleep paralysis episode, individuals remain conscious and aware of their surroundings, yet they experience a temporary inability to move or speak.

Hallucinations are common in people who experience sleep paralysis. These hallucinations can manifest in various forms, including:

• Intruder hallucinations. Involves sensing a threatening presence, fear, hearing, and seeing things, such as shadows in the dark.
• Incubus hallucinations. Involves feeling tightness or pain in the chest, breathing difficulties, and seeing a figure seated on one’s chest.
• Vestibular-motor hallucinations. Involves feeling out-of-body experiences, such as levitating.

Sleep paralysis can occur in isolation (isolated sleep paralysis) or as a symptom of a medical condition such as narcolepsy or seizure disorder. Recurrent sleep paralysis episodes are considered REM sleep phase parasomnia.

Although sleep paralysis isn't typically harmful and tends to resolve on its own, episodes can be distressing.

Sleep paralysis vs. mental health

While the exact causes of sleep paralysis remain unknown, researchers have identified several risk factors. These include a family history of sleep paralysis, certain personality traits, sleep disorders, poor sleep hygiene, substance use, and mental health problems.

According to a literature review, about 8% of people experience at least one episode of sleep paralysis at some point in their life. However, these rates are higher among psychiatric patients, with 31% having at least one episode during their lifetime.

Studies show that poorer mental health increases the likelihood of experiencing sleep paralysis. The prevalence of sleep paralysis is increased among those with symptoms of depression, anxiety, panic disorder, and post-traumatic stress disorder (PTSD). Also, episodes of sleep paralysis tend to occur more frequently in individuals who have experienced trauma or child sexual abuse.

Linking sleep paralysis & mental health

Although sleep paralysis is not considered dangerous, it can cause significant emotional distress. For instance, research indicates that sleep paralysis may increase the risk of depression among student athletes.

Moreover, people who undergo recurrent sleep paralysis episodes may develop anxiety and fear of sleeping. This fear results from the disturbing content of the hallucinations they experience during these episodes and the temporary loss of muscle control known as muscle atony.

In some cases, paralysis may disturb sleep quality, leading to excessive daytime drowsiness, poor concentration and memory, and worsening performance in school and work activities, decreasing the overall quality of life.

Sleep paralysis and anxiety

Studies suggest a close link between sleep paralysis and anxiety. In a survey with 100 students from Cairo, 43% of participants reported having at least one-lifetime episode of sleep paralysis. Among those who had experienced sleep paralysis, 37% reported having hallucinations during these episodes.

Participants who had experienced sleep paralysis at least once had higher symptoms of trait anxiety, meaning they were more likely to judge everyday events as potentially threatening. They also exhibited higher rates of severe worry than those without sleep paralysis. Furthermore, those who experienced hallucinations during sleep paralysis were more likely to develop symptoms of trait anxiety.

There is also evidence indicating a correlation between sleep paralysis and social anxiety. According to a survey conducted among individuals who had experienced sleep paralysis at least once, approximately 11% reported having social anxiety, while 11% had been diagnosed with generalized anxiety disorder. In this study, sleep paralysis distress was associated with a phenomenon known as "felt presence," which refers to the sensation of someone's presence during sleep.

This could help explain the connection between sleep paralysis and social anxiety. The feeling of a presence during sleep paralysis could represent a socially scary situation, like being afraid of being judged by others or feeling like one is being watched.

In another study of participants who had experienced sleep paralysis, 31% met the diagnostic criteria for panic disorder. Panic disorder is a type of anxiety disorder that involves sudden episodes of intense panic or fear. Interestingly, those who did not experience sleep paralysis did not meet the diagnostic criteria for panic disorder.

Sleep paralysis and depression

Mental health conditions, including depression, can trigger sleep paralysis.

For instance, a study involving 606 students who had experienced at least one episode of sleep paralysis found that 17 of these students were diagnosed with psychiatric disorders. Five had depression, six had anxiety, two had a combination of depression and anxiety, and the rest had bipolar disorder or panic disorder.

Sleep paralysis and PTSD

Experiencing a traumatic event like a car crash or the death of a loved one can have a significant impact on a person’s mental health. Some people fail to recover and develop PTSD symptoms.

If someone has been diagnosed with PTSD, they are at a higher risk of dealing with sleep paralysis. One study focused on the connection between sleep paralysis and PTSD, particularly in firefighters. Firefighters often face traumatic situations as part of their job, which puts them at higher risk of developing PTSD symptoms.

The study found that 15% of the participants had PTSD. There was also a strong association between PTSD and sleep paralysis. For instance, individuals with PTSD had approximately 1.86 higher odds of developing sleep paralysis than those without PTSD.

Dealing with sleep paralysis

In most cases, treatment for sleep paralysis is not necessary. One can prevent or decrease the frequency of episodes by improving sleep hygiene.

However, if someone is experiencing sleep paralysis due to an underlying medical condition like anxiety or PTSD, it is recommended that they consult with their doctor. By addressing and effectively managing the condition, it is possible to reduce the frequency of sleep paralysis episodes.

When sleep paralysis occurs too frequently or is distressing, a doctor may prescribe medication to help reduce the episodes. The treatment may involve antidepressant medications at low doses. Additionally, cognitive behavioral therapy for insomnia (CBT-I), a type of talk therapy, may also help manage sleep paralysis.

Mental health conditions can trigger sleep paralysis. At the same time, experiencing sleep paralysis can make someone more susceptible to developing mental health issues. Prioritizing mental well-being and establishing healthy sleep habits is crucial. By taking care of our minds through self-care, stress management, and seeking support when needed, we can significantly reduce the occurrence of these unsettling experiences.