Sleep paralysis is a neurological symptom — meaning it’s related to the nervous system. It's a common co-occurrence with sleep conditions, including narcolepsy. Sleep paralysis can be treatable with the right medical diagnosis and care.
Paralysis, or muscle atonia, is typically an ordinary mechanism in rapid eye movement (REM) sleep that prevents people from physically acting out their dreams and accidentally hurting themselves. Under normal circumstances, the average person would never even realize that the paralysis occurred.
However, muscle atonia can become a problem if it begins to occur outside of REM sleep or with awareness. Generally, sleep paralysis episodes occur as a person begins to fall asleep or awaken, causing them to feel as if they cannot move or speak. The experience is often frightening, but it is not actively harmful.
Sleep paralysis is also fairly common. Many people experience sleep paralysis even if they don’t have an underlying sleep disorder such as narcolepsy. Roughly 8 percent of the general population experiences sleep paralysis at least once during their lifetime. The prevalence is higher among those with narcolepsy, occurring in 20 percent to 50 percent of cases.
Sleep paralysis may be experienced differently by different people. As one MyNarcolepsyTeam member described, “You feel paralyzed. You’re awake, you can hear but not speak, and your body feels like it's trembling. It does not last long; it usually occurs while you are sitting and relaxing.”
Other common sleep paralysis symptoms include:
In some cases, people with sleep paralysis may also experience visual, tactile (touch-based), or auditory hallucinations. “I have weird dreams every single night,” a MyNarcolepsyTeam member recalled of their hallucinations. “They are vivid, and I remember them all. Some are recurring and scary. I also cannot move or open my eyes when my mind is awake.”
Medical experts sort these vivid dreams into three main types:
People who have narcolepsy may find themselves periodically falling asleep during the day, often for just minutes or seconds at a time. These episodes can be unnerving and disruptive, especially when the episodes occur midway through normal tasks such as eating, talking, or driving.
Some people who have narcolepsy may also experience cataplexy — a sudden loss of muscle tone. Episodes of cataplexy are triggered by strong emotions and occur in some cases of narcolepsy. Doctors define people who experience both sleep attacks and cataplexy as having type 1 narcolepsy. People who only experience sleep episodes and no cataplexy are classified as having type 2 narcolepsy.
Researchers aren’t sure why narcolepsy, in general, occurs. However, studies have noted that people with type 1 narcolepsy tend to have low levels of hypocretin, a neurochemical that regulates REM sleep and wakefulness.
When the average person falls asleep, it takes about 60 to 90 minutes for them to fall into the REM stage of sleep, when dreaming occurs. As a protective measure, the brain induces muscle weakness to prevent sleepers from accidentally hurting themselves by acting out their dreams. But for someone with narcolepsy, REM sleep often comes on in just 15 minutes. Researchers believe that sleep paralysis occurs because of these REM timing abnormalities, meaning a person’s brain starts or remains in REM, even when the person is awake.
Sleep paralysis also occurs much more frequently among people with narcolepsy than it does in the general population. Usually, a person with narcolepsy experiences sleep paralysis as they wake, though paralysis can occur less frequently before nighttime sleep. Paralysis can usually be broken by physical stimuli (being touched or spoken to) and is less likely to occur if a person sleeps in an uncomfortable position.
Narcolepsy isn’t the only condition that can cause sleep paralysis. Research indicates that high stress, sleep deprivation, excessive alcohol consumption, and even minor sleep disruptions caused by shift work or jet lag can prompt sleep paralysis. Environmental circumstances may also play a role. Students, for example, are significantly more likely to report having sleep paralysis than the average person (28 percent versus 8 percent), research has shown.
However, sleep paralysis most often appears among those who have psychiatric conditions, including post-traumatic stress disorder (PTSD), panic disorders, social phobias, and generalized anxiety disorders.
Depression is also associated with sleep paralysis, although the relationship between the two conditions is unclear. Doctors aren’t sure whether depression increases the chances that a person will experience paralysis, or if depression itself is a symptom of chronic sleep paralysis.
Generally speaking, your doctor will be able to make a preliminary diagnosis of narcolepsy based on your reported symptoms and medical history. During your initial appointment, they will likely ask you details about lifestyle factors that could be prompting your paralysis, such as stress, alcohol consumption, and work schedules. Your doctor may also ask you to undergo a few tests to determine whether you have an underlying sleep disorder.
If your clinician suspects that you have narcolepsy, they may recommend you participate in sleep studies to assess your brain and bodily activity overnight — and often the following day as well. These tests will involve sleeping in a medical facility, where sleep specialists can gather data and develop insights about your condition. During this time, sleep specialists will conduct a few assessments. Once your clinician has figured out the root cause of your sleep paralysis, they can help you develop a plan to treat it.
The treatments your doctor recommends will depend on the severity of your sleep paralysis and its underlying causes. If your clinician believes your sleep paralysis is occurring due to jet lag or shift work, they may recommend that you transition to a role that allows you to stay home or work daytime hours. Similarly, if your sleep paralysis episodes occur as a result of stress or alcohol consumption, your doctor will probably suggest that you make lifestyle changes to mitigate the effects on your sleep. Sleep paralysis does not usually require treatment when it occurs without other sleep disorders.
If narcolepsy is the cause of a person’s sleep paralysis, it’s important to treat the narcolepsy. Treating the underlying sleep disorder reduces the likelihood that you will have sleep paralysis attacks.
There are several potential treatment options for people with narcolepsy. Talk to your doctor about which may be right for you.
Stimulants are often the first medications doctors prescribe to people with narcolepsy. These medications help a person stay awake during the daytime hours and lessen drowsiness. Stimulants frequently recommended include Provigil (modafinil) and Nuvigil (armodafinil). These drugs have been designed to provide steady stimulation throughout the day, without the highs and lows caused by older narcolepsy drugs.
Selective serotonin reuptake inhibitors (SSRIs) inhibit REM sleep. This capability makes them helpful in preventing sleep paralysis, cataplexy, and hypnagogic hallucinations. Common SSRIs include Prozac (fluoxetine) and Effexor (venlafaxine). Talk to your doctor about what you can expect when starting these medications. In some people, the medications can cause side effects such as insomnia, digestive problems, and weight gain.
In some cases, doctors may prescribe antidepressants such as Tofranil (imipramine) and Anafranil (clomipramine) to reduce cataplexy. Like SSRIs, these medications may come with side effects, such as light-headedness and dry mouth.
If you have sleep paralysis from narcolepsy, you can also take a few at-home steps to minimize attacks. These include:
Setting aside electronic devices about 30 minutes before bedtime can also improve sleep hygiene.
Cognitive behavioral therapy (CBT) is a form of therapy that helps people reframe their negative thoughts and feelings towards normal sleep. Research indicates that CBT may help decrease sleep paralysis. This therapeutic approach has also been proven to help people living with mental health conditions associated with sleep paralysis, such as PTSD and anxiety. Even if CBT doesn’t directly alleviate symptoms, the therapy may help treat the underlying factors that trigger paralysis attacks.
Narcolepsy isn’t always the easiest condition to navigate. Every day, actions that other people take for granted — such as driving, talking, writing — can turn into frustrating challenges. But you don’t have to navigate these difficulties alone. MyNarcolepsyTeam is the social media platform designed specifically for people with narcolepsy. Members come together to ask questions, offer advice and support, and share stories of others who understand life with narcolepsy.
Do you have any insights about how to manage sleep paralysis with narcolepsy? Share your experience in the comments below by posting on MyNarcolepsyTeam.