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| Boilerpipe Text | "Night demon" redirects here. For the American heavy metal band, see
Night Demon (band)
.
Sleep paralysis
The Nightmare
by Swiss artist
Henry Fuseli
(1781) is thought to be a depiction of sleep paralysis perceived as a
demonic
visitation.
Specialty
Psychiatry
sleep medicine
Symptoms
Awareness but an inability to move during waking or falling asleep
hallucinations
[
1
]
[
2
]
Complications
Nyctophobia
Duration
No more than a couple of minutes
[
2
]
Risk factors
Narcolepsy
obstructive sleep apnea
alcohol use
sleep deprivation
[
1
]
[
2
]
Diagnostic method
Based on description
[
2
]
Differential diagnosis
Narcolepsy
atonic seizure
hypokalemic periodic paralysis
night terror
[
1
]
[
2
]
Treatment
Reassurance
sleep hygiene
cognitive behavioral therapy
antidepressants
[
1
]
Frequency
8–50%
[
2
]
Deaths
None; physically harmless
[
3
]
Sleep paralysis
is a state,
during waking up
or
falling asleep
, in which a person is conscious but in a complete state of
paralysis
.
[
1
]
[
2
]
During an episode, the person may
hallucinate
(hear, feel, or see things that are not there), which often results in
fear
.
[
1
]
[
3
]
Episodes generally last no more than a few minutes.
[
2
]
It can recur multiple times or occur as a single episode.
[
1
]
[
3
]
This condition may occur in those who are otherwise healthy or those with
narcolepsy
, or it may run in families as a result of specific
genetic
changes. The condition can be triggered by
sleep deprivation
,
psychological stress
, or abnormal
sleep cycles
. The underlying mechanism is believed to involve a dysfunction in
REM sleep
.
[
2
]
Diagnosis is based on a person's description. Other conditions that can present similarly include narcolepsy,
atonic seizure
, and
hypokalemic periodic paralysis
.
[
2
]
Treatment options for sleep paralysis have been poorly studied. It is recommended that people be reassured that the condition is common and generally not serious. Other efforts that may be tried include
sleep hygiene
,
cognitive behavioral therapy
, and
antidepressants
.
[
1
]
Between 8% to 50% of people experience sleep paralysis at some point during their lifetime.
[
2
]
[
4
]
About 5% of people have regular episodes. Males and females are affected equally.
[
2
]
Sleep paralysis has been described throughout history. It is believed to have played a role in the creation of stories about
alien abduction
and other
paranormal
events.
[
1
]
The main symptom of sleep paralysis is being unable to move or speak during waking.
[
1
]
Imagined sounds such as
humming
,
hissing
,
static
,
zapping
and buzzing noises are reported during sleep paralysis.
[
5
]
Other sounds such as
voices
,
whispers
,
screaming
,
growling
, and
roars
are also experienced. It has also been known that one may feel pressure on their chest and intense pain in their head during an episode.
[
6
]
These symptoms are usually accompanied by intense
emotions
such as
fear
and
panic
.
[
7
]
People also have feelings of drowning or sinking, being dragged out of bed or of flying,
numbness
, and feelings of electric
tingles
or
vibrations
running through their body.
[
8
]
Sleep paralysis may include hallucinations, such as an intruding presence or dark figure in the room. These are commonly known as
sleep paralysis demons
or
shadow people
. It may also include the inability to breathe or the individual feeling a sense of terror, accompanied by a feeling of pressure on one's chest and
difficulty breathing
.
[
9
]
The pathophysiology of sleep paralysis has not been concretely identified, although there are several theories about its cause.
[
10
]
The first of these stems from the understanding that sleep paralysis is a
parasomnia
resulting from dysfunctional overlap of the REM and waking stages of sleep.
[
11
]
Polysomnographic
studies have found that individuals who experience sleep paralysis have shorter REM sleep latencies than normal along with shortened NREM and REM sleep cycles, and fragmentation of REM sleep. This study supports the observation that disturbance of regular sleeping patterns can precipitate an episode of sleep paralysis, because fragmentation of REM sleep commonly occurs when sleep patterns are disrupted and has now been seen in combination with sleep paralysis.
[
12
]
Another major theory is that the neural functions that regulate sleep are out of balance, causing different sleep states to overlap. In this case, cholinergic sleep "on"
neural populations
are hyperactivated and the serotonergic sleep "off" neural populations are under-activated. As a result, the cells capable of sending the signals, that would allow for complete arousal from the sleep state, the serotonergic neural populations, have difficulty in overcoming the signals sent by the cells that keep the brain in the sleep state. During normal REM sleep, the threshold for a stimulus to cause arousal is greatly elevated. Under normal conditions, medial and
vestibular nuclei
,
cortical
,
thalamic
, and
cerebellar
centers coordinate things such as head and eye movement, and orientation in space.
[
8
]
In individuals reporting sleep paralysis, there is almost no blocking of exogenous stimuli, which means it is much easier for a stimulus to arouse the individual. The vestibular nuclei in particular has been identified as being closely related to dreaming during the REM stage of sleep.
[
8
]
According to this hypothesis, vestibular-motor disorientation, unlike hallucinations, arise from completely endogenous sources of stimuli.
[
13
]
If the effects of sleep "on" neural populations cannot be counteracted, characteristics of REM sleep are retained upon awakening. Common consequences of sleep paralysis include headaches, muscle pains or weakness or paranoia. As the correlation with REM sleep suggests, the paralysis is not complete: use of
EOG
traces shows that eye movement is still possible during such episodes; however, the individual experiencing sleep paralysis is unable to speak.
[
14
]
Research has found a genetic component in sleep paralysis.
[
15
]
The characteristic fragmentation of REM sleep,
hypnopompic
, and
hypnagogic
hallucinations have a heritable component in other parasomnias, which lends credence to the idea that sleep paralysis is also genetic. Twin studies have shown that if one twin of a monozygotic pair (
identical twins
) experiences sleep paralysis that the other twin is very likely to experience it as well.
[
16
]
The identification of a genetic component means that there is some sort of disruption of a function at the physiological level. Further studies must be conducted to determine whether there is a mistake in the signaling pathway for arousal as suggested by the first theory presented, or whether the regulation of melatonin or the neural populations themselves have been disrupted.
A picture of a
succubus
-like vision.
My Dream, My Bad Dream
, 1915, by Fritz Schwimbeck
Several types of hallucinations have been linked to sleep paralysis: the belief that there is an intruder in the room, the feeling of a presence, and the sensation of floating. One common hallucination is the presence of an
incubus
. A neurological hypothesis is that in sleep paralysis the
cerebellum
, which usually coordinates body movement and provides information on body position, experiences a brief myoclonic spike in brain activity inducing a
floating
sensation.
[
13
]
The
intruder
and incubus hallucinations highly correlate with one another, and moderately correlated with the third hallucination, vestibular-motor disorientation, also known as
out-of-body experiences
,
[
13
]
which differ from the other two in not involving the threat-activated vigilance system.
[
17
]
Threat hyper-vigilance
[
edit
]
A
hyper-vigilant
state created in the
midbrain
may further contribute to hallucinations.
[
8
]
More specifically, the emergency response is activated in the brain when individuals wake up paralyzed and feel vulnerable to attack. This helplessness can intensify the effects of the threat response well above the level typical of normal dreams, which could explain why such visions during sleep paralysis are so vivid. The threat-activated vigilance system is a protective mechanism that differentiates between dangerous situations and determines whether the fear response is appropriate.
[
13
]
The hyper-vigilance response can lead to the creation of endogenous stimuli that contribute to the perceived threat.
[
8
]
A similar process may explain hallucinations, with slight variations, in which an evil presence is perceived by the subject to be attempting to suffocate them, either by pressing heavily on the chest or by strangulation. A neurological explanation holds that this results from a combination of the threat vigilance activation system and the muscle paralysis associated with sleep paralysis that removes voluntary control of breathing. Several features of REM breathing patterns exacerbate the feeling of suffocation.
[
13
]
These include shallow rapid breathing,
hypercapnia
, and slight blockage of the airway, which is a symptom prevalent in
sleep apnea
patients.
[
8
]
According to this account, the subjects attempt to breathe deeply and find themselves unable to do so, creating a sensation of resistance, which the threat-activated vigilance system interprets as an unearthly being sitting on their chest, threatening suffocation.
[
8
]
The sensation of entrapment causes a feedback loop when the fear of suffocation increases as a result of continued helplessness, causing the subjects to struggle to end the SP episode.
[
13
]
Sleep paralysis is mainly diagnosed via clinical interview and ruling out other potential
sleep disorders
that could account for the feelings of paralysis.
[
10
]
[
11
]
Several measures are available to reliably diagnose
[
17
]
[
18
]
or screen (
Munich Parasomnia Screening
)
[
19
]
for recurrent isolated sleep paralysis.
Episodes of sleep paralysis can occur in the context of several medical conditions (e.g., narcolepsy,
hypokalemia
). When episodes occur independent of these conditions or substance use, it is termed "isolated sleep paralysis" (ISP).
[
18
]
When ISP episodes are more frequent and cause clinically significant distress or interference, it is classified as "recurrent isolated sleep paralysis" (RISP). Episodes of sleep paralysis, regardless of classification, are generally short (1–6 minutes), but longer episodes also have been documented.
[
8
]
It can be difficult to differentiate between
cataplexy
brought on by narcolepsy and true sleep paralysis, because the two phenomena are physically indistinguishable. The best way to differentiate between the two is to note when the attacks occur most often. Narcolepsy attacks are more common when the individual is falling asleep; ISP and RISP attacks are more common upon awakening.
[
17
]
Differential diagnoses
[
edit
]
Similar conditions include:
[
20
]
Exploding head syndrome
(EHS) potentially frightening parasomnia, the hallucinations are usually briefer and always loud or jarring. There is no paralysis during EHS.
Nightmare disorder
(ND); also REM-based parasomnia.
Sleep terrors
(STs) are potentially frightening parasomnia, but are not REM based and there is a lack of awareness to surroundings, characteristic screams during STs.
Noctural panic attacks
(NPAs) involve fear and acute distress but lack paralysis and dream imagery.
Post-traumatic stress disorder
(PTSD) often includes scary imagery and anxiety but not limited to sleep-wake transitions.
Several circumstances have been identified that are associated with an increased risk of sleep paralysis. These include
insomnia
,
sleep deprivation
, an erratic sleep schedule,
stress
, and physical fatigue. It is also believed that there may be a genetic component in the development of RISP, because there is a high concurrent incidence of sleep paralysis in
monozygotic twins
.
[
16
]
Sleeping in the
supine position
(on one's back) has been found an especially prominent instigator of sleep paralysis.
[
9
]
[
21
]
Sleeping in the supine position is believed to make the sleeper more vulnerable to episodes of sleep paralysis because in this sleeping position, it is possible for the soft palate to collapse and obstruct the airway. This is a possibility regardless of whether the individual has been diagnosed with sleep apnea or not. There may also be a greater rate of
microarousals
while sleeping in the supine position because there is a greater amount of pressure being exerted on the lungs due to gravity.
[
21
]
While many factors can increase the risk for ISP or RISP, they can be avoided with minor lifestyle changes.
[
11
]
Medical treatment starts with education about sleep stages and the inability to move muscles during REM sleep. People should be evaluated for
narcolepsy
if symptoms persist.
[
22
]
The safest treatment for sleep paralysis is for people to adopt healthier sleeping habits. However, in more serious cases
tricyclic antidepressants
or
selective serotonin reuptake inhibitors
(SSRIs) may be used. Most people tend to overcome sleep paralysis by being woken up through touch or movement.
[
23
]
Despite the fact that these treatments are prescribed, there is currently no drug that has been found to completely interrupt episodes of sleep paralysis the majority of the time.
[
24
]
Though no large trials have taken place which focus on the treatment of sleep paralysis, several drugs have promise in case studies. Two trials of
GHB
for people with narcolepsy demonstrated reductions in sleep paralysis episodes.
[
25
]
Pimavanserin
has been proposed as a possible candidate for future studies in treating sleep paralysis.
[
26
]
Cognitive-behavior therapy
[
edit
]
Some of the earliest work in treating sleep paralysis was done using a
cognitive-behavior therapy
called CA-CBT. The work focuses on psycho-education and modifying catastrophic cognitions about the sleep paralysis attack.
[
27
]
[
28
]
This approach has previously been used to treat sleep paralysis in Egypt, although clinical trials are lacking.
[
29
]
The first published psychosocial treatment for recurrent isolated sleep paralysis was cognitive-behavior therapy - isolated sleep paralysis (CBT-ISP).
[
18
]
It begins with self-monitoring of symptoms, cognitive restructuring of maladaptive thoughts relevant to ISP (e.g., "the paralysis will be permanent"), and psychoeducation about the nature of sleep paralysis. Prevention techniques include ISP-specific sleep hygiene and the preparatory use of various relaxation techniques (e.g. diaphragmatic breathing, mindfulness, progressive muscle relaxation, meditation). Episode disruption techniques
[
30
]
are first practiced in session and then applied during actual attacks. No controlled trial of CBT-ISP has yet been conducted to prove its effectiveness.
Sleep paralysis is experienced equally in males and females.
[
4
]
[
31
]
Lifetime prevalence rates derived from 35 aggregated studies indicate that approximately 8% of the general population, 28% of students, and 32% of psychiatric patients experience at least one episode of sleep paralysis at some point in their lives.
[
4
]
Rates of recurrent sleep paralysis are not as well known, but 15–45% of those with a lifetime history of sleep paralysis may meet diagnostic criteria for Recurrent Isolated Sleep Paralysis.
[
17
]
[
10
]
In surveys from Canada, China, England, Japan and Nigeria, 20% to 60% of individuals reported having experienced sleep paralysis at least once in their lifetime.
[
7
]
In general, non-white people appear to experience sleep paralysis at higher rates than white people, but the magnitude of the difference is rather small.
[
4
]
Approximately 36% of the general population that experiences isolated sleep paralysis, develop it between 25 and 44 years of age.
[
32
]
Isolated sleep paralysis is commonly seen in patients that have been diagnosed with narcolepsy. Approximately 30–50% of people that have been diagnosed with narcolepsy, have experienced sleep paralysis as an auxiliary symptom. A majority of the individuals who have experienced sleep paralysis, have sporadic episodes that occur once a month to once a year. Only 3% of individuals who experience sleep paralysis that is not associated with a
neuromuscular disorder
have nightly episodes.
[
32
]
Society and culture
[
edit
]
A 19th century version of
Füssli's
The Nightmare
(1781)
The original definition of sleep paralysis was codified by
Samuel Johnson
in his
A Dictionary of the English Language
as
nightmare
, a term that evolved into the modern definition. The term was first used and dubbed by British neurologist,
S.A.K. Wilson
in his 1928 dissertation,
The Narcolepsies.
[
33
]
Such sleep paralysis was widely considered the work of
demons
, and more specifically
incubi
, which were thought to sit on the chests of sleepers. In
Old English
, the name for these beings was
mare
or
mære
(from a
proto-Germanic
*marōn
, cf.
Old Norse
mara
), hence comes the
mare
in the word
nightmare
. The word might be
cognate
to
Greek
Marōn
(in the
Odyssey
) and
Sanskrit
Māra
.
Cultural significance and priming
[
edit
]
Le Cauchemar
(
The Nightmare
), by Eugène Thivier (1894)
Although the core features of sleep paralysis (e.g., atonia, a clear sensorium, and frequent hallucinations) appear to be universal, the ways in which they are experienced vary according to time, place, and culture.
[
9
]
[
34
]
Over 100 terms have been identified for these experiences.
[
18
]
Some scientists have proposed sleep paralysis as an explanation for reports of paranormal and spiritual phenomena such as
ghosts
,
[
35
]
[
36
]
alien visits,
[
37
]
demons
or
demonic possession
,
[
9
]
[
38
]
alien abduction
experiences,
[
39
]
[
40
]
the
night hag
and
shadow people
haunting.
[
10
]
[
13
]
According to some scientists, culture may be a major factor in shaping sleep paralysis.
[
38
]
When sleep paralysis is interpreted through a particular cultural filter, it may take on greater salience. For example, if sleep paralysis is feared in a certain culture, this fear could lead to conditioned fear, and thus worsen the experience, in turn leading to higher rates.
[
9
]
[
38
]
Consistent with this idea, high rates and long durations of immobility during sleep paralysis have been found in Egypt, where there are elaborate beliefs about sleep paralysis, involving
malevolent spirit
-like creatures, the
jinn
.
[
38
]
Research has found that sleep paralysis is associated with great fear and fear of impending death in 50% of sufferers in Egypt. A study comparing rates and characteristics of sleep paralysis in Egypt and Denmark found that the phenomenon is three times more common in Egypt than Denmark.
[
38
]
In Denmark, unlike Egypt, there are no elaborate supernatural beliefs about sleep paralysis, and the experience is often interpreted as an odd physiological event, with overall shorter sleep paralysis episodes and fewer people (17%) fearing that they could die from it.
[
34
]
The
night hag
is a generic name for a folkloric creature found in cultures around the world, and which is used to explain the phenomenon of sleep paralysis. A common description is that a person feels the presence of a supernatural malevolent being which immobilizes the person as if standing on the chest.
[
41
]
This phenomenon goes by many names.
In
Albanian folk beliefs
,
Mokthi
is believed to be a male spirit with a golden
fez
hat who appears to women who are usually tired or suffering and stops them from moving. It is believed that if they can take his golden hat, he will grant them a wish, but then he will visit them frequently although he is harmless. There are talismans that can provide protection from Mokthi and one way is to put one's husband's hat near the pillow while sleeping.
Mokthi
or
Makthi
in
Albanian
means "Nightmare".
[
42
]
The names of sleep paralysis vary in some Arab countries; it is popularly known as "Al-Jathoom," in Morocco it is called "Boughtat," and in other regions it is known as "Raboos." This entity, believed to be a jinn, perches on the sleeper's chest.
[
34
]
[
43
]
In
Bengali folklore
, sleep paralysis is believed to be caused by a supernatural entity called
Boba
(
Bengali
:
বোবা
,
lit.
'
dumb
'
).
Boba
attacks a person by strangling him when the person sleeps in a
supine position
. In
Bengal
, the phenomenon is called
Bobay Dhora
(
Bengali
:
বোবায় ধরা
,
lit.
'
Struck by
Boba
'
).
[
44
]
Sleep paralysis among
Cambodians
is known as "the ghost pushes you down," and entails the belief in dangerous visitations from deceased relatives.
[
36
]
Sleep paralysis among the
Japanese
is known as
kanashibari
(金縛り), lit. "metal binding" and entails the belief of dangerous visitations from childlike
Yōkai
, called a
makuragaeshi
(枕返し or 反枕, lit. "pillow flip"), sitting on the victim's chest.
In the different regions of
Italy
, there are many examples of supernatural beings associated with sleep paralysis. In the regions of
Marche
and
Abruzzo
, it is referred to as a
Pandafeche
[
it
]
or
pantafica
[
it
]
attack;
[
9
]
the
Pandafeche
usually refers to an evil
witch
, sometimes a ghostlike spirit or a terrifying catlike creature, that mounts on the chest of the victim and tries to harm him. The only way to avoid her is to keep a bag of sand or beans close to the bed, so that the witch will stop to count how many beans or sand-grains are inside it. A similar tradition is present in the
Sardinian
folklore, where the
Ammuntadore
is known as a creature that mounts on the people's chest during their sleep to give them nightmares, and it can change its shape according to the person's fears. In Northern Italy, specifically in the
Tyrol
area, the
Trud
is a witch that sits on the people's chest at night, making them unable to breathe; to chase her away, people should make the
sign of the Cross
, something that would need a great struggle in a situation of paralysis.
[
45
]
A similar folklore is present in the
Sannio
area, around the city of
Benevento
, where the witch is called
Janara
.
[
46
]
In Southern Italy, sleep paralysis is usually explained with the presence of a
sprite
standing on the people's chest; if the person manages to catch the sprite (or steal his hat), in exchange for his freedom (or to have his hat back) he can reveal the hiding place of a rich treasure; this sprite has different names in different regions of Italy: Monaciello in
Campania
, Monachicchio in
Basilicata
, Laurieddhu or Scazzamurill in
Apulia
, Mazzmuredd in
Molise
.
[
46
]
In
Newfoundland
, which is in eastern Canada, sleep paralysis is referred to as the Old Hag,
[
35
]
[
47
]
and victims of a
hagging
are said to be
hag-ridden
upon awakening.
[
48
]
Victims report being completely conscious, but unable to speak or move, and report a person or an animal which sits upon their chest.
[
49
]
Despite the name, the attacker can be either male or female.
[
50
]
Some suggested cures or preventions for the Old Hag include sleeping with a Bible under the pillow,
[
49
]
calling the sleeper's name backwards
[
51
]
or in an extreme example, sleeping with a shingle or board embedded with nails strapped to the chest.
[
52
]
This object was called a Hag Board.
[
53
]
The Old Hag is well-enough known in the province to be a pop culture figure, appearing in films and plays
[
54
]
as well as in crafted objects.
[
55
]
Nigeria
[
56
]
has myriad interpretations of the cause of sleep paralysis, due to numerous cultures and belief systems that exist there.
Sleep paralysis is sometimes interpreted as space alien abduction in the
United States
.
[
57
]
Various forms of
magic
and
spiritual possession
were also advanced as causes, in literature. In nineteenth-century
Europe
, the vagaries of diet were thought to be responsible. For example, in
Charles Dickens
's
A Christmas Carol
,
Ebenezer Scrooge
attributes the
ghost
he sees to "... an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato..." In a similar vein, the
Household Cyclopedia
(1881) offers the following advice about nightmares:
Great attention is to be paid to regularity and choice of diet. Intemperance of every kind is hurtful, but nothing is more productive of this disease than drinking bad wine. Of eatables those which are most prejudicial are all fat and greasy meats and pastry. Moderate exercise contributes in a superior degree to promote the digestion of food and prevent flatulence; those, however, who are necessarily confined to a sedentary occupation, should particularly avoid applying themselves to study or bodily labor immediately after eating. Going to bed before the usual hour is a frequent cause of night-mare, as it either occasions the patient to sleep too long or to lie long awake in the night. Passing a whole night or part of a night without rest likewise gives birth to the disease, as it occasions the patient, on the succeeding night, to sleep too soundly. Indulging in sleep too late in the morning, is an almost certain method to bring on the paroxysm, and the more frequently it returns, the greater strength it acquires; the propensity to sleep at this time is almost irresistible.
[
58
]
J. M. Barrie
, the author of the
Peter Pan
stories, may have had sleep paralysis. He said of himself "In my early boyhood it was a sheet that tried to choke me in the night."
[
59
]
He also described several incidents in the Peter Pan stories that indicate that he was familiar with an awareness of a loss of muscle tone whilst in a dream-like state. For example, Maimie is asleep but calls out "What was that....It is coming nearer! It is feeling your bed with its horns-it is boring for [into] you",
[
60
]
and when the Darling children were dreaming of flying, Barrie says "Nothing horrid was visible in the air, yet their progress had become slow and laboured, exactly as if they were pushing their way through hostile forces. Sometimes they hung in the air until Peter had beaten on it with his fists."
[
61
]
Barrie describes many
parasomnias
and neurological symptoms in his books and uses them to explore the nature of consciousness from an experiential point of view.
[
62
]
Herman Melville
described an episode resembling sleep paralysis in his novel
Moby-Dick
(1851). In Chapter 4 ("The Counterpane"), Ishmael recalls a childhood incident in which "a supernatural hand seemed placed in mine," leaving him aware but unable to move. The passage has been analyzed as one of the earliest fictional depictions consistent with modern clinical descriptions of the condition.
[
63
]
The Nightmare
is a 2015 documentary that discusses the causes of sleep paralysis as seen through extensive interviews with participants, and the experiences are re-enacted by professional actors. In synopsis, it proposes that such cultural phenomena as
alien abduction
, the
near-death experience
and
shadow people
can, in many cases, be attributed to sleep paralysis. The "real-life" horror film debuted at the
Sundance Film Festival
on January 26, 2015, and premiered in theatres on June 5, 2015.
[
64
]
Catatonia
– Psychiatric behavioural syndrome
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d
e
f
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j
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.
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.
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.
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.
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a
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h
i
j
k
l
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ISBN
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.
^
a
b
c
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Sleep Paralysis and Associated Hypnagogic and Hypnopompic Experiences
from University of Waterloo |
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## Contents
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- [(Top)](https://en.wikipedia.org/wiki/Sleep_paralysis)
- [1 Symptoms and signs](https://en.wikipedia.org/wiki/Sleep_paralysis#Symptoms_and_signs)
- [2 Pathophysiology](https://en.wikipedia.org/wiki/Sleep_paralysis#Pathophysiology)
Toggle Pathophysiology subsection
- [2\.1 Hallucinations](https://en.wikipedia.org/wiki/Sleep_paralysis#Hallucinations)
- [2\.2 Threat hyper-vigilance](https://en.wikipedia.org/wiki/Sleep_paralysis#Threat_hyper-vigilance)
- [3 Diagnosis](https://en.wikipedia.org/wiki/Sleep_paralysis#Diagnosis)
Toggle Diagnosis subsection
- [3\.1 Diagnosis](https://en.wikipedia.org/wiki/Sleep_paralysis#Diagnosis_2)
- [3\.2 Differential diagnoses](https://en.wikipedia.org/wiki/Sleep_paralysis#Differential_diagnoses)
- [4 Prevention](https://en.wikipedia.org/wiki/Sleep_paralysis#Prevention)
- [5 Treatment](https://en.wikipedia.org/wiki/Sleep_paralysis#Treatment)
Toggle Treatment subsection
- [5\.1 Medications](https://en.wikipedia.org/wiki/Sleep_paralysis#Medications)
- [5\.2 Cognitive-behavior therapy](https://en.wikipedia.org/wiki/Sleep_paralysis#Cognitive-behavior_therapy)
- [6 Epidemiology](https://en.wikipedia.org/wiki/Sleep_paralysis#Epidemiology)
- [7 Society and culture](https://en.wikipedia.org/wiki/Sleep_paralysis#Society_and_culture)
Toggle Society and culture subsection
- [7\.1 Etymology](https://en.wikipedia.org/wiki/Sleep_paralysis#Etymology)
- [7\.2 Cultural significance and priming](https://en.wikipedia.org/wiki/Sleep_paralysis#Cultural_significance_and_priming)
- [7\.3 Folklore](https://en.wikipedia.org/wiki/Sleep_paralysis#Folklore)
- [7\.3.1 Albania](https://en.wikipedia.org/wiki/Sleep_paralysis#Albania)
- [7\.3.2 Arab](https://en.wikipedia.org/wiki/Sleep_paralysis#Arab)
- [7\.3.3 Bengal](https://en.wikipedia.org/wiki/Sleep_paralysis#Bengal)
- [7\.3.4 Cambodia](https://en.wikipedia.org/wiki/Sleep_paralysis#Cambodia)
- [7\.3.5 Japan](https://en.wikipedia.org/wiki/Sleep_paralysis#Japan)
- [7\.3.6 Italy](https://en.wikipedia.org/wiki/Sleep_paralysis#Italy)
- [7\.3.7 Newfoundland](https://en.wikipedia.org/wiki/Sleep_paralysis#Newfoundland)
- [7\.3.8 Nigeria](https://en.wikipedia.org/wiki/Sleep_paralysis#Nigeria)
- [7\.3.9 United States](https://en.wikipedia.org/wiki/Sleep_paralysis#United_States)
- [7\.4 Literature](https://en.wikipedia.org/wiki/Sleep_paralysis#Literature)
- [7\.5 Documentary films](https://en.wikipedia.org/wiki/Sleep_paralysis#Documentary_films)
- [8 See also](https://en.wikipedia.org/wiki/Sleep_paralysis#See_also)
- [9 References](https://en.wikipedia.org/wiki/Sleep_paralysis#References)
- [10 External links](https://en.wikipedia.org/wiki/Sleep_paralysis#External_links)
Toggle the table of contents
# Sleep paralysis
62 languages
- [العربية](https://ar.wikipedia.org/wiki/%D8%B4%D9%84%D9%84_%D8%A7%D9%84%D9%86%D9%88%D9%85 "شلل النوم – Arabic")
- [الدارجة](https://ary.wikipedia.org/wiki/%D8%A8%D9%88%D8%BA%D8%B7%D8%A7%D8%B7 "بوغطاط – Moroccan Arabic")
- [Asturianu](https://ast.wikipedia.org/wiki/Paral%C3%ADs_del_sua%C3%B1u "Paralís del suañu – Asturian")
- [Azərbaycanca](https://az.wikipedia.org/wiki/Yuxu_iflici "Yuxu iflici – Azerbaijani")
- [تۆرکجه](https://azb.wikipedia.org/wiki/%DB%8C%D9%88%D8%AE%D9%88_%DA%86%D9%88%D9%84%D8%A7%D9%82%DB%8C "یوخو چولاقی – South Azerbaijani")
- [Български](https://bg.wikipedia.org/wiki/%D0%A1%D1%8A%D0%BD%D0%BD%D0%B0_%D0%BF%D0%B0%D1%80%D0%B0%D0%BB%D0%B8%D0%B7%D0%B0 "Сънна парализа – Bulgarian")
- [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%AC%E0%A7%8B%E0%A6%AC%E0%A6%BE%E0%A6%AF%E0%A6%BC_%E0%A6%A7%E0%A6%B0%E0%A6%BE "বোবায় ধরা – Bangla")
- [Català](https://ca.wikipedia.org/wiki/Par%C3%A0lisi_del_son "Paràlisi del son – Catalan")
- [閩東語 / Mìng-dĕ̤ng-ngṳ̄](https://cdo.wikipedia.org/wiki/K%C3%A9%CC%A4%E1%B9%B3k_mu%C3%B4i-g%C5%ABi_c%C4%AB "Ké̤ṳk muôi-gūi cī – Mindong")
- [کوردی](https://ckb.wikipedia.org/wiki/%D8%A6%DB%8C%D9%81%D9%84%DB%8C%D8%AC%DB%8C%DB%8C_%D8%AE%DB%95%D9%88 "ئیفلیجیی خەو – Central Kurdish")
- [Čeština](https://cs.wikipedia.org/wiki/Sp%C3%A1nkov%C3%A1_paral%C3%BDza "Spánková paralýza – Czech")
- [Чӑвашла](https://cv.wikipedia.org/wiki/%D0%AB%D0%B9%D1%85%C4%83_%D0%BF%D0%B0%D1%80%D0%B0%D0%BB%D0%B8%D1%87%C4%95 "Ыйхă параличĕ – Chuvash")
- [Dansk](https://da.wikipedia.org/wiki/S%C3%B8vnparalyse "Søvnparalyse – Danish")
- [Deutsch](https://de.wikipedia.org/wiki/Schlafparalyse "Schlafparalyse – German")
- [Zazaki](https://diq.wikipedia.org/wiki/Paraliz%C3%AA_hewni "Paralizê hewni – Dimli")
- [Ελληνικά](https://el.wikipedia.org/wiki/%CE%A0%CE%B1%CF%81%CE%AC%CE%BB%CF%85%CF%83%CE%B7_%CF%8D%CF%80%CE%BD%CE%BF%CF%85 "Παράλυση ύπνου – Greek")
- [Español](https://es.wikipedia.org/wiki/Par%C3%A1lisis_del_sue%C3%B1o "Parálisis del sueño – Spanish")
- [Eesti](https://et.wikipedia.org/wiki/Uneparal%C3%BC%C3%BCs "Uneparalüüs – Estonian")
- [Euskara](https://eu.wikipedia.org/wiki/Loaren_paralisi "Loaren paralisi – Basque")
- [فارسی](https://fa.wikipedia.org/wiki/%D9%81%D9%84%D8%AC_%D8%AE%D9%88%D8%A7%D8%A8 "فلج خواب – Persian")
- [Suomi](https://fi.wikipedia.org/wiki/Unihalvaus "Unihalvaus – Finnish")
- [Français](https://fr.wikipedia.org/wiki/Paralysie_du_sommeil "Paralysie du sommeil – French")
- [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Sleep_paralysis "Sleep paralysis – Ghanaian Pidgin")
- [עברית](https://he.wikipedia.org/wiki/%D7%A9%D7%99%D7%AA%D7%95%D7%A7_%D7%A9%D7%99%D7%A0%D7%94 "שיתוק שינה – Hebrew")
- [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%A8%E0%A4%BF%E0%A4%A6%E0%A5%8D%E0%A4%B0%E0%A4%BE_%E0%A4%B2%E0%A4%95%E0%A4%B5%E0%A4%BE "निद्रा लकवा – Hindi")
- [Hrvatski](https://hr.wikipedia.org/wiki/Paraliza_sna "Paraliza sna – Croatian")
- [Magyar](https://hu.wikipedia.org/wiki/Alv%C3%A1si_b%C3%A9nul%C3%A1s "Alvási bénulás – Hungarian")
- [Հայերեն](https://hy.wikipedia.org/wiki/%D5%94%D5%B6%D5%AB_%D5%BA%D5%A1%D6%80%D5%A1%D5%AC%D5%AB%D5%A6 "Քնի պարալիզ – Armenian")
- [Jaku Iban](https://iba.wikipedia.org/wiki/Pajung_tinduk "Pajung tinduk – Iban")
- [Bahasa Indonesia](https://id.wikipedia.org/wiki/Kelumpuhan_tidur "Kelumpuhan tidur – Indonesian")
- [Italiano](https://it.wikipedia.org/wiki/Paralisi_nel_sonno "Paralisi nel sonno – Italian")
- [日本語](https://ja.wikipedia.org/wiki/%E9%87%91%E7%B8%9B%E3%82%8A "金縛り – Japanese")
- [ქართული](https://ka.wikipedia.org/wiki/%E1%83%AB%E1%83%98%E1%83%9A%E1%83%98%E1%83%A1_%E1%83%9E%E1%83%90%E1%83%A0%E1%83%90%E1%83%9A%E1%83%98%E1%83%96%E1%83%98 "ძილის პარალიზი – Georgian")
- [한국어](https://ko.wikipedia.org/wiki/%EA%B0%80%EC%9C%84%EB%88%8C%EB%A6%BC "가위눌림 – Korean")
- [Lietuvių](https://lt.wikipedia.org/wiki/Miego_paraly%C5%BEius "Miego paralyžius – Lithuanian")
- [Македонски](https://mk.wikipedia.org/wiki/%D0%9F%D0%B0%D1%80%D0%B0%D0%BB%D0%B8%D0%B7%D0%B0_%D0%BF%D1%80%D0%B8_%D1%81%D0%BF%D0%B8%D0%B5%D1%9A%D0%B5 "Парализа при спиење – Macedonian")
- [Bahasa Melayu](https://ms.wikipedia.org/wiki/Kelumpuhan_tidur "Kelumpuhan tidur – Malay")
- [မြန်မာဘာသာ](https://my.wikipedia.org/wiki/%E1%80%98%E1%80%AE%E1%80%9C%E1%80%B0%E1%80%B8%E1%80%85%E1%80%AE%E1%80%B8%E1%80%81%E1%80%BC%E1%80%84%E1%80%BA%E1%80%B8 "ဘီလူးစီးခြင်း – Burmese")
- [Nederlands](https://nl.wikipedia.org/wiki/Slaapverlamming "Slaapverlamming – Dutch")
- [Norsk bokmål](https://no.wikipedia.org/wiki/S%C3%B8vnparalyse "Søvnparalyse – Norwegian Bokmål")
- [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%A8%E0%AC%BF%E0%AC%A6%E0%AD%8D%E0%AC%B0%E0%AC%BE_%E0%AC%AA%E0%AC%95%E0%AD%8D%E0%AC%B7%E0%AC%BE%E0%AC%98%E0%AC%BE%E0%AC%A4 "ନିଦ୍ରା ପକ୍ଷାଘାତ – Odia")
- [Polski](https://pl.wikipedia.org/wiki/Pora%C5%BCenie_przysenne "Porażenie przysenne – Polish")
- [Português](https://pt.wikipedia.org/wiki/Paralisia_do_sono "Paralisia do sono – Portuguese")
- [Română](https://ro.wikipedia.org/wiki/Paralizie_%C3%AEn_timpul_somnului "Paralizie în timpul somnului – Romanian")
- [Русский](https://ru.wikipedia.org/wiki/%D0%A1%D0%BE%D0%BD%D0%BD%D1%8B%D0%B9_%D0%BF%D0%B0%D1%80%D0%B0%D0%BB%D0%B8%D1%87 "Сонный паралич – Russian")
- [Саха тыла](https://sah.wikipedia.org/wiki/%D0%A2%D2%AF%D2%AF%D0%BB%D0%B3%D1%8D_%D0%B1%D0%B0%D1%82%D1%82%D0%B0%D1%82%D1%8B%D1%8B "Түүлгэ баттатыы – Yakut")
- [سنڌي](https://sd.wikipedia.org/wiki/%D9%86%D9%86%DA%8A_%D8%AC%D9%88_%D9%81%D8%A7%D9%84%D8%AC "ننڊ جو فالج – Sindhi")
- [Simple English](https://simple.wikipedia.org/wiki/Sleep_paralysis "Sleep paralysis – Simple English")
- [Српски / srpski](https://sr.wikipedia.org/wiki/Paraliza_sna "Paraliza sna – Serbian")
- [Sesotho](https://st.wikipedia.org/wiki/Sesitahloohwana "Sesitahloohwana – Southern Sotho")
- [Sunda](https://su.wikipedia.org/wiki/Eureup-eureup "Eureup-eureup – Sundanese")
- [Svenska](https://sv.wikipedia.org/wiki/S%C3%B6mnparalys "Sömnparalys – Swedish")
- [Kiswahili](https://sw.wikipedia.org/wiki/Upooza_wa_usingizini "Upooza wa usingizini – Swahili")
- [தமிழ்](https://ta.wikipedia.org/wiki/%E0%AE%A4%E0%AF%81%E0%AE%AF%E0%AE%BF%E0%AE%B2%E0%AF%8D_%E0%AE%B5%E0%AE%BE%E0%AE%A4%E0%AE%AE%E0%AF%8D "துயில் வாதம் – Tamil")
- [Тоҷикӣ](https://tg.wikipedia.org/wiki/%D0%91%D0%B0x%D1%82%D0%B0%D0%BA "Баxтак – Tajik")
- [ไทย](https://th.wikipedia.org/wiki/%E0%B8%9C%E0%B8%B5%E0%B8%AD%E0%B8%B3 "ผีอำ – Thai")
- [Türkçe](https://tr.wikipedia.org/wiki/Uyku_felci "Uyku felci – Turkish")
- [Українська](https://uk.wikipedia.org/wiki/%D0%A1%D0%BE%D0%BD%D0%BD%D0%B8%D0%B9_%D0%BF%D0%B0%D1%80%D0%B0%D0%BB%D1%96%D1%87 "Сонний параліч – Ukrainian")
- [اردو](https://ur.wikipedia.org/wiki/%D9%86%DB%8C%D9%86%D8%AF_%DA%A9%D8%A7_%D9%81%D8%A7%D9%84%D8%AC "نیند کا فالج – Urdu")
- [Oʻzbekcha / ўзбекча](https://uz.wikipedia.org/wiki/Uyqu_falaji "Uyqu falaji – Uzbek")
- [Tiếng Việt](https://vi.wikipedia.org/wiki/Ch%E1%BB%A9ng_t%C3%AA_li%E1%BB%87t_khi_ng%E1%BB%A7 "Chứng tê liệt khi ngủ – Vietnamese")
- [中文](https://zh.wikipedia.org/wiki/%E7%9D%A1%E7%9C%A0%E7%98%AB%E7%97%AA%E7%97%87 "睡眠瘫痪症 – Chinese")
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From Wikipedia, the free encyclopedia
Sleeping disorder
For the normal sleep behavior of body paralysis during dreams, see [Rapid eye movement sleep](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep").
"Night demon" redirects here. For the American heavy metal band, see [Night Demon (band)](https://en.wikipedia.org/wiki/Night_Demon_\(band\) "Night Demon (band)").
Medical condition
| Sleep paralysis | |
|---|---|
| [](https://en.wikipedia.org/wiki/File:Henry_Fuseli_\(1741%E2%80%931825\),_The_Nightmare,_1781.jpg) | |
| *[The Nightmare](https://en.wikipedia.org/wiki/The_Nightmare "The Nightmare")* by Swiss artist [Henry Fuseli](https://en.wikipedia.org/wiki/Henry_Fuseli "Henry Fuseli") (1781) is thought to be a depiction of sleep paralysis perceived as a [demonic](https://en.wikipedia.org/wiki/Demon "Demon") visitation. | |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") [sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | Awareness but an inability to move during waking or falling asleep hallucinations[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Nyctophobia](https://en.wikipedia.org/wiki/Nyctophobia "Nyctophobia") |
| Duration | No more than a couple of minutes[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") | [Narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") [obstructive sleep apnea](https://en.wikipedia.org/wiki/Obstructive_sleep_apnea "Obstructive sleep apnea") alcohol use [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation")[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | Based on description[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") | [Narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") [atonic seizure](https://en.wikipedia.org/wiki/Atonic_seizure "Atonic seizure") [hypokalemic periodic paralysis](https://en.wikipedia.org/wiki/Hypokalemic_periodic_paralysis "Hypokalemic periodic paralysis") [night terror](https://en.wikipedia.org/wiki/Night_terror "Night terror")[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| Treatment | Reassurance [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") [antidepressants](https://en.wikipedia.org/wiki/Antidepressants "Antidepressants")[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1) |
| Frequency | 8–50%[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| Deaths | None; physically harmless[\[3\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:11-3) |
**Sleep paralysis** is a state, [during waking up](https://en.wikipedia.org/wiki/Hypnopompic "Hypnopompic") or [falling asleep](https://en.wikipedia.org/wiki/Hypnagogic "Hypnagogic"), in which a person is conscious but in a complete state of [paralysis](https://en.wikipedia.org/wiki/Paralysis "Paralysis").[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) During an episode, the person may [hallucinate](https://en.wikipedia.org/wiki/Hallucination "Hallucination") (hear, feel, or see things that are not there), which often results in [fear](https://en.wikipedia.org/wiki/Fear "Fear").[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[3\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:11-3) Episodes generally last no more than a few minutes.[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) It can recur multiple times or occur as a single episode.[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[3\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:11-3)
This condition may occur in those who are otherwise healthy or those with [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy"), or it may run in families as a result of specific [genetic](https://en.wikipedia.org/wiki/Genetics "Genetics") changes. The condition can be triggered by [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), or abnormal [sleep cycles](https://en.wikipedia.org/wiki/Sleep_cycles "Sleep cycles"). The underlying mechanism is believed to involve a dysfunction in [REM sleep](https://en.wikipedia.org/wiki/REM_sleep "REM sleep").[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) Diagnosis is based on a person's description. Other conditions that can present similarly include narcolepsy, [atonic seizure](https://en.wikipedia.org/wiki/Atonic_seizure "Atonic seizure"), and [hypokalemic periodic paralysis](https://en.wikipedia.org/wiki/Hypokalemic_periodic_paralysis "Hypokalemic periodic paralysis").[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2)
Treatment options for sleep paralysis have been poorly studied. It is recommended that people be reassured that the condition is common and generally not serious. Other efforts that may be tried include [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy"), and [antidepressants](https://en.wikipedia.org/wiki/Antidepressants "Antidepressants").[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)
Between 8% to 50% of people experience sleep paralysis at some point during their lifetime.[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2)[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4) About 5% of people have regular episodes. Males and females are affected equally.[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) Sleep paralysis has been described throughout history. It is believed to have played a role in the creation of stories about [alien abduction](https://en.wikipedia.org/wiki/Alien_abduction "Alien abduction") and other [paranormal](https://en.wikipedia.org/wiki/Paranormal "Paranormal") events.[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)
## Symptoms and signs
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=1 "Edit section: Symptoms and signs")\]
The main symptom of sleep paralysis is being unable to move or speak during waking.[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)
Imagined sounds such as [humming](https://en.wikipedia.org/wiki/Humming "Humming"), [hissing](https://en.wikipedia.org/wiki/Noise_\(electronics\) "Noise (electronics)"), [static](https://en.wikipedia.org/wiki/White_noise "White noise"), [zapping](https://en.wikipedia.org/wiki/Electrostatic_discharge "Electrostatic discharge") and buzzing noises are reported during sleep paralysis.[\[5\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-5) Other sounds such as [voices](https://en.wikipedia.org/wiki/Voice "Voice"), [whispers](https://en.wikipedia.org/wiki/Whisper "Whisper"), [screaming](https://en.wikipedia.org/wiki/Screaming "Screaming"), [growling](https://en.wikipedia.org/wiki/Growling "Growling"), and [roars](https://en.wikipedia.org/wiki/Roaring "Roaring") are also experienced. It has also been known that one may feel pressure on their chest and intense pain in their head during an episode.[\[6\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-6) These symptoms are usually accompanied by intense [emotions](https://en.wikipedia.org/wiki/Emotion "Emotion") such as [fear](https://en.wikipedia.org/wiki/Fear "Fear") and [panic](https://en.wikipedia.org/wiki/Panic "Panic").[\[7\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Blackmore2002-7) People also have feelings of drowning or sinking, being dragged out of bed or of flying, [numbness](https://en.wikipedia.org/wiki/Numbness "Numbness"), and feelings of electric [tingles](https://en.wikipedia.org/wiki/Paresthesia "Paresthesia") or [vibrations](https://en.wikipedia.org/wiki/Vibration "Vibration") running through their body.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
Sleep paralysis may include hallucinations, such as an intruding presence or dark figure in the room. These are commonly known as *sleep paralysis demons* or [shadow people](https://en.wikipedia.org/wiki/Shadow_people "Shadow people"). It may also include the inability to breathe or the individual feeling a sense of terror, accompanied by a feeling of pressure on one's chest and [difficulty breathing](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath").[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)
## Pathophysiology
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=2 "Edit section: Pathophysiology")\]
The pathophysiology of sleep paralysis has not been concretely identified, although there are several theories about its cause.[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10) The first of these stems from the understanding that sleep paralysis is a [parasomnia](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") resulting from dysfunctional overlap of the REM and waking stages of sleep.[\[11\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Goldstein-11) [Polysomnographic](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") studies have found that individuals who experience sleep paralysis have shorter REM sleep latencies than normal along with shortened NREM and REM sleep cycles, and fragmentation of REM sleep. This study supports the observation that disturbance of regular sleeping patterns can precipitate an episode of sleep paralysis, because fragmentation of REM sleep commonly occurs when sleep patterns are disrupted and has now been seen in combination with sleep paralysis.[\[12\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Walther-12)
Another major theory is that the neural functions that regulate sleep are out of balance, causing different sleep states to overlap. In this case, cholinergic sleep "on" [neural populations](https://en.wikipedia.org/wiki/Neural_population "Neural population") are hyperactivated and the serotonergic sleep "off" neural populations are under-activated. As a result, the cells capable of sending the signals, that would allow for complete arousal from the sleep state, the serotonergic neural populations, have difficulty in overcoming the signals sent by the cells that keep the brain in the sleep state. During normal REM sleep, the threshold for a stimulus to cause arousal is greatly elevated. Under normal conditions, medial and [vestibular nuclei](https://en.wikipedia.org/wiki/Vestibular_nuclei "Vestibular nuclei"), [cortical](https://en.wikipedia.org/wiki/Cortex_\(anatomy\) "Cortex (anatomy)"), [thalamic](https://en.wikipedia.org/wiki/Thalamic "Thalamic"), and [cerebellar](https://en.wikipedia.org/wiki/Cerebellar "Cerebellar") centers coordinate things such as head and eye movement, and orientation in space.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
In individuals reporting sleep paralysis, there is almost no blocking of exogenous stimuli, which means it is much easier for a stimulus to arouse the individual. The vestibular nuclei in particular has been identified as being closely related to dreaming during the REM stage of sleep.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) According to this hypothesis, vestibular-motor disorientation, unlike hallucinations, arise from completely endogenous sources of stimuli.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
If the effects of sleep "on" neural populations cannot be counteracted, characteristics of REM sleep are retained upon awakening. Common consequences of sleep paralysis include headaches, muscle pains or weakness or paranoia. As the correlation with REM sleep suggests, the paralysis is not complete: use of [EOG](https://en.wikipedia.org/wiki/EOG "EOG") traces shows that eye movement is still possible during such episodes; however, the individual experiencing sleep paralysis is unable to speak.[\[14\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-14)
Research has found a genetic component in sleep paralysis.[\[15\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-15) The characteristic fragmentation of REM sleep, [hypnopompic](https://en.wikipedia.org/wiki/Hypnopompic "Hypnopompic"), and [hypnagogic](https://en.wikipedia.org/wiki/Hypnagogia "Hypnagogia") hallucinations have a heritable component in other parasomnias, which lends credence to the idea that sleep paralysis is also genetic. Twin studies have shown that if one twin of a monozygotic pair ([identical twins](https://en.wikipedia.org/wiki/Twin#Monozygotic_\(identical\)_twins "Twin")) experiences sleep paralysis that the other twin is very likely to experience it as well.[\[16\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sehgal-16) The identification of a genetic component means that there is some sort of disruption of a function at the physiological level. Further studies must be conducted to determine whether there is a mistake in the signaling pathway for arousal as suggested by the first theory presented, or whether the regulation of melatonin or the neural populations themselves have been disrupted.
### Hallucinations
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=3 "Edit section: Hallucinations")\]
[](https://en.wikipedia.org/wiki/File:Fritz_Schwimbeck_-_My_Dream,_My_Bad_Dream._1915.jpg)
A picture of a [succubus](https://en.wikipedia.org/wiki/Succubus "Succubus")\-like vision. *My Dream, My Bad Dream*, 1915, by Fritz Schwimbeck
Several types of hallucinations have been linked to sleep paralysis: the belief that there is an intruder in the room, the feeling of a presence, and the sensation of floating. One common hallucination is the presence of an [incubus](https://en.wikipedia.org/wiki/Incubus "Incubus"). A neurological hypothesis is that in sleep paralysis the [cerebellum](https://en.wikipedia.org/wiki/Cerebellum "Cerebellum"), which usually coordinates body movement and provides information on body position, experiences a brief myoclonic spike in brain activity inducing a [floating](https://en.wikipedia.org/wiki/Floating_\(psychological_phenomenon\) "Floating (psychological phenomenon)") sensation.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
The [intruder](https://en.wikipedia.org/wiki/Trespasser "Trespasser") and incubus hallucinations highly correlate with one another, and moderately correlated with the third hallucination, vestibular-motor disorientation, also known as [out-of-body experiences](https://en.wikipedia.org/wiki/Out-of-body_experience "Out-of-body experience"),[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13) which differ from the other two in not involving the threat-activated vigilance system.[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)
### Threat hyper-vigilance
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=4 "Edit section: Threat hyper-vigilance")\]
A [hyper-vigilant](https://en.wikipedia.org/wiki/Hypervigilance "Hypervigilance") state created in the [midbrain](https://en.wikipedia.org/wiki/Midbrain "Midbrain") may further contribute to hallucinations.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) More specifically, the emergency response is activated in the brain when individuals wake up paralyzed and feel vulnerable to attack. This helplessness can intensify the effects of the threat response well above the level typical of normal dreams, which could explain why such visions during sleep paralysis are so vivid. The threat-activated vigilance system is a protective mechanism that differentiates between dangerous situations and determines whether the fear response is appropriate.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
The hyper-vigilance response can lead to the creation of endogenous stimuli that contribute to the perceived threat.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) A similar process may explain hallucinations, with slight variations, in which an evil presence is perceived by the subject to be attempting to suffocate them, either by pressing heavily on the chest or by strangulation. A neurological explanation holds that this results from a combination of the threat vigilance activation system and the muscle paralysis associated with sleep paralysis that removes voluntary control of breathing. Several features of REM breathing patterns exacerbate the feeling of suffocation.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13) These include shallow rapid breathing, [hypercapnia](https://en.wikipedia.org/wiki/Hypercapnia "Hypercapnia"), and slight blockage of the airway, which is a symptom prevalent in [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea") patients.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
According to this account, the subjects attempt to breathe deeply and find themselves unable to do so, creating a sensation of resistance, which the threat-activated vigilance system interprets as an unearthly being sitting on their chest, threatening suffocation.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) The sensation of entrapment causes a feedback loop when the fear of suffocation increases as a result of continued helplessness, causing the subjects to struggle to end the SP episode.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
## Diagnosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=5 "Edit section: Diagnosis")\]
Sleep paralysis is mainly diagnosed via clinical interview and ruling out other potential [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") that could account for the feelings of paralysis.[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10)[\[11\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Goldstein-11) Several measures are available to reliably diagnose[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) or screen (*Munich Parasomnia Screening*)[\[19\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-19) for recurrent isolated sleep paralysis.
### Diagnosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=6 "Edit section: Diagnosis")\]
Episodes of sleep paralysis can occur in the context of several medical conditions (e.g., narcolepsy, [hypokalemia](https://en.wikipedia.org/wiki/Hypokalemia "Hypokalemia")). When episodes occur independent of these conditions or substance use, it is termed "isolated sleep paralysis" (ISP).[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) When ISP episodes are more frequent and cause clinically significant distress or interference, it is classified as "recurrent isolated sleep paralysis" (RISP). Episodes of sleep paralysis, regardless of classification, are generally short (1–6 minutes), but longer episodes also have been documented.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
It can be difficult to differentiate between [cataplexy](https://en.wikipedia.org/wiki/Cataplexy "Cataplexy") brought on by narcolepsy and true sleep paralysis, because the two phenomena are physically indistinguishable. The best way to differentiate between the two is to note when the attacks occur most often. Narcolepsy attacks are more common when the individual is falling asleep; ISP and RISP attacks are more common upon awakening.[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)
### Differential diagnoses
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=7 "Edit section: Differential diagnoses")\]
Similar conditions include:[\[20\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2015-20)
- [Exploding head syndrome](https://en.wikipedia.org/wiki/Exploding_head_syndrome "Exploding head syndrome") (EHS) potentially frightening parasomnia, the hallucinations are usually briefer and always loud or jarring. There is no paralysis during EHS.
- [Nightmare disorder](https://en.wikipedia.org/wiki/Nightmare_disorder "Nightmare disorder") (ND); also REM-based parasomnia.
- [Sleep terrors](https://en.wikipedia.org/wiki/Sleep_terrors "Sleep terrors") (STs) are potentially frightening parasomnia, but are not REM based and there is a lack of awareness to surroundings, characteristic screams during STs.
- [Noctural panic attacks](https://en.wikipedia.org/wiki/Noctural_panic_attacks "Noctural panic attacks") (NPAs) involve fear and acute distress but lack paralysis and dream imagery.
- [Post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD) often includes scary imagery and anxiety but not limited to sleep-wake transitions.
## Prevention
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=8 "Edit section: Prevention")\]
Several circumstances have been identified that are associated with an increased risk of sleep paralysis. These include [insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia"), [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), an erratic sleep schedule, [stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)"), and physical fatigue. It is also believed that there may be a genetic component in the development of RISP, because there is a high concurrent incidence of sleep paralysis in [monozygotic twins](https://en.wikipedia.org/wiki/Monozygotic_twins "Monozygotic twins").[\[16\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sehgal-16) Sleeping in the [supine position](https://en.wikipedia.org/wiki/Supine_position "Supine position") (on one's back) has been found an especially prominent instigator of sleep paralysis.[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[21\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwotwo-21)
Sleeping in the supine position is believed to make the sleeper more vulnerable to episodes of sleep paralysis because in this sleeping position, it is possible for the soft palate to collapse and obstruct the airway. This is a possibility regardless of whether the individual has been diagnosed with sleep apnea or not. There may also be a greater rate of [microarousals](https://en.wikipedia.org/wiki/Microarousal "Microarousal") while sleeping in the supine position because there is a greater amount of pressure being exerted on the lungs due to gravity.[\[21\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwotwo-21)
While many factors can increase the risk for ISP or RISP, they can be avoided with minor lifestyle changes.[\[11\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Goldstein-11)
## Treatment
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=9 "Edit section: Treatment")\]
Medical treatment starts with education about sleep stages and the inability to move muscles during REM sleep. People should be evaluated for [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") if symptoms persist.[\[22\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-22) The safest treatment for sleep paralysis is for people to adopt healthier sleeping habits. However, in more serious cases [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") or [selective serotonin reuptake inhibitors](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitors "Selective serotonin reuptake inhibitors") (SSRIs) may be used. Most people tend to overcome sleep paralysis by being woken up through touch or movement.[\[23\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-23) Despite the fact that these treatments are prescribed, there is currently no drug that has been found to completely interrupt episodes of sleep paralysis the majority of the time.[\[24\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Med-24)
### Medications
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=10 "Edit section: Medications")\]
Though no large trials have taken place which focus on the treatment of sleep paralysis, several drugs have promise in case studies. Two trials of [GHB](https://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid "Gamma-Hydroxybutyric acid") for people with narcolepsy demonstrated reductions in sleep paralysis episodes.[\[25\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:4-25)
[Pimavanserin](https://en.wikipedia.org/wiki/Pimavanserin "Pimavanserin") has been proposed as a possible candidate for future studies in treating sleep paralysis.[\[26\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-newrev2018-26)
### Cognitive-behavior therapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=11 "Edit section: Cognitive-behavior therapy")\]
Some of the earliest work in treating sleep paralysis was done using a [cognitive-behavior therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") called CA-CBT. The work focuses on psycho-education and modifying catastrophic cognitions about the sleep paralysis attack.[\[27\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-27)[\[28\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-28) This approach has previously been used to treat sleep paralysis in Egypt, although clinical trials are lacking.[\[29\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-29)
The first published psychosocial treatment for recurrent isolated sleep paralysis was cognitive-behavior therapy - isolated sleep paralysis (CBT-ISP).[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) It begins with self-monitoring of symptoms, cognitive restructuring of maladaptive thoughts relevant to ISP (e.g., "the paralysis will be permanent"), and psychoeducation about the nature of sleep paralysis. Prevention techniques include ISP-specific sleep hygiene and the preparatory use of various relaxation techniques (e.g. diaphragmatic breathing, mindfulness, progressive muscle relaxation, meditation). Episode disruption techniques[\[30\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:5-30) are first practiced in session and then applied during actual attacks. No controlled trial of CBT-ISP has yet been conducted to prove its effectiveness.
## Epidemiology
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=12 "Edit section: Epidemiology")\]
Sleep paralysis is experienced equally in males and females.[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4)[\[31\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Dauvilliers-31) Lifetime prevalence rates derived from 35 aggregated studies indicate that approximately 8% of the general population, 28% of students, and 32% of psychiatric patients experience at least one episode of sleep paralysis at some point in their lives.[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4) Rates of recurrent sleep paralysis are not as well known, but 15–45% of those with a lifetime history of sleep paralysis may meet diagnostic criteria for Recurrent Isolated Sleep Paralysis.[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10) In surveys from Canada, China, England, Japan and Nigeria, 20% to 60% of individuals reported having experienced sleep paralysis at least once in their lifetime.[\[7\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Blackmore2002-7) In general, non-white people appear to experience sleep paralysis at higher rates than white people, but the magnitude of the difference is rather small.[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4) Approximately 36% of the general population that experiences isolated sleep paralysis, develop it between 25 and 44 years of age.[\[32\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Ohayon-32)
Isolated sleep paralysis is commonly seen in patients that have been diagnosed with narcolepsy. Approximately 30–50% of people that have been diagnosed with narcolepsy, have experienced sleep paralysis as an auxiliary symptom. A majority of the individuals who have experienced sleep paralysis, have sporadic episodes that occur once a month to once a year. Only 3% of individuals who experience sleep paralysis that is not associated with a [neuromuscular disorder](https://en.wikipedia.org/wiki/Neuromuscular_disorder "Neuromuscular disorder") have nightly episodes.[\[32\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Ohayon-32)
## Society and culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=13 "Edit section: Society and culture")\]
### Etymology
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=14 "Edit section: Etymology")\]
[](https://en.wikipedia.org/wiki/File:Der_Albtraum_\(Anonym_19_Jh\).jpg)
A 19th century version of *[Füssli's](https://en.wikipedia.org/wiki/Henry_Fuseli "Henry Fuseli") The Nightmare* (1781)
The original definition of sleep paralysis was codified by [Samuel Johnson](https://en.wikipedia.org/wiki/Samuel_Johnson "Samuel Johnson") in his *[A Dictionary of the English Language](https://en.wikipedia.org/wiki/A_Dictionary_of_the_English_Language "A Dictionary of the English Language")* as *[nightmare](https://en.wikipedia.org/wiki/Nightmare "Nightmare")*, a term that evolved into the modern definition. The term was first used and dubbed by British neurologist, [S.A.K. Wilson](https://en.wikipedia.org/wiki/Samuel_Alexander_Kinnier_Wilson "Samuel Alexander Kinnier Wilson") in his 1928 dissertation, *The Narcolepsies.*[\[33\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-33) Such sleep paralysis was widely considered the work of [demons](https://en.wikipedia.org/wiki/Demon "Demon"), and more specifically [incubi](https://en.wikipedia.org/wiki/Incubus "Incubus"), which were thought to sit on the chests of sleepers. In [Old English](https://en.wikipedia.org/wiki/Old_English_language "Old English language"), the name for these beings was *mare* or *mære* (from a [proto-Germanic](https://en.wikipedia.org/wiki/Proto-Germanic_language "Proto-Germanic language") *\*marōn*, cf. [Old Norse](https://en.wikipedia.org/wiki/Old_Norse_language "Old Norse language") *[mara](https://en.wikipedia.org/wiki/Mara_\(folklore\) "Mara (folklore)")*), hence comes the *mare* in the word *nightmare*. The word might be [cognate](https://en.wikipedia.org/wiki/Cognate "Cognate") to [Greek](https://en.wikipedia.org/wiki/Ancient_Greek "Ancient Greek") *Marōn* (in the [Odyssey](https://en.wikipedia.org/wiki/Odyssey "Odyssey")) and [Sanskrit](https://en.wikipedia.org/wiki/Sanskrit "Sanskrit") *[Māra](https://en.wikipedia.org/wiki/Mara_\(demon\) "Mara (demon)")*.
### Cultural significance and priming
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=15 "Edit section: Cultural significance and priming")\]
[](https://en.wikipedia.org/wiki/File:Augustins_-_Cauchemar_-_Eug%C3%A8ne_Thivier_-_RI_1156.jpg)
*Le Cauchemar* (*The Nightmare*), by Eugène Thivier (1894)
Although the core features of sleep paralysis (e.g., atonia, a clear sensorium, and frequent hallucinations) appear to be universal, the ways in which they are experienced vary according to time, place, and culture.[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[34\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:2-34) Over 100 terms have been identified for these experiences.[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) Some scientists have proposed sleep paralysis as an explanation for reports of paranormal and spiritual phenomena such as [ghosts](https://en.wikipedia.org/wiki/Ghost "Ghost"),[\[35\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:8-35)[\[36\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:3-36) alien visits,[\[37\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-37) [demons](https://en.wikipedia.org/wiki/Demons "Demons") or [demonic possession](https://en.wikipedia.org/wiki/Demonic_possession "Demonic possession"),[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) [alien abduction](https://en.wikipedia.org/wiki/Alien_abduction "Alien abduction") experiences,[\[39\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-pmid15881271-39)[\[40\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cordon2005-8-40) the [night hag](https://en.wikipedia.org/wiki/Night_hag "Night hag") and [shadow people](https://en.wikipedia.org/wiki/Shadow_people "Shadow people") haunting.[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10)[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
According to some scientists, culture may be a major factor in shaping sleep paralysis.[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) When sleep paralysis is interpreted through a particular cultural filter, it may take on greater salience. For example, if sleep paralysis is feared in a certain culture, this fear could lead to conditioned fear, and thus worsen the experience, in turn leading to higher rates.[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) Consistent with this idea, high rates and long durations of immobility during sleep paralysis have been found in Egypt, where there are elaborate beliefs about sleep paralysis, involving [malevolent spirit](https://en.wikipedia.org/wiki/Malevolent_spirit "Malevolent spirit")\-like creatures, the *[jinn](https://en.wikipedia.org/wiki/Jinn "Jinn").*[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38)
Research has found that sleep paralysis is associated with great fear and fear of impending death in 50% of sufferers in Egypt. A study comparing rates and characteristics of sleep paralysis in Egypt and Denmark found that the phenomenon is three times more common in Egypt than Denmark.[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) In Denmark, unlike Egypt, there are no elaborate supernatural beliefs about sleep paralysis, and the experience is often interpreted as an odd physiological event, with overall shorter sleep paralysis episodes and fewer people (17%) fearing that they could die from it.[\[34\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:2-34)
### Folklore
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=16 "Edit section: Folklore")\]
Main article: [Night hag](https://en.wikipedia.org/wiki/Night_hag "Night hag")
The [night hag](https://en.wikipedia.org/wiki/Night_hag "Night hag") is a generic name for a folkloric creature found in cultures around the world, and which is used to explain the phenomenon of sleep paralysis. A common description is that a person feels the presence of a supernatural malevolent being which immobilizes the person as if standing on the chest.[\[41\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-41) This phenomenon goes by many names.
#### Albania
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=17 "Edit section: Albania")\]
In [Albanian folk beliefs](https://en.wikipedia.org/wiki/Albanian_folk_beliefs "Albanian folk beliefs"), *Mokthi* is believed to be a male spirit with a golden [fez](https://en.wikipedia.org/wiki/Fez_\(hat\) "Fez (hat)") hat who appears to women who are usually tired or suffering and stops them from moving. It is believed that if they can take his golden hat, he will grant them a wish, but then he will visit them frequently although he is harmless. There are talismans that can provide protection from Mokthi and one way is to put one's husband's hat near the pillow while sleeping. *Mokthi* or *Makthi* in [Albanian](https://en.wikipedia.org/wiki/Albanian_language "Albanian language") means "Nightmare".[\[42\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-42)
#### Arab
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=18 "Edit section: Arab")\]
The names of sleep paralysis vary in some Arab countries; it is popularly known as "Al-Jathoom," in Morocco it is called "Boughtat," and in other regions it is known as "Raboos." This entity, believed to be a jinn, perches on the sleeper's chest.[\[34\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:2-34)[\[43\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-43)
#### Bengal
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=19 "Edit section: Bengal")\]
In [Bengali folklore](https://en.wikipedia.org/wiki/Bangladeshi_folk_literature "Bangladeshi folk literature"), sleep paralysis is believed to be caused by a supernatural entity called *[Boba](https://en.wikipedia.org/wiki/Ghosts_in_Bengali_culture "Ghosts in Bengali culture")* ([Bengali](https://en.wikipedia.org/wiki/Bengali_language "Bengali language"): বোবা, [lit.](https://en.wikipedia.org/wiki/Literal_translation "Literal translation")'dumb'). *Boba* attacks a person by strangling him when the person sleeps in a [supine position](https://en.wikipedia.org/wiki/Supine_position "Supine position"). In [Bengal](https://en.wikipedia.org/wiki/Bengal "Bengal"), the phenomenon is called *Bobay Dhora* ([Bengali](https://en.wikipedia.org/wiki/Bengali_language "Bengali language"): বোবায় ধরা, [lit.](https://en.wikipedia.org/wiki/Literal_translation "Literal translation")'Struck by *Boba*').[\[44\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-44)
#### Cambodia
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=20 "Edit section: Cambodia")\]
Sleep paralysis among [Cambodians](https://en.wikipedia.org/wiki/Cambodia "Cambodia") is known as "the ghost pushes you down," and entails the belief in dangerous visitations from deceased relatives.[\[36\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:3-36)
#### Japan
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=21 "Edit section: Japan")\]
Sleep paralysis among the [Japanese](https://en.wikipedia.org/wiki/Japan "Japan") is known as *kanashibari* (金縛り), lit. "metal binding" and entails the belief of dangerous visitations from childlike [Yōkai](https://en.wikipedia.org/wiki/Y%C5%8Dkai "Yōkai"), called a *[makuragaeshi](https://en.wikipedia.org/wiki/Makuragaeshi "Makuragaeshi")* (枕返し or 反枕, lit. "pillow flip"), sitting on the victim's chest.
#### Italy
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=22 "Edit section: Italy")\]
In the different regions of [Italy](https://en.wikipedia.org/wiki/Italy "Italy"), there are many examples of supernatural beings associated with sleep paralysis. In the regions of [Marche](https://en.wikipedia.org/wiki/Marche "Marche") and [Abruzzo](https://en.wikipedia.org/wiki/Abruzzo "Abruzzo"), it is referred to as a *[Pandafeche](https://en.wikipedia.org/w/index.php?title=Pandafeche&action=edit&redlink=1 "Pandafeche (page does not exist)") \[[it](https://it.wikipedia.org/wiki/Pandafeche "it:Pandafeche")\]* or *[pantafica](https://en.wikipedia.org/w/index.php?title=Pantafica&action=edit&redlink=1 "Pantafica (page does not exist)") \[[it](https://it.wikipedia.org/wiki/pantafica "it:pantafica")\]* attack;[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9) the *Pandafeche* usually refers to an evil [witch](https://en.wikipedia.org/wiki/Witchcraft "Witchcraft"), sometimes a ghostlike spirit or a terrifying catlike creature, that mounts on the chest of the victim and tries to harm him. The only way to avoid her is to keep a bag of sand or beans close to the bed, so that the witch will stop to count how many beans or sand-grains are inside it. A similar tradition is present in the [Sardinian](https://en.wikipedia.org/wiki/Sardinia "Sardinia") folklore, where the *Ammuntadore* is known as a creature that mounts on the people's chest during their sleep to give them nightmares, and it can change its shape according to the person's fears. In Northern Italy, specifically in the [Tyrol](https://en.wikipedia.org/wiki/Tyrol "Tyrol") area, the *Trud* is a witch that sits on the people's chest at night, making them unable to breathe; to chase her away, people should make the [sign of the Cross](https://en.wikipedia.org/wiki/Sign_of_the_cross "Sign of the cross"), something that would need a great struggle in a situation of paralysis.[\[45\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-45) A similar folklore is present in the [Sannio](https://en.wikipedia.org/wiki/Samnium "Samnium") area, around the city of [Benevento](https://en.wikipedia.org/wiki/Benevento "Benevento"), where the witch is called *[Janara](https://en.wikipedia.org/wiki/Witches_of_Benevento "Witches of Benevento")*.[\[46\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:10-46) In Southern Italy, sleep paralysis is usually explained with the presence of a [sprite](https://en.wikipedia.org/wiki/Sprite_\(folklore\) "Sprite (folklore)") standing on the people's chest; if the person manages to catch the sprite (or steal his hat), in exchange for his freedom (or to have his hat back) he can reveal the hiding place of a rich treasure; this sprite has different names in different regions of Italy: Monaciello in [Campania](https://en.wikipedia.org/wiki/Campania "Campania"), Monachicchio in [Basilicata](https://en.wikipedia.org/wiki/Basilicata "Basilicata"), Laurieddhu or Scazzamurill in [Apulia](https://en.wikipedia.org/wiki/Apulia "Apulia"), Mazzmuredd in [Molise](https://en.wikipedia.org/wiki/Molise "Molise").[\[46\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:10-46)
#### Newfoundland
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=23 "Edit section: Newfoundland")\]
In [Newfoundland](https://en.wikipedia.org/wiki/Newfoundland_and_Labrador "Newfoundland and Labrador"), which is in eastern Canada, sleep paralysis is referred to as the Old Hag,[\[35\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:8-35)[\[47\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-47) and victims of a *hagging* are said to be *hag-ridden* upon awakening.[\[48\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-48) Victims report being completely conscious, but unable to speak or move, and report a person or an animal which sits upon their chest.[\[49\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:9-49) Despite the name, the attacker can be either male or female.[\[50\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-50) Some suggested cures or preventions for the Old Hag include sleeping with a Bible under the pillow,[\[49\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:9-49) calling the sleeper's name backwards[\[51\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-51) or in an extreme example, sleeping with a shingle or board embedded with nails strapped to the chest.[\[52\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-52) This object was called a Hag Board.[\[53\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-53) The Old Hag is well-enough known in the province to be a pop culture figure, appearing in films and plays[\[54\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-54) as well as in crafted objects.[\[55\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-55)
#### Nigeria
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=24 "Edit section: Nigeria")\]
[Nigeria](https://en.wikipedia.org/wiki/Nigeria "Nigeria")[\[56\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-56) has myriad interpretations of the cause of sleep paralysis, due to numerous cultures and belief systems that exist there.
#### United States
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=25 "Edit section: United States")\]
Sleep paralysis is sometimes interpreted as space alien abduction in the [United States](https://en.wikipedia.org/wiki/United_States "United States").[\[57\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-57)
### Literature
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=26 "Edit section: Literature")\]
Various forms of [magic](https://en.wikipedia.org/wiki/Magic_\(paranormal\) "Magic (paranormal)") and [spiritual possession](https://en.wikipedia.org/wiki/Spiritual_possession "Spiritual possession") were also advanced as causes, in literature. In nineteenth-century [Europe](https://en.wikipedia.org/wiki/Europe "Europe"), the vagaries of diet were thought to be responsible. For example, in [Charles Dickens](https://en.wikipedia.org/wiki/Charles_Dickens "Charles Dickens")'s *[A Christmas Carol](https://en.wikipedia.org/wiki/A_Christmas_Carol "A Christmas Carol")*, [Ebenezer Scrooge](https://en.wikipedia.org/wiki/Ebenezer_Scrooge "Ebenezer Scrooge") attributes the [ghost](https://en.wikipedia.org/wiki/Ghost "Ghost") he sees to "... an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato..." In a similar vein, the *[Household Cyclopedia](https://en.wikipedia.org/wiki/Household_Cyclopedia "Household Cyclopedia")* (1881) offers the following advice about nightmares:
> Great attention is to be paid to regularity and choice of diet. Intemperance of every kind is hurtful, but nothing is more productive of this disease than drinking bad wine. Of eatables those which are most prejudicial are all fat and greasy meats and pastry. Moderate exercise contributes in a superior degree to promote the digestion of food and prevent flatulence; those, however, who are necessarily confined to a sedentary occupation, should particularly avoid applying themselves to study or bodily labor immediately after eating. Going to bed before the usual hour is a frequent cause of night-mare, as it either occasions the patient to sleep too long or to lie long awake in the night. Passing a whole night or part of a night without rest likewise gives birth to the disease, as it occasions the patient, on the succeeding night, to sleep too soundly. Indulging in sleep too late in the morning, is an almost certain method to bring on the paroxysm, and the more frequently it returns, the greater strength it acquires; the propensity to sleep at this time is almost irresistible.[\[58\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-58)
[J. M. Barrie](https://en.wikipedia.org/wiki/J._M._Barrie "J. M. Barrie"), the author of the [Peter Pan](https://en.wikipedia.org/wiki/Peter_Pan_\(character\) "Peter Pan (character)") stories, may have had sleep paralysis. He said of himself "In my early boyhood it was a sheet that tried to choke me in the night."[\[59\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-59) He also described several incidents in the Peter Pan stories that indicate that he was familiar with an awareness of a loss of muscle tone whilst in a dream-like state. For example, Maimie is asleep but calls out "What was that....It is coming nearer! It is feeling your bed with its horns-it is boring for \[into\] you",[\[60\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-60) and when the Darling children were dreaming of flying, Barrie says "Nothing horrid was visible in the air, yet their progress had become slow and laboured, exactly as if they were pushing their way through hostile forces. Sometimes they hung in the air until Peter had beaten on it with his fists."[\[61\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-61) Barrie describes many [parasomnias](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") and neurological symptoms in his books and uses them to explore the nature of consciousness from an experiential point of view.[\[62\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-62)
[Herman Melville](https://en.wikipedia.org/wiki/Herman_Melville "Herman Melville") described an episode resembling sleep paralysis in his novel *[Moby-Dick](https://en.wikipedia.org/wiki/Moby-Dick "Moby-Dick")* (1851). In Chapter 4 ("The Counterpane"), Ishmael recalls a childhood incident in which "a supernatural hand seemed placed in mine," leaving him aware but unable to move. The passage has been analyzed as one of the earliest fictional depictions consistent with modern clinical descriptions of the condition.[\[63\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-63)
### Documentary films
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=27 "Edit section: Documentary films")\]
[*The Nightmare*](https://en.wikipedia.org/wiki/The_Nightmare_\(2015_American_film\) "The Nightmare (2015 American film)") is a 2015 documentary that discusses the causes of sleep paralysis as seen through extensive interviews with participants, and the experiences are re-enacted by professional actors. In synopsis, it proposes that such cultural phenomena as [alien abduction](https://en.wikipedia.org/wiki/Alien_abduction "Alien abduction"), the [near-death experience](https://en.wikipedia.org/wiki/Near-death_experience "Near-death experience") and [shadow people](https://en.wikipedia.org/wiki/Shadow_person "Shadow person") can, in many cases, be attributed to sleep paralysis. The "real-life" horror film debuted at the [Sundance Film Festival](https://en.wikipedia.org/wiki/2015_Sundance_Film_Festival "2015 Sundance Film Festival") on January 26, 2015, and premiered in theatres on June 5, 2015.[\[64\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-64)
## See also
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=28 "Edit section: See also")\]
- [Catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia") – Psychiatric behavioural syndrome
## References
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=29 "Edit section: References")\]
1. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-6) [***h***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-7) [***i***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-8) [***j***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-9)
Sharpless BA (2016). ["A clinician's guide to recurrent isolated sleep paralysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958367). *Neuropsychiatric Disease and Treatment*. **12**: 1761–67\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2147/NDT.S100307](https://doi.org/10.2147%2FNDT.S100307). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4958367](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958367). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27486325](https://pubmed.ncbi.nlm.nih.gov/27486325).
2. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-6) [***h***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-7) [***i***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-8) [***j***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-9) [***k***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-10) [***l***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-11)
Avidan AY, Zee PC (2011). [*Handbook of Sleep Medicine*](https://books.google.com/books?id=D66s7fxc-0cC&pg=PT113) (2nd ed.). Lippincott Williams & Wilkins. p. Chapter 5. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4511-5385-9](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4511-5385-9 "Special:BookSources/978-1-4511-5385-9")
.
3. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:11_3-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:11_3-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:11_3-2)
["Sleep paralysis"](https://www.nhs.uk/conditions/sleep-paralysis/). *nhs.uk*. 2017-10-23. Retrieved 2023-02-06.
4. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-3)
Sharpless BA, Barber JP (October 2011). ["Lifetime prevalence rates of sleep paralysis: A systematic review"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156892). *Sleep Medicine Reviews*. **15** (5): 311–315\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.smrv.2011.01.007](https://doi.org/10.1016%2Fj.smrv.2011.01.007). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3156892](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156892). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21571556](https://pubmed.ncbi.nlm.nih.gov/21571556).
5. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-5)** Thorpy, M.J. (ed.). (1990). *'Sleep paralysis'. l Classification of Sleep Disorders: Diagnostic and Coding Manual*. Rochester, Minn.: American Sleep Disorders Association.
6. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-6)**
Spanos N.P., McNulty S.A., DuBreuil S.C., Pires M. (1995). "The frequency and correlates of sleep paralysis in a university sample". *Journal of Research in Personality*. **29** (3): 285–305\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1006/jrpe.1995.1017](https://doi.org/10.1006%2Fjrpe.1995.1017).
`{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list"))
7. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Blackmore2002_7-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Blackmore2002_7-1)
Blackmore Susan J., Parker Jennifer J. (2002). ["Comparing the Content of Sleep Paralysis and Dream Reports"](http://www.susanblackmore.co.uk/Articles/PDFs/Dreaming%202002.pdf) (PDF). *Dreaming*. **12** (1): 45–59\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1023/A:1013894522583](https://doi.org/10.1023%2FA%3A1013894522583). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [143952687](https://api.semanticscholar.org/CorpusID:143952687). [Archived](https://web.archive.org/web/20160429025711/http://www.susanblackmore.co.uk/Articles/PDFs/Dreaming%202002.pdf) (PDF) from the original on 2016-04-29.
8. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-6) [***h***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-7)
Cheyne J, Rueffer S, Newby-Clark I (1999). "Hypnagogic and Hypnopompic Hallucinations during Sleep Paralysis: Neurological and Cultural Construction of the Night-Mare". *Consciousness and Cognition*. **8** (3): 319–337\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1006/ccog.1999.0404](https://doi.org/10.1006%2Fccog.1999.0404). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10487786](https://pubmed.ncbi.nlm.nih.gov/10487786). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [23758148](https://api.semanticscholar.org/CorpusID:23758148).
9. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:1_9-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:1_9-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:1_9-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:1_9-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:1_9-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:1_9-5)
Jalal B, Romanelli A, Hinton DE (2015-12-01). "Cultural Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated Supernatural Beliefs". *Culture, Medicine and Psychiatry*. **39** (4): 651–664\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11013-015-9442-y](https://doi.org/10.1007%2Fs11013-015-9442-y). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1573-076X](https://search.worldcat.org/issn/1573-076X). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25802016](https://pubmed.ncbi.nlm.nih.gov/25802016). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [46090345](https://api.semanticscholar.org/CorpusID:46090345).
10. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-3)
A Sharpless, Brian (2016-11-15). *Unusual and rare psychological disorders: a handbook for clinical practice and research*. Oxford University Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-024586-3](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-024586-3 "Special:BookSources/978-0-19-024586-3")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [952152912](https://search.worldcat.org/oclc/952152912).
`{{cite book}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list"))
11. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Goldstein_11-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Goldstein_11-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Goldstein_11-2)
Goldstein K (2011). "Parasomnias". *Disease-a-Month*. **57** (7): 364–88\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.disamonth.2011.04.007](https://doi.org/10.1016%2Fj.disamonth.2011.04.007). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21807161](https://pubmed.ncbi.nlm.nih.gov/21807161).
12. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Walther_12-0)**
Walther B, Schulz H (2004). "Recurrent isolated sleep paralysis: Polysomnographic and clinical findings". *Somnologie – Schlafforschung und Schlafmedizin*. **8** (2): 53–60\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1439-054X.2004.00017.x](https://doi.org/10.1111%2Fj.1439-054X.2004.00017.x). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [143146512](https://api.semanticscholar.org/CorpusID:143146512).
13. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheynetwothree_13-6)
Cheyne J (2003). "Sleep Paralysis and the Structure of Waking-Nightmare Hallucinations". *[Dreaming](https://en.wikipedia.org/wiki/Dreaming_\(journal\) "Dreaming (journal)")*. **13** (3): 163–179\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1023/A:1025373412722](https://doi.org/10.1023%2FA%3A1025373412722). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [145006406](https://api.semanticscholar.org/CorpusID:145006406).
14. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-14)**
Hearne, K. (1990). *The Dream Machine: Lucid dreams and how to control them*, p. 18.
[ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[0-85030-906-9](https://en.wikipedia.org/wiki/Special:BookSources/0-85030-906-9 "Special:BookSources/0-85030-906-9")
.
15. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-15)** (Sehgal 2011)
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50. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-50)**
Hufford D (1995). "Beings Without Bodies: An Experience-Centered Theory of the Belief in Spirits". In Walker B (ed.). *Out of the Ordinary: Folklore and the Supernatural*. University Press of Colorado. pp. 11–45\.
51. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-51)**
Rieti B (1989). ["The Black Heart in Newfoundland: The Magic of the Book"](http://collections.mun.ca/cdm/ref/collection/cult_trad/id/3233). *Culture and Tradition Volume 13*. Retrieved 2020-06-25.
52. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-52)**
"Superstitions in Newfoundland". *The Journal of American Folklore*. **9** (34): 222–223\. 1896. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2307/533410](https://doi.org/10.2307%2F533410). [JSTOR](https://en.wikipedia.org/wiki/JSTOR_\(identifier\) "JSTOR (identifier)") [533410](https://www.jstor.org/stable/533410).
53. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-53)**
Guy R (2010). ["That Old Nonsense"](http://collections.mun.ca/cdm/compoundobject/collection/quarterly/id/40813/rec/65). *The Newfoundland Quarterly*. **103** (2): 12–13\.
54. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-54)**
["Gordon Pinsent explores depression with short film Martin's Hagge"](https://www.cbc.ca/news/canada/newfoundland-labrador/martins-hagge-gordon-pinsent-1.4582725). *CBC.ca*. 19 March 2018. Retrieved 27 June 2020.
55. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-55)**
Jarvis DG (October 2018). ["Exploring Folklore Through Craft with Janet Peter"](https://www.mun.ca/ich/resources/ICH_Case_Study_001__Janet_Peter_WEB2.pdf) (PDF). *Living Heritage Economy Case Study*. **001**.
56. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-56)**
Olunu E, Kimo R, Onigbinde EO, Akpanobong MA, Enang IE, Osanakpo M, Monday IT, Otohinoyi DA, Fakoya AO (2018). ["Sleep Paralysis, a Medical Condition with a Diverse Cultural Interpretation"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082011). *International Journal of Applied and Basic Medical Research*. **8** (3): 137–142\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.4103/ijabmr.IJABMR\_19\_18](https://doi.org/10.4103%2Fijabmr.IJABMR_19_18). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [2229-516X](https://search.worldcat.org/issn/2229-516X). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6082011](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30123741](https://pubmed.ncbi.nlm.nih.gov/30123741).
57. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-57)**
McNally RJ, Clancy SA (2005-03-01). "Sleep Paralysis, Sexual Abuse, and Space Alien Abduction". *Transcultural Psychiatry*. **42** (1): 113–122\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/1363461505050715](https://doi.org/10.1177%2F1363461505050715). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1363-4615](https://search.worldcat.org/issn/1363-4615). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [15881271](https://pubmed.ncbi.nlm.nih.gov/15881271). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [9569785](https://api.semanticscholar.org/CorpusID:9569785).
58. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-58)**
["The Household Cyclopedia – Medicine"](https://web.archive.org/web/20091202195226/http://www.mspong.org/cyclopedia/medicine.html#nightmare). *mspong.org*. Archived from [the original](http://www.mspong.org/cyclopedia/medicine.html#nightmare) on 2009-12-02.
59. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-59)**
Barrie J (1887). *My Ghastly Dream*. Edinburgh Evening Post.
60. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-60)**
Barrie J (1906). *Peter Pan in Kensington Gardens*. Hodder and Stoughton.
61. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-61)**
Barrie J (1911). *Peter and Wendy*. Hodder and Stoughton.
62. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-62)**
Ridley R (2016). *Peter Pan and the Mind of J. M. Barrie. An Exploration of Cognition and Consciousness*. Cambridge Scholars Publishing. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4438-9107-3](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4438-9107-3 "Special:BookSources/978-1-4438-9107-3")
.
63. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-63)**
Herman J (1997). "Literature and sleep: An instance of sleep paralysis in Moby Dick". *Sleep*. **20** (7): 577–579\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/sleep/20.7.577](https://doi.org/10.1093%2Fsleep%2F20.7.577). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [9322274](https://pubmed.ncbi.nlm.nih.gov/9322274).
64. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-64)**
["Watch: First Trailer for Creepy Sleep Paralysis Doc 'The Nightmare'"](https://www.firstshowing.net/2015/watch-first-trailer-for-creepy-sleep-paralysis-doc-the-nightmare/). *firstshowing.net*. May 2015. [Archived](https://web.archive.org/web/20150503024546/http://www.firstshowing.net/2015/watch-first-trailer-for-creepy-sleep-paralysis-doc-the-nightmare/) from the original on 2015-05-03.
## External links
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=30 "Edit section: External links")\]
- [Sleep information and links](http://www.stanford.edu/~dement/paralysis.html) [Archived](https://web.archive.org/web/20160306075040/http://stanford.edu/~dement/paralysis.html) 2016-03-06 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") from Stanford University
- [Sleep Paralysis and Associated Hypnagogic and Hypnopompic Experiences](https://web.archive.org/web/20030605094412/http://www.arts.uwaterloo.ca/~acheyne/S_P.html) from University of Waterloo
| | |
|---|---|
| Classification | [D](https://www.wikidata.org/wiki/Q486851 "d:Q486851") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11")**: [7B01.1](https://icd.who.int/browse/latest-release/mms/en#1822188276) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [G47.8](https://icd.who.int/browse10/2019/en#/G47.8), [G83.8](https://icd.who.int/browse10/2019/en#/G83.8) **[MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings")**: [D020188](https://meshb.nlm.nih.gov/record/ui?ui=D020188) **[DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database")**: [12182](http://www.diseasesdatabase.com/ddb12182.htm) **[SNOMED CT](https://en.wikipedia.org/wiki/SNOMED_CT "SNOMED CT")**: [277180005](https://browser.ihtsdotools.org/?perspective=full&conceptId1=277180005&languages=en) |
| [v](https://en.wikipedia.org/wiki/Template:Sleep "Template:Sleep") [t](https://en.wikipedia.org/wiki/Template_talk:Sleep "Template talk:Sleep") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Sleep "Special:EditPage/Template:Sleep")[Sleep](https://en.wikipedia.org/wiki/Sleep "Sleep") and [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") | |
|---|---|
| Stages of [sleep cycles](https://en.wikipedia.org/wiki/Sleep_cycle "Sleep cycle") | [Rapid eye movement (REM)](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep") [Quiescent sleep](https://en.wikipedia.org/wiki/Non-rapid_eye_movement_sleep "Non-rapid eye movement sleep") [Slow-wave](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep") |
| [Brain waves](https://en.wikipedia.org/wiki/Electroencephalography "Electroencephalography") | [Alpha wave](https://en.wikipedia.org/wiki/Alpha_wave "Alpha wave") [Beta wave](https://en.wikipedia.org/wiki/Beta_wave "Beta wave") [Delta wave](https://en.wikipedia.org/wiki/Delta_wave "Delta wave") [Gamma wave](https://en.wikipedia.org/wiki/Gamma_wave "Gamma wave") [K-complex](https://en.wikipedia.org/wiki/K-complex "K-complex") [Mu rhythm](https://en.wikipedia.org/wiki/Mu_wave "Mu wave") [PGO waves](https://en.wikipedia.org/wiki/PGO_waves "PGO waves") [Sensorimotor rhythm](https://en.wikipedia.org/wiki/Sensorimotor_rhythm "Sensorimotor rhythm") [Sleep spindle](https://en.wikipedia.org/wiki/Sleep_spindle "Sleep spindle") [Theta wave](https://en.wikipedia.org/wiki/Theta_wave "Theta wave") |
| [Sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") | |
| | |
| [Anatomical](https://en.wikipedia.org/wiki/Oral_and_maxillofacial_pathology "Oral and maxillofacial pathology") | [Mouth breathing](https://en.wikipedia.org/wiki/Mouth_breathing "Mouth breathing") [SRBD](https://en.wikipedia.org/wiki/Sleep-related_breathing_disorder "Sleep-related breathing disorder") [Sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea") [Catathrenia](https://en.wikipedia.org/wiki/Catathrenia "Catathrenia") [Central hypoventilation syndrome](https://en.wikipedia.org/wiki/Central_hypoventilation_syndrome "Central hypoventilation syndrome") [Obesity hypoventilation syndrome](https://en.wikipedia.org/wiki/Obesity_hypoventilation_syndrome "Obesity hypoventilation syndrome") [Obstructive sleep apnea](https://en.wikipedia.org/wiki/Obstructive_sleep_apnea "Obstructive sleep apnea") [Periodic breathing](https://en.wikipedia.org/wiki/Periodic_breathing "Periodic breathing") [Snoring](https://en.wikipedia.org/wiki/Snoring "Snoring") |
| [Dyssomnia](https://en.wikipedia.org/wiki/Dyssomnia "Dyssomnia") | [Excessive daytime sleepiness](https://en.wikipedia.org/wiki/Excessive_daytime_sleepiness "Excessive daytime sleepiness") [Hypersomnia](https://en.wikipedia.org/wiki/Hypersomnia "Hypersomnia") [Insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia") [Kleine–Levin syndrome](https://en.wikipedia.org/wiki/Kleine%E2%80%93Levin_syndrome "Kleine–Levin syndrome") [Narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") [Idiopathic hypersomnia](https://en.wikipedia.org/wiki/Idiopathic_hypersomnia "Idiopathic hypersomnia") [Night eating syndrome](https://en.wikipedia.org/wiki/Night_eating_syndrome "Night eating syndrome") [Nocturia](https://en.wikipedia.org/wiki/Nocturia "Nocturia") [Non-restorative sleep](https://en.wikipedia.org/wiki/Non-restorative_sleep "Non-restorative sleep") [Sleep state misperception](https://en.wikipedia.org/wiki/Sleep_state_misperception "Sleep state misperception") |
| [Circadian rhythm disorders](https://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder "Circadian rhythm sleep disorder") | [Advanced sleep phase disorder](https://en.wikipedia.org/wiki/Advanced_sleep_phase_disorder "Advanced sleep phase disorder") [Cyclic alternating pattern](https://en.wikipedia.org/wiki/Cyclic_alternating_pattern "Cyclic alternating pattern") [Delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder") [Irregular sleep–wake rhythm](https://en.wikipedia.org/wiki/Irregular_sleep%E2%80%93wake_rhythm "Irregular sleep–wake rhythm") [Jet lag](https://en.wikipedia.org/wiki/Jet_lag "Jet lag") [Non-24-hour sleep–wake disorder](https://en.wikipedia.org/wiki/Non-24-hour_sleep%E2%80%93wake_disorder "Non-24-hour sleep–wake disorder") [Shift work sleep disorder](https://en.wikipedia.org/wiki/Shift_work_sleep_disorder "Shift work sleep disorder") |
| [Parasomnia](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") | [Bruxism](https://en.wikipedia.org/wiki/Bruxism "Bruxism") [Nightmare disorder](https://en.wikipedia.org/wiki/Nightmare_disorder "Nightmare disorder") [Night terror](https://en.wikipedia.org/wiki/Night_terror "Night terror") [Periodic limb movement disorder](https://en.wikipedia.org/wiki/Periodic_limb_movement_disorder "Periodic limb movement disorder") [Rapid eye movement sleep behavior disorder](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder "Rapid eye movement sleep behavior disorder") [Sleepwalking](https://en.wikipedia.org/wiki/Sleepwalking "Sleepwalking") [Sleep driving](https://en.wikipedia.org/wiki/Sleep_driving "Sleep driving") [Sleep-talking](https://en.wikipedia.org/wiki/Sleep-talking "Sleep-talking") |
| Benign phenomena | [Dreams](https://en.wikipedia.org/wiki/Dream "Dream") [Lucid dreams](https://en.wikipedia.org/wiki/Lucid_dream "Lucid dream") [Exploding head syndrome](https://en.wikipedia.org/wiki/Exploding_head_syndrome "Exploding head syndrome") [Hypnic jerk](https://en.wikipedia.org/wiki/Hypnic_jerk "Hypnic jerk") [Hypnagogia](https://en.wikipedia.org/wiki/Hypnagogia "Hypnagogia") / [Sleep onset](https://en.wikipedia.org/wiki/Sleep_onset "Sleep onset") [Hypnopompia](https://en.wikipedia.org/wiki/Hypnopompia "Hypnopompia") [Sleep paralysis]() [Sleep inertia](https://en.wikipedia.org/wiki/Sleep_inertia "Sleep inertia") [Somnolence](https://en.wikipedia.org/wiki/Somnolence "Somnolence") [Nocturnal clitoral tumescence](https://en.wikipedia.org/wiki/Nocturnal_clitoral_tumescence "Nocturnal clitoral tumescence") [Nocturnal penile tumescence](https://en.wikipedia.org/wiki/Nocturnal_penile_tumescence "Nocturnal penile tumescence") [Nocturnal emission](https://en.wikipedia.org/wiki/Nocturnal_emission "Nocturnal emission") |
| [Treatment](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") | [Sleep diary](https://en.wikipedia.org/wiki/Sleep_diary "Sleep diary") [Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") [Sleep induction](https://en.wikipedia.org/wiki/Sleep_induction "Sleep induction") [Hypnosis](https://en.wikipedia.org/wiki/Hypnosis "Hypnosis") [Lullaby](https://en.wikipedia.org/wiki/Lullaby "Lullaby") [Somnology](https://en.wikipedia.org/wiki/Somnology "Somnology") [Polysomnography](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") [Sleep surgery](https://en.wikipedia.org/wiki/Sleep_surgery "Sleep surgery") |
| Other | [Sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") [Behavioral sleep medicine](https://en.wikipedia.org/wiki/Behavioral_sleep_medicine "Behavioral sleep medicine") [Sleep study](https://en.wikipedia.org/wiki/Sleep_study "Sleep study") [Melatonin](https://en.wikipedia.org/wiki/Melatonin "Melatonin") [Neuroscience of sleep](https://en.wikipedia.org/wiki/Neuroscience_of_sleep "Neuroscience of sleep") |
| Daily life | [Bed](https://en.wikipedia.org/wiki/Bed "Bed") [Bunk bed](https://en.wikipedia.org/wiki/Bunk_bed "Bunk bed") [Daybed](https://en.wikipedia.org/wiki/Daybed "Daybed") [Four-poster bed](https://en.wikipedia.org/wiki/Four-poster_bed "Four-poster bed") [Futon](https://en.wikipedia.org/wiki/Futon "Futon") [Hammock](https://en.wikipedia.org/wiki/Hammock "Hammock") [Mattress](https://en.wikipedia.org/wiki/Mattress "Mattress") [Sleeping bag](https://en.wikipedia.org/wiki/Sleeping_bag "Sleeping bag") [Bed bug](https://en.wikipedia.org/wiki/Bed_bug "Bed bug") [Bedding](https://en.wikipedia.org/wiki/Bedding "Bedding") [Bedroom](https://en.wikipedia.org/wiki/Bedroom "Bedroom") [Bedtime](https://en.wikipedia.org/wiki/Bedtime "Bedtime") [Procrastination](https://en.wikipedia.org/wiki/Bedtime_procrastination "Bedtime procrastination") [Story](https://en.wikipedia.org/wiki/Bedtime_story "Bedtime story") [Biphasic and polyphasic sleep](https://en.wikipedia.org/wiki/Biphasic_and_polyphasic_sleep "Biphasic and polyphasic sleep") [Chronotype](https://en.wikipedia.org/wiki/Chronotype "Chronotype") [Circadian rhythm](https://en.wikipedia.org/wiki/Circadian_rhythm "Circadian rhythm") [Comfort object](https://en.wikipedia.org/wiki/Comfort_object "Comfort object") [Dream diary](https://en.wikipedia.org/wiki/Dream_diary "Dream diary") [Microarousal](https://en.wikipedia.org/wiki/Microarousal "Microarousal") [Microsleep](https://en.wikipedia.org/wiki/Microsleep "Microsleep") [Nap](https://en.wikipedia.org/wiki/Nap "Nap") [Nightwear](https://en.wikipedia.org/wiki/Nightwear "Nightwear") [Power nap](https://en.wikipedia.org/wiki/Power_nap "Power nap") [Second wind](https://en.wikipedia.org/wiki/Second_wind_\(sleep\) "Second wind (sleep)") [Siesta](https://en.wikipedia.org/wiki/Siesta "Siesta") [Sleep and breathing](https://en.wikipedia.org/wiki/Sleep_and_breathing "Sleep and breathing") [Sleep and creativity](https://en.wikipedia.org/wiki/Sleep_and_creativity "Sleep and creativity") [Sleep and learning](https://en.wikipedia.org/wiki/Sleep_and_learning "Sleep and learning") [Sleep and memory](https://en.wikipedia.org/wiki/Sleep_and_memory "Sleep and memory") [Sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") / [Sleep debt](https://en.wikipedia.org/wiki/Sleep_debt "Sleep debt") [Sleeping while on duty](https://en.wikipedia.org/wiki/Sleeping_while_on_duty "Sleeping while on duty") [Sleepover](https://en.wikipedia.org/wiki/Sleepover "Sleepover") |
| [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [](https://www.wikidata.org/wiki/Q486851#identifiers "Edit this at Wikidata") | |
|---|---|
| International | [FAST](https://id.worldcat.org/fast/1120856) |
| National | [United States](https://id.loc.gov/authorities/sh85123409) [Czech Republic](https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph1197577&CON_LNG=ENG) [Israel](https://www.nli.org.il/en/authorities/987007548626005171) |
| Other | [IdRef](https://www.idref.fr/050847821) [Yale LUX](https://lux.collections.yale.edu/view/concept/715d3db0-efcf-4ae9-8696-5fbb005e5299) |
Retrieved from "<https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&oldid=1343987736>"
[Categories](https://en.wikipedia.org/wiki/Help:Category "Help:Category"):
- [Dream](https://en.wikipedia.org/wiki/Category:Dream "Category:Dream")
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- [Parasomnias](https://en.wikipedia.org/wiki/Category:Parasomnias "Category:Parasomnias")
- [Sleep disorders](https://en.wikipedia.org/wiki/Category:Sleep_disorders "Category:Sleep disorders")
- [Sleep in mythology and folklore](https://en.wikipedia.org/wiki/Category:Sleep_in_mythology_and_folklore "Category:Sleep in mythology and folklore")
- [Sleep physiology](https://en.wikipedia.org/wiki/Category:Sleep_physiology "Category:Sleep physiology")
- [Symptoms and signs of mental disorders](https://en.wikipedia.org/wiki/Category:Symptoms_and_signs_of_mental_disorders "Category:Symptoms and signs of mental disorders")
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Sleep paralysis
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| Readable Markdown | "Night demon" redirects here. For the American heavy metal band, see [Night Demon (band)](https://en.wikipedia.org/wiki/Night_Demon_\(band\) "Night Demon (band)").
| Sleep paralysis | |
|---|---|
| [](https://en.wikipedia.org/wiki/File:Henry_Fuseli_\(1741%E2%80%931825\),_The_Nightmare,_1781.jpg) | |
| *[The Nightmare](https://en.wikipedia.org/wiki/The_Nightmare "The Nightmare")* by Swiss artist [Henry Fuseli](https://en.wikipedia.org/wiki/Henry_Fuseli "Henry Fuseli") (1781) is thought to be a depiction of sleep paralysis perceived as a [demonic](https://en.wikipedia.org/wiki/Demon "Demon") visitation. | |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") [sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | Awareness but an inability to move during waking or falling asleep hallucinations[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Nyctophobia](https://en.wikipedia.org/wiki/Nyctophobia "Nyctophobia") |
| Duration | No more than a couple of minutes[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") | [Narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") [obstructive sleep apnea](https://en.wikipedia.org/wiki/Obstructive_sleep_apnea "Obstructive sleep apnea") alcohol use [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation")[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | Based on description[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") | [Narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") [atonic seizure](https://en.wikipedia.org/wiki/Atonic_seizure "Atonic seizure") [hypokalemic periodic paralysis](https://en.wikipedia.org/wiki/Hypokalemic_periodic_paralysis "Hypokalemic periodic paralysis") [night terror](https://en.wikipedia.org/wiki/Night_terror "Night terror")[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| Treatment | Reassurance [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") [antidepressants](https://en.wikipedia.org/wiki/Antidepressants "Antidepressants")[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1) |
| Frequency | 8–50%[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) |
| Deaths | None; physically harmless[\[3\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:11-3) |
**Sleep paralysis** is a state, [during waking up](https://en.wikipedia.org/wiki/Hypnopompic "Hypnopompic") or [falling asleep](https://en.wikipedia.org/wiki/Hypnagogic "Hypnagogic"), in which a person is conscious but in a complete state of [paralysis](https://en.wikipedia.org/wiki/Paralysis "Paralysis").[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) During an episode, the person may [hallucinate](https://en.wikipedia.org/wiki/Hallucination "Hallucination") (hear, feel, or see things that are not there), which often results in [fear](https://en.wikipedia.org/wiki/Fear "Fear").[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[3\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:11-3) Episodes generally last no more than a few minutes.[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) It can recur multiple times or occur as a single episode.[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)[\[3\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:11-3)
This condition may occur in those who are otherwise healthy or those with [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy"), or it may run in families as a result of specific [genetic](https://en.wikipedia.org/wiki/Genetics "Genetics") changes. The condition can be triggered by [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), or abnormal [sleep cycles](https://en.wikipedia.org/wiki/Sleep_cycles "Sleep cycles"). The underlying mechanism is believed to involve a dysfunction in [REM sleep](https://en.wikipedia.org/wiki/REM_sleep "REM sleep").[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) Diagnosis is based on a person's description. Other conditions that can present similarly include narcolepsy, [atonic seizure](https://en.wikipedia.org/wiki/Atonic_seizure "Atonic seizure"), and [hypokalemic periodic paralysis](https://en.wikipedia.org/wiki/Hypokalemic_periodic_paralysis "Hypokalemic periodic paralysis").[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2)
Treatment options for sleep paralysis have been poorly studied. It is recommended that people be reassured that the condition is common and generally not serious. Other efforts that may be tried include [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy"), and [antidepressants](https://en.wikipedia.org/wiki/Antidepressants "Antidepressants").[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)
Between 8% to 50% of people experience sleep paralysis at some point during their lifetime.[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2)[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4) About 5% of people have regular episodes. Males and females are affected equally.[\[2\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Av2011-2) Sleep paralysis has been described throughout history. It is believed to have played a role in the creation of stories about [alien abduction](https://en.wikipedia.org/wiki/Alien_abduction "Alien abduction") and other [paranormal](https://en.wikipedia.org/wiki/Paranormal "Paranormal") events.[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)
The main symptom of sleep paralysis is being unable to move or speak during waking.[\[1\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2016-1)
Imagined sounds such as [humming](https://en.wikipedia.org/wiki/Humming "Humming"), [hissing](https://en.wikipedia.org/wiki/Noise_\(electronics\) "Noise (electronics)"), [static](https://en.wikipedia.org/wiki/White_noise "White noise"), [zapping](https://en.wikipedia.org/wiki/Electrostatic_discharge "Electrostatic discharge") and buzzing noises are reported during sleep paralysis.[\[5\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-5) Other sounds such as [voices](https://en.wikipedia.org/wiki/Voice "Voice"), [whispers](https://en.wikipedia.org/wiki/Whisper "Whisper"), [screaming](https://en.wikipedia.org/wiki/Screaming "Screaming"), [growling](https://en.wikipedia.org/wiki/Growling "Growling"), and [roars](https://en.wikipedia.org/wiki/Roaring "Roaring") are also experienced. It has also been known that one may feel pressure on their chest and intense pain in their head during an episode.[\[6\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-6) These symptoms are usually accompanied by intense [emotions](https://en.wikipedia.org/wiki/Emotion "Emotion") such as [fear](https://en.wikipedia.org/wiki/Fear "Fear") and [panic](https://en.wikipedia.org/wiki/Panic "Panic").[\[7\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Blackmore2002-7) People also have feelings of drowning or sinking, being dragged out of bed or of flying, [numbness](https://en.wikipedia.org/wiki/Numbness "Numbness"), and feelings of electric [tingles](https://en.wikipedia.org/wiki/Paresthesia "Paresthesia") or [vibrations](https://en.wikipedia.org/wiki/Vibration "Vibration") running through their body.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
Sleep paralysis may include hallucinations, such as an intruding presence or dark figure in the room. These are commonly known as *sleep paralysis demons* or [shadow people](https://en.wikipedia.org/wiki/Shadow_people "Shadow people"). It may also include the inability to breathe or the individual feeling a sense of terror, accompanied by a feeling of pressure on one's chest and [difficulty breathing](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath").[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)
The pathophysiology of sleep paralysis has not been concretely identified, although there are several theories about its cause.[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10) The first of these stems from the understanding that sleep paralysis is a [parasomnia](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") resulting from dysfunctional overlap of the REM and waking stages of sleep.[\[11\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Goldstein-11) [Polysomnographic](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") studies have found that individuals who experience sleep paralysis have shorter REM sleep latencies than normal along with shortened NREM and REM sleep cycles, and fragmentation of REM sleep. This study supports the observation that disturbance of regular sleeping patterns can precipitate an episode of sleep paralysis, because fragmentation of REM sleep commonly occurs when sleep patterns are disrupted and has now been seen in combination with sleep paralysis.[\[12\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Walther-12)
Another major theory is that the neural functions that regulate sleep are out of balance, causing different sleep states to overlap. In this case, cholinergic sleep "on" [neural populations](https://en.wikipedia.org/wiki/Neural_population "Neural population") are hyperactivated and the serotonergic sleep "off" neural populations are under-activated. As a result, the cells capable of sending the signals, that would allow for complete arousal from the sleep state, the serotonergic neural populations, have difficulty in overcoming the signals sent by the cells that keep the brain in the sleep state. During normal REM sleep, the threshold for a stimulus to cause arousal is greatly elevated. Under normal conditions, medial and [vestibular nuclei](https://en.wikipedia.org/wiki/Vestibular_nuclei "Vestibular nuclei"), [cortical](https://en.wikipedia.org/wiki/Cortex_\(anatomy\) "Cortex (anatomy)"), [thalamic](https://en.wikipedia.org/wiki/Thalamic "Thalamic"), and [cerebellar](https://en.wikipedia.org/wiki/Cerebellar "Cerebellar") centers coordinate things such as head and eye movement, and orientation in space.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
In individuals reporting sleep paralysis, there is almost no blocking of exogenous stimuli, which means it is much easier for a stimulus to arouse the individual. The vestibular nuclei in particular has been identified as being closely related to dreaming during the REM stage of sleep.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) According to this hypothesis, vestibular-motor disorientation, unlike hallucinations, arise from completely endogenous sources of stimuli.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
If the effects of sleep "on" neural populations cannot be counteracted, characteristics of REM sleep are retained upon awakening. Common consequences of sleep paralysis include headaches, muscle pains or weakness or paranoia. As the correlation with REM sleep suggests, the paralysis is not complete: use of [EOG](https://en.wikipedia.org/wiki/EOG "EOG") traces shows that eye movement is still possible during such episodes; however, the individual experiencing sleep paralysis is unable to speak.[\[14\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-14)
Research has found a genetic component in sleep paralysis.[\[15\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-15) The characteristic fragmentation of REM sleep, [hypnopompic](https://en.wikipedia.org/wiki/Hypnopompic "Hypnopompic"), and [hypnagogic](https://en.wikipedia.org/wiki/Hypnagogia "Hypnagogia") hallucinations have a heritable component in other parasomnias, which lends credence to the idea that sleep paralysis is also genetic. Twin studies have shown that if one twin of a monozygotic pair ([identical twins](https://en.wikipedia.org/wiki/Twin#Monozygotic_\(identical\)_twins "Twin")) experiences sleep paralysis that the other twin is very likely to experience it as well.[\[16\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sehgal-16) The identification of a genetic component means that there is some sort of disruption of a function at the physiological level. Further studies must be conducted to determine whether there is a mistake in the signaling pathway for arousal as suggested by the first theory presented, or whether the regulation of melatonin or the neural populations themselves have been disrupted.
[](https://en.wikipedia.org/wiki/File:Fritz_Schwimbeck_-_My_Dream,_My_Bad_Dream._1915.jpg)
A picture of a [succubus](https://en.wikipedia.org/wiki/Succubus "Succubus")\-like vision. *My Dream, My Bad Dream*, 1915, by Fritz Schwimbeck
Several types of hallucinations have been linked to sleep paralysis: the belief that there is an intruder in the room, the feeling of a presence, and the sensation of floating. One common hallucination is the presence of an [incubus](https://en.wikipedia.org/wiki/Incubus "Incubus"). A neurological hypothesis is that in sleep paralysis the [cerebellum](https://en.wikipedia.org/wiki/Cerebellum "Cerebellum"), which usually coordinates body movement and provides information on body position, experiences a brief myoclonic spike in brain activity inducing a [floating](https://en.wikipedia.org/wiki/Floating_\(psychological_phenomenon\) "Floating (psychological phenomenon)") sensation.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
The [intruder](https://en.wikipedia.org/wiki/Trespasser "Trespasser") and incubus hallucinations highly correlate with one another, and moderately correlated with the third hallucination, vestibular-motor disorientation, also known as [out-of-body experiences](https://en.wikipedia.org/wiki/Out-of-body_experience "Out-of-body experience"),[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13) which differ from the other two in not involving the threat-activated vigilance system.[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)
### Threat hyper-vigilance
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=4 "Edit section: Threat hyper-vigilance")\]
A [hyper-vigilant](https://en.wikipedia.org/wiki/Hypervigilance "Hypervigilance") state created in the [midbrain](https://en.wikipedia.org/wiki/Midbrain "Midbrain") may further contribute to hallucinations.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) More specifically, the emergency response is activated in the brain when individuals wake up paralyzed and feel vulnerable to attack. This helplessness can intensify the effects of the threat response well above the level typical of normal dreams, which could explain why such visions during sleep paralysis are so vivid. The threat-activated vigilance system is a protective mechanism that differentiates between dangerous situations and determines whether the fear response is appropriate.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
The hyper-vigilance response can lead to the creation of endogenous stimuli that contribute to the perceived threat.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) A similar process may explain hallucinations, with slight variations, in which an evil presence is perceived by the subject to be attempting to suffocate them, either by pressing heavily on the chest or by strangulation. A neurological explanation holds that this results from a combination of the threat vigilance activation system and the muscle paralysis associated with sleep paralysis that removes voluntary control of breathing. Several features of REM breathing patterns exacerbate the feeling of suffocation.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13) These include shallow rapid breathing, [hypercapnia](https://en.wikipedia.org/wiki/Hypercapnia "Hypercapnia"), and slight blockage of the airway, which is a symptom prevalent in [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea") patients.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
According to this account, the subjects attempt to breathe deeply and find themselves unable to do so, creating a sensation of resistance, which the threat-activated vigilance system interprets as an unearthly being sitting on their chest, threatening suffocation.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8) The sensation of entrapment causes a feedback loop when the fear of suffocation increases as a result of continued helplessness, causing the subjects to struggle to end the SP episode.[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
Sleep paralysis is mainly diagnosed via clinical interview and ruling out other potential [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") that could account for the feelings of paralysis.[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10)[\[11\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Goldstein-11) Several measures are available to reliably diagnose[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) or screen (*Munich Parasomnia Screening*)[\[19\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-19) for recurrent isolated sleep paralysis.
Episodes of sleep paralysis can occur in the context of several medical conditions (e.g., narcolepsy, [hypokalemia](https://en.wikipedia.org/wiki/Hypokalemia "Hypokalemia")). When episodes occur independent of these conditions or substance use, it is termed "isolated sleep paralysis" (ISP).[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) When ISP episodes are more frequent and cause clinically significant distress or interference, it is classified as "recurrent isolated sleep paralysis" (RISP). Episodes of sleep paralysis, regardless of classification, are generally short (1–6 minutes), but longer episodes also have been documented.[\[8\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheyneninenine-8)
It can be difficult to differentiate between [cataplexy](https://en.wikipedia.org/wiki/Cataplexy "Cataplexy") brought on by narcolepsy and true sleep paralysis, because the two phenomena are physically indistinguishable. The best way to differentiate between the two is to note when the attacks occur most often. Narcolepsy attacks are more common when the individual is falling asleep; ISP and RISP attacks are more common upon awakening.[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)
### Differential diagnoses
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=7 "Edit section: Differential diagnoses")\]
Similar conditions include:[\[20\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sharp2015-20)
- [Exploding head syndrome](https://en.wikipedia.org/wiki/Exploding_head_syndrome "Exploding head syndrome") (EHS) potentially frightening parasomnia, the hallucinations are usually briefer and always loud or jarring. There is no paralysis during EHS.
- [Nightmare disorder](https://en.wikipedia.org/wiki/Nightmare_disorder "Nightmare disorder") (ND); also REM-based parasomnia.
- [Sleep terrors](https://en.wikipedia.org/wiki/Sleep_terrors "Sleep terrors") (STs) are potentially frightening parasomnia, but are not REM based and there is a lack of awareness to surroundings, characteristic screams during STs.
- [Noctural panic attacks](https://en.wikipedia.org/wiki/Noctural_panic_attacks "Noctural panic attacks") (NPAs) involve fear and acute distress but lack paralysis and dream imagery.
- [Post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD) often includes scary imagery and anxiety but not limited to sleep-wake transitions.
Several circumstances have been identified that are associated with an increased risk of sleep paralysis. These include [insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia"), [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation"), an erratic sleep schedule, [stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)"), and physical fatigue. It is also believed that there may be a genetic component in the development of RISP, because there is a high concurrent incidence of sleep paralysis in [monozygotic twins](https://en.wikipedia.org/wiki/Monozygotic_twins "Monozygotic twins").[\[16\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Sehgal-16) Sleeping in the [supine position](https://en.wikipedia.org/wiki/Supine_position "Supine position") (on one's back) has been found an especially prominent instigator of sleep paralysis.[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[21\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwotwo-21)
Sleeping in the supine position is believed to make the sleeper more vulnerable to episodes of sleep paralysis because in this sleeping position, it is possible for the soft palate to collapse and obstruct the airway. This is a possibility regardless of whether the individual has been diagnosed with sleep apnea or not. There may also be a greater rate of [microarousals](https://en.wikipedia.org/wiki/Microarousal "Microarousal") while sleeping in the supine position because there is a greater amount of pressure being exerted on the lungs due to gravity.[\[21\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwotwo-21)
While many factors can increase the risk for ISP or RISP, they can be avoided with minor lifestyle changes.[\[11\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Goldstein-11)
Medical treatment starts with education about sleep stages and the inability to move muscles during REM sleep. People should be evaluated for [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") if symptoms persist.[\[22\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-22) The safest treatment for sleep paralysis is for people to adopt healthier sleeping habits. However, in more serious cases [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") or [selective serotonin reuptake inhibitors](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitors "Selective serotonin reuptake inhibitors") (SSRIs) may be used. Most people tend to overcome sleep paralysis by being woken up through touch or movement.[\[23\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-23) Despite the fact that these treatments are prescribed, there is currently no drug that has been found to completely interrupt episodes of sleep paralysis the majority of the time.[\[24\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Med-24)
Though no large trials have taken place which focus on the treatment of sleep paralysis, several drugs have promise in case studies. Two trials of [GHB](https://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid "Gamma-Hydroxybutyric acid") for people with narcolepsy demonstrated reductions in sleep paralysis episodes.[\[25\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:4-25)
[Pimavanserin](https://en.wikipedia.org/wiki/Pimavanserin "Pimavanserin") has been proposed as a possible candidate for future studies in treating sleep paralysis.[\[26\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-newrev2018-26)
### Cognitive-behavior therapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=11 "Edit section: Cognitive-behavior therapy")\]
Some of the earliest work in treating sleep paralysis was done using a [cognitive-behavior therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") called CA-CBT. The work focuses on psycho-education and modifying catastrophic cognitions about the sleep paralysis attack.[\[27\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-27)[\[28\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-28) This approach has previously been used to treat sleep paralysis in Egypt, although clinical trials are lacking.[\[29\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-29)
The first published psychosocial treatment for recurrent isolated sleep paralysis was cognitive-behavior therapy - isolated sleep paralysis (CBT-ISP).[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) It begins with self-monitoring of symptoms, cognitive restructuring of maladaptive thoughts relevant to ISP (e.g., "the paralysis will be permanent"), and psychoeducation about the nature of sleep paralysis. Prevention techniques include ISP-specific sleep hygiene and the preparatory use of various relaxation techniques (e.g. diaphragmatic breathing, mindfulness, progressive muscle relaxation, meditation). Episode disruption techniques[\[30\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:5-30) are first practiced in session and then applied during actual attacks. No controlled trial of CBT-ISP has yet been conducted to prove its effectiveness.
Sleep paralysis is experienced equally in males and females.[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4)[\[31\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Dauvilliers-31) Lifetime prevalence rates derived from 35 aggregated studies indicate that approximately 8% of the general population, 28% of students, and 32% of psychiatric patients experience at least one episode of sleep paralysis at some point in their lives.[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4) Rates of recurrent sleep paralysis are not as well known, but 15–45% of those with a lifetime history of sleep paralysis may meet diagnostic criteria for Recurrent Isolated Sleep Paralysis.[\[17\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-FISP-17)[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10) In surveys from Canada, China, England, Japan and Nigeria, 20% to 60% of individuals reported having experienced sleep paralysis at least once in their lifetime.[\[7\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Blackmore2002-7) In general, non-white people appear to experience sleep paralysis at higher rates than white people, but the magnitude of the difference is rather small.[\[4\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Bri2011-4) Approximately 36% of the general population that experiences isolated sleep paralysis, develop it between 25 and 44 years of age.[\[32\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Ohayon-32)
Isolated sleep paralysis is commonly seen in patients that have been diagnosed with narcolepsy. Approximately 30–50% of people that have been diagnosed with narcolepsy, have experienced sleep paralysis as an auxiliary symptom. A majority of the individuals who have experienced sleep paralysis, have sporadic episodes that occur once a month to once a year. Only 3% of individuals who experience sleep paralysis that is not associated with a [neuromuscular disorder](https://en.wikipedia.org/wiki/Neuromuscular_disorder "Neuromuscular disorder") have nightly episodes.[\[32\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Ohayon-32)
## Society and culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=13 "Edit section: Society and culture")\]
[](https://en.wikipedia.org/wiki/File:Der_Albtraum_\(Anonym_19_Jh\).jpg)
A 19th century version of *[Füssli's](https://en.wikipedia.org/wiki/Henry_Fuseli "Henry Fuseli") The Nightmare* (1781)
The original definition of sleep paralysis was codified by [Samuel Johnson](https://en.wikipedia.org/wiki/Samuel_Johnson "Samuel Johnson") in his *[A Dictionary of the English Language](https://en.wikipedia.org/wiki/A_Dictionary_of_the_English_Language "A Dictionary of the English Language")* as *[nightmare](https://en.wikipedia.org/wiki/Nightmare "Nightmare")*, a term that evolved into the modern definition. The term was first used and dubbed by British neurologist, [S.A.K. Wilson](https://en.wikipedia.org/wiki/Samuel_Alexander_Kinnier_Wilson "Samuel Alexander Kinnier Wilson") in his 1928 dissertation, *The Narcolepsies.*[\[33\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-33) Such sleep paralysis was widely considered the work of [demons](https://en.wikipedia.org/wiki/Demon "Demon"), and more specifically [incubi](https://en.wikipedia.org/wiki/Incubus "Incubus"), which were thought to sit on the chests of sleepers. In [Old English](https://en.wikipedia.org/wiki/Old_English_language "Old English language"), the name for these beings was *mare* or *mære* (from a [proto-Germanic](https://en.wikipedia.org/wiki/Proto-Germanic_language "Proto-Germanic language") *\*marōn*, cf. [Old Norse](https://en.wikipedia.org/wiki/Old_Norse_language "Old Norse language") *[mara](https://en.wikipedia.org/wiki/Mara_\(folklore\) "Mara (folklore)")*), hence comes the *mare* in the word *nightmare*. The word might be [cognate](https://en.wikipedia.org/wiki/Cognate "Cognate") to [Greek](https://en.wikipedia.org/wiki/Ancient_Greek "Ancient Greek") *Marōn* (in the [Odyssey](https://en.wikipedia.org/wiki/Odyssey "Odyssey")) and [Sanskrit](https://en.wikipedia.org/wiki/Sanskrit "Sanskrit") *[Māra](https://en.wikipedia.org/wiki/Mara_\(demon\) "Mara (demon)")*.
### Cultural significance and priming
\[[edit](https://en.wikipedia.org/w/index.php?title=Sleep_paralysis&action=edit§ion=15 "Edit section: Cultural significance and priming")\]
[](https://en.wikipedia.org/wiki/File:Augustins_-_Cauchemar_-_Eug%C3%A8ne_Thivier_-_RI_1156.jpg)
*Le Cauchemar* (*The Nightmare*), by Eugène Thivier (1894)
Although the core features of sleep paralysis (e.g., atonia, a clear sensorium, and frequent hallucinations) appear to be universal, the ways in which they are experienced vary according to time, place, and culture.[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[34\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:2-34) Over 100 terms have been identified for these experiences.[\[18\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:7-18) Some scientists have proposed sleep paralysis as an explanation for reports of paranormal and spiritual phenomena such as [ghosts](https://en.wikipedia.org/wiki/Ghost "Ghost"),[\[35\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:8-35)[\[36\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:3-36) alien visits,[\[37\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-37) [demons](https://en.wikipedia.org/wiki/Demons "Demons") or [demonic possession](https://en.wikipedia.org/wiki/Demonic_possession "Demonic possession"),[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) [alien abduction](https://en.wikipedia.org/wiki/Alien_abduction "Alien abduction") experiences,[\[39\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-pmid15881271-39)[\[40\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cordon2005-8-40) the [night hag](https://en.wikipedia.org/wiki/Night_hag "Night hag") and [shadow people](https://en.wikipedia.org/wiki/Shadow_people "Shadow people") haunting.[\[10\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:0-10)[\[13\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-Cheynetwothree-13)
According to some scientists, culture may be a major factor in shaping sleep paralysis.[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) When sleep paralysis is interpreted through a particular cultural filter, it may take on greater salience. For example, if sleep paralysis is feared in a certain culture, this fear could lead to conditioned fear, and thus worsen the experience, in turn leading to higher rates.[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9)[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) Consistent with this idea, high rates and long durations of immobility during sleep paralysis have been found in Egypt, where there are elaborate beliefs about sleep paralysis, involving [malevolent spirit](https://en.wikipedia.org/wiki/Malevolent_spirit "Malevolent spirit")\-like creatures, the *[jinn](https://en.wikipedia.org/wiki/Jinn "Jinn").*[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38)
Research has found that sleep paralysis is associated with great fear and fear of impending death in 50% of sufferers in Egypt. A study comparing rates and characteristics of sleep paralysis in Egypt and Denmark found that the phenomenon is three times more common in Egypt than Denmark.[\[38\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:6-38) In Denmark, unlike Egypt, there are no elaborate supernatural beliefs about sleep paralysis, and the experience is often interpreted as an odd physiological event, with overall shorter sleep paralysis episodes and fewer people (17%) fearing that they could die from it.[\[34\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:2-34)
The [night hag](https://en.wikipedia.org/wiki/Night_hag "Night hag") is a generic name for a folkloric creature found in cultures around the world, and which is used to explain the phenomenon of sleep paralysis. A common description is that a person feels the presence of a supernatural malevolent being which immobilizes the person as if standing on the chest.[\[41\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-41) This phenomenon goes by many names.
In [Albanian folk beliefs](https://en.wikipedia.org/wiki/Albanian_folk_beliefs "Albanian folk beliefs"), *Mokthi* is believed to be a male spirit with a golden [fez](https://en.wikipedia.org/wiki/Fez_\(hat\) "Fez (hat)") hat who appears to women who are usually tired or suffering and stops them from moving. It is believed that if they can take his golden hat, he will grant them a wish, but then he will visit them frequently although he is harmless. There are talismans that can provide protection from Mokthi and one way is to put one's husband's hat near the pillow while sleeping. *Mokthi* or *Makthi* in [Albanian](https://en.wikipedia.org/wiki/Albanian_language "Albanian language") means "Nightmare".[\[42\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-42)
The names of sleep paralysis vary in some Arab countries; it is popularly known as "Al-Jathoom," in Morocco it is called "Boughtat," and in other regions it is known as "Raboos." This entity, believed to be a jinn, perches on the sleeper's chest.[\[34\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:2-34)[\[43\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-43)
In [Bengali folklore](https://en.wikipedia.org/wiki/Bangladeshi_folk_literature "Bangladeshi folk literature"), sleep paralysis is believed to be caused by a supernatural entity called *[Boba](https://en.wikipedia.org/wiki/Ghosts_in_Bengali_culture "Ghosts in Bengali culture")* ([Bengali](https://en.wikipedia.org/wiki/Bengali_language "Bengali language"): বোবা, [lit.](https://en.wikipedia.org/wiki/Literal_translation "Literal translation")'dumb'). *Boba* attacks a person by strangling him when the person sleeps in a [supine position](https://en.wikipedia.org/wiki/Supine_position "Supine position"). In [Bengal](https://en.wikipedia.org/wiki/Bengal "Bengal"), the phenomenon is called *Bobay Dhora* ([Bengali](https://en.wikipedia.org/wiki/Bengali_language "Bengali language"): বোবায় ধরা, [lit.](https://en.wikipedia.org/wiki/Literal_translation "Literal translation")'Struck by *Boba*').[\[44\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-44)
Sleep paralysis among [Cambodians](https://en.wikipedia.org/wiki/Cambodia "Cambodia") is known as "the ghost pushes you down," and entails the belief in dangerous visitations from deceased relatives.[\[36\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:3-36)
Sleep paralysis among the [Japanese](https://en.wikipedia.org/wiki/Japan "Japan") is known as *kanashibari* (金縛り), lit. "metal binding" and entails the belief of dangerous visitations from childlike [Yōkai](https://en.wikipedia.org/wiki/Y%C5%8Dkai "Yōkai"), called a *[makuragaeshi](https://en.wikipedia.org/wiki/Makuragaeshi "Makuragaeshi")* (枕返し or 反枕, lit. "pillow flip"), sitting on the victim's chest.
In the different regions of [Italy](https://en.wikipedia.org/wiki/Italy "Italy"), there are many examples of supernatural beings associated with sleep paralysis. In the regions of [Marche](https://en.wikipedia.org/wiki/Marche "Marche") and [Abruzzo](https://en.wikipedia.org/wiki/Abruzzo "Abruzzo"), it is referred to as a *[Pandafeche](https://en.wikipedia.org/w/index.php?title=Pandafeche&action=edit&redlink=1 "Pandafeche (page does not exist)") \[[it](https://it.wikipedia.org/wiki/Pandafeche "it:Pandafeche")\]* or *[pantafica](https://en.wikipedia.org/w/index.php?title=Pantafica&action=edit&redlink=1 "Pantafica (page does not exist)") \[[it](https://it.wikipedia.org/wiki/pantafica "it:pantafica")\]* attack;[\[9\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:1-9) the *Pandafeche* usually refers to an evil [witch](https://en.wikipedia.org/wiki/Witchcraft "Witchcraft"), sometimes a ghostlike spirit or a terrifying catlike creature, that mounts on the chest of the victim and tries to harm him. The only way to avoid her is to keep a bag of sand or beans close to the bed, so that the witch will stop to count how many beans or sand-grains are inside it. A similar tradition is present in the [Sardinian](https://en.wikipedia.org/wiki/Sardinia "Sardinia") folklore, where the *Ammuntadore* is known as a creature that mounts on the people's chest during their sleep to give them nightmares, and it can change its shape according to the person's fears. In Northern Italy, specifically in the [Tyrol](https://en.wikipedia.org/wiki/Tyrol "Tyrol") area, the *Trud* is a witch that sits on the people's chest at night, making them unable to breathe; to chase her away, people should make the [sign of the Cross](https://en.wikipedia.org/wiki/Sign_of_the_cross "Sign of the cross"), something that would need a great struggle in a situation of paralysis.[\[45\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-45) A similar folklore is present in the [Sannio](https://en.wikipedia.org/wiki/Samnium "Samnium") area, around the city of [Benevento](https://en.wikipedia.org/wiki/Benevento "Benevento"), where the witch is called *[Janara](https://en.wikipedia.org/wiki/Witches_of_Benevento "Witches of Benevento")*.[\[46\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:10-46) In Southern Italy, sleep paralysis is usually explained with the presence of a [sprite](https://en.wikipedia.org/wiki/Sprite_\(folklore\) "Sprite (folklore)") standing on the people's chest; if the person manages to catch the sprite (or steal his hat), in exchange for his freedom (or to have his hat back) he can reveal the hiding place of a rich treasure; this sprite has different names in different regions of Italy: Monaciello in [Campania](https://en.wikipedia.org/wiki/Campania "Campania"), Monachicchio in [Basilicata](https://en.wikipedia.org/wiki/Basilicata "Basilicata"), Laurieddhu or Scazzamurill in [Apulia](https://en.wikipedia.org/wiki/Apulia "Apulia"), Mazzmuredd in [Molise](https://en.wikipedia.org/wiki/Molise "Molise").[\[46\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:10-46)
In [Newfoundland](https://en.wikipedia.org/wiki/Newfoundland_and_Labrador "Newfoundland and Labrador"), which is in eastern Canada, sleep paralysis is referred to as the Old Hag,[\[35\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:8-35)[\[47\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-47) and victims of a *hagging* are said to be *hag-ridden* upon awakening.[\[48\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-48) Victims report being completely conscious, but unable to speak or move, and report a person or an animal which sits upon their chest.[\[49\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:9-49) Despite the name, the attacker can be either male or female.[\[50\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-50) Some suggested cures or preventions for the Old Hag include sleeping with a Bible under the pillow,[\[49\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-:9-49) calling the sleeper's name backwards[\[51\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-51) or in an extreme example, sleeping with a shingle or board embedded with nails strapped to the chest.[\[52\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-52) This object was called a Hag Board.[\[53\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-53) The Old Hag is well-enough known in the province to be a pop culture figure, appearing in films and plays[\[54\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-54) as well as in crafted objects.[\[55\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-55)
[Nigeria](https://en.wikipedia.org/wiki/Nigeria "Nigeria")[\[56\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-56) has myriad interpretations of the cause of sleep paralysis, due to numerous cultures and belief systems that exist there.
Sleep paralysis is sometimes interpreted as space alien abduction in the [United States](https://en.wikipedia.org/wiki/United_States "United States").[\[57\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-57)
Various forms of [magic](https://en.wikipedia.org/wiki/Magic_\(paranormal\) "Magic (paranormal)") and [spiritual possession](https://en.wikipedia.org/wiki/Spiritual_possession "Spiritual possession") were also advanced as causes, in literature. In nineteenth-century [Europe](https://en.wikipedia.org/wiki/Europe "Europe"), the vagaries of diet were thought to be responsible. For example, in [Charles Dickens](https://en.wikipedia.org/wiki/Charles_Dickens "Charles Dickens")'s *[A Christmas Carol](https://en.wikipedia.org/wiki/A_Christmas_Carol "A Christmas Carol")*, [Ebenezer Scrooge](https://en.wikipedia.org/wiki/Ebenezer_Scrooge "Ebenezer Scrooge") attributes the [ghost](https://en.wikipedia.org/wiki/Ghost "Ghost") he sees to "... an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato..." In a similar vein, the *[Household Cyclopedia](https://en.wikipedia.org/wiki/Household_Cyclopedia "Household Cyclopedia")* (1881) offers the following advice about nightmares:
> Great attention is to be paid to regularity and choice of diet. Intemperance of every kind is hurtful, but nothing is more productive of this disease than drinking bad wine. Of eatables those which are most prejudicial are all fat and greasy meats and pastry. Moderate exercise contributes in a superior degree to promote the digestion of food and prevent flatulence; those, however, who are necessarily confined to a sedentary occupation, should particularly avoid applying themselves to study or bodily labor immediately after eating. Going to bed before the usual hour is a frequent cause of night-mare, as it either occasions the patient to sleep too long or to lie long awake in the night. Passing a whole night or part of a night without rest likewise gives birth to the disease, as it occasions the patient, on the succeeding night, to sleep too soundly. Indulging in sleep too late in the morning, is an almost certain method to bring on the paroxysm, and the more frequently it returns, the greater strength it acquires; the propensity to sleep at this time is almost irresistible.[\[58\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-58)
[J. M. Barrie](https://en.wikipedia.org/wiki/J._M._Barrie "J. M. Barrie"), the author of the [Peter Pan](https://en.wikipedia.org/wiki/Peter_Pan_\(character\) "Peter Pan (character)") stories, may have had sleep paralysis. He said of himself "In my early boyhood it was a sheet that tried to choke me in the night."[\[59\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-59) He also described several incidents in the Peter Pan stories that indicate that he was familiar with an awareness of a loss of muscle tone whilst in a dream-like state. For example, Maimie is asleep but calls out "What was that....It is coming nearer! It is feeling your bed with its horns-it is boring for \[into\] you",[\[60\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-60) and when the Darling children were dreaming of flying, Barrie says "Nothing horrid was visible in the air, yet their progress had become slow and laboured, exactly as if they were pushing their way through hostile forces. Sometimes they hung in the air until Peter had beaten on it with his fists."[\[61\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-61) Barrie describes many [parasomnias](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") and neurological symptoms in his books and uses them to explore the nature of consciousness from an experiential point of view.[\[62\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-62)
[Herman Melville](https://en.wikipedia.org/wiki/Herman_Melville "Herman Melville") described an episode resembling sleep paralysis in his novel *[Moby-Dick](https://en.wikipedia.org/wiki/Moby-Dick "Moby-Dick")* (1851). In Chapter 4 ("The Counterpane"), Ishmael recalls a childhood incident in which "a supernatural hand seemed placed in mine," leaving him aware but unable to move. The passage has been analyzed as one of the earliest fictional depictions consistent with modern clinical descriptions of the condition.[\[63\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-63)
[*The Nightmare*](https://en.wikipedia.org/wiki/The_Nightmare_\(2015_American_film\) "The Nightmare (2015 American film)") is a 2015 documentary that discusses the causes of sleep paralysis as seen through extensive interviews with participants, and the experiences are re-enacted by professional actors. In synopsis, it proposes that such cultural phenomena as [alien abduction](https://en.wikipedia.org/wiki/Alien_abduction "Alien abduction"), the [near-death experience](https://en.wikipedia.org/wiki/Near-death_experience "Near-death experience") and [shadow people](https://en.wikipedia.org/wiki/Shadow_person "Shadow person") can, in many cases, be attributed to sleep paralysis. The "real-life" horror film debuted at the [Sundance Film Festival](https://en.wikipedia.org/wiki/2015_Sundance_Film_Festival "2015 Sundance Film Festival") on January 26, 2015, and premiered in theatres on June 5, 2015.[\[64\]](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_note-64)
- [Catatonia](https://en.wikipedia.org/wiki/Catatonia "Catatonia") – Psychiatric behavioural syndrome
1. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-6) [***h***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-7) [***i***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-8) [***j***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Sharp2016_1-9)
Sharpless BA (2016). ["A clinician's guide to recurrent isolated sleep paralysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958367). *Neuropsychiatric Disease and Treatment*. **12**: 1761–67\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2147/NDT.S100307](https://doi.org/10.2147%2FNDT.S100307). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4958367](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958367). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27486325](https://pubmed.ncbi.nlm.nih.gov/27486325).
2. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-6) [***h***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-7) [***i***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-8) [***j***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-9) [***k***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-10) [***l***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Av2011_2-11)
Avidan AY, Zee PC (2011). [*Handbook of Sleep Medicine*](https://books.google.com/books?id=D66s7fxc-0cC&pg=PT113) (2nd ed.). Lippincott Williams & Wilkins. p. Chapter 5. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4511-5385-9](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4511-5385-9 "Special:BookSources/978-1-4511-5385-9")
.
3. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:11_3-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:11_3-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:11_3-2)
["Sleep paralysis"](https://www.nhs.uk/conditions/sleep-paralysis/). *nhs.uk*. 2017-10-23. Retrieved 2023-02-06.
4. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Bri2011_4-3)
Sharpless BA, Barber JP (October 2011). ["Lifetime prevalence rates of sleep paralysis: A systematic review"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156892). *Sleep Medicine Reviews*. **15** (5): 311–315\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.smrv.2011.01.007](https://doi.org/10.1016%2Fj.smrv.2011.01.007). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3156892](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156892). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21571556](https://pubmed.ncbi.nlm.nih.gov/21571556).
5. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-5)** Thorpy, M.J. (ed.). (1990). *'Sleep paralysis'. l Classification of Sleep Disorders: Diagnostic and Coding Manual*. Rochester, Minn.: American Sleep Disorders Association.
6. **[^](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-6)**
Spanos N.P., McNulty S.A., DuBreuil S.C., Pires M. (1995). "The frequency and correlates of sleep paralysis in a university sample". *Journal of Research in Personality*. **29** (3): 285–305\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1006/jrpe.1995.1017](https://doi.org/10.1006%2Fjrpe.1995.1017).
`{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list"))
7. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Blackmore2002_7-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Blackmore2002_7-1)
Blackmore Susan J., Parker Jennifer J. (2002). ["Comparing the Content of Sleep Paralysis and Dream Reports"](http://www.susanblackmore.co.uk/Articles/PDFs/Dreaming%202002.pdf) (PDF). *Dreaming*. **12** (1): 45–59\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1023/A:1013894522583](https://doi.org/10.1023%2FA%3A1013894522583). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [143952687](https://api.semanticscholar.org/CorpusID:143952687). [Archived](https://web.archive.org/web/20160429025711/http://www.susanblackmore.co.uk/Articles/PDFs/Dreaming%202002.pdf) (PDF) from the original on 2016-04-29.
8. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-3) [***e***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-4) [***f***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-5) [***g***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-6) [***h***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-Cheyneninenine_8-7)
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Jalal B, Romanelli A, Hinton DE (2015-12-01). "Cultural Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated Supernatural Beliefs". *Culture, Medicine and Psychiatry*. **39** (4): 651–664\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11013-015-9442-y](https://doi.org/10.1007%2Fs11013-015-9442-y). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1573-076X](https://search.worldcat.org/issn/1573-076X). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25802016](https://pubmed.ncbi.nlm.nih.gov/25802016). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [46090345](https://api.semanticscholar.org/CorpusID:46090345).
10. ^ [***a***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-0) [***b***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-1) [***c***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-2) [***d***](https://en.wikipedia.org/wiki/Sleep_paralysis#cite_ref-:0_10-3)
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