The science of sleep paralysis, a brain-body glitch making people see demons and witches
Baland Jalal lay in bed terrified, experiencing his own real-life horror film.
Newly awake, the 19-year-old could see his surroundings but couldn't move or speak, and he didn't know why.
He thought, ''My God, what do I do?'' Jalal, now 39, said of that moment in 2005. 'I tried to call my mom (and) dad, but no words would emerge from my throat. … I had this ominous presence of a monster, and it lifted my legs up and down.
'It strangled me, trying to kill me. And I was 100% sure that I was going to die,' Jalal added. 'It literally feels like all the evil of the universe is condensed into a bubble, and it's in your bedroom.'
This type of hallucination is a hallmark for many people with sleep paralysis.
It occurs during transitions into or out of rapid eye movement, or REM, sleep, similar to a traffic jam at a busy intersection — your brain, awake and alert, and body, still asleep and immobilized, collide momentarily, said Dr. Matthew P. Walker, director of the Center for Human Sleep Science at the University of California, Berkeley, via email.
Following deep sleep, REM sleep is the next critical phase of sleep cycles, characterized by more dreaming that's also extra vivid and lifelike, and by faster heart rate and breathing. It's essential for memory, concentration, mood regulation and immune function.
Jalal's experiences propelled him to study this phenomenon around the world. He aimed to discover the cause of sleep paralysis, he said, and why some people with the diagnosis 'have these powerful encounters where it feels like evil of epic proportions.'
He has since earned a doctorate in psychiatry and is now a researcher in Harvard University's psychology department and a leading expert on sleep paralysis. He also treats patients struggling with it.
An estimated 30% of people worldwide experience at least one episode of sleep paralysis in their lifetime, according to the Cleveland Clinic. How many of those people have recurring and impairing sleep paralysis isn't clear, but the percentage is likely low, Jalal said.
Here's what else you should know about sleep paralysis and how it can be managed.
In REM sleep, our bodies are paralyzed so we don't act out our dreams and risk hurting ourselves or others, Jalal said. Sleep paralysis episodes are usually only a few minutes long but can last up to 20 minutes, according to the Cleveland Clinic.
During sleep paralysis, however, 'we regain consciousness before the muscles regain their freedom from REM-induced paralysis,' said Walker, who is also a professor of neuroscience and psychology at the University of California, Berkeley
About 40% of people with sleep paralysis have visual, auditory or tactile hallucinations, such as pressure on one's chest or feeling out of body, Jalal said. For about 90% of those individuals, the illusions are terrifying. They can include ghosts or cat- or alien-like creatures, and their actions can be as innocuous as simply approaching them or as nefarious as molesting or trying to kill them.
In Jalal's academic travels, he discovered the contents and interpretations of hallucinations, views on what causes sleep paralysis, and episode frequency and duration can all also have a cultural basis. People living in Egypt and Italy, for example, would often see witches and evil genies, hold them responsible and think they could die from sleep paralysis, Jalal said. People in Denmark, Poland and parts of the United States, on the other hand, have less supernatural or exotic explanations and less fear.
'Why do we see these monsters? Is it the dreaming imagery … that's spilling over into conscious awareness?' Jalal said. 'My answer to that is, according to my research, no, not exactly. But it's part of it.'
When you're aware yet paralyzed and confused, your natural reaction is to escape that situation. Your brain is bombarding your body with signals to move, but your body can't return any feedback.
Jalal's theory, in short, is that your brain says, 'to hell with it' and concocts a story it thinks your body must be facing to be experiencing such bizarre symptoms.
The reduced activity in your prefrontal cortex — responsible for reason and logic — also contributes to hallucinations becoming 'extremely realistic and emotionally charged, amplified by an overly active amygdala, the brain's emotional alarm center,' Walker said.
Though scientists know that wake-sleep glitch is what's happening during a sleep paralysis episode, they're not entirely sure why. But there are several factors that can increase the risk of fragmented sleep and sleep paralysis.
Those factors include stress and related conditions such as anxiety, post-traumatic stress disorder (PTSD), bipolar disorder and panic disorder, experts said. Much of Jalal's sleep paralysis occurred when he was in school. Now when he has an episode once or twice per year, it's usually during a high-stress period, he said. (Once you've experienced sleep paralysis, you can be conscious of that during an episode but still feel afraid.)
Other common contributors are sleep deprivation, jet lag, an irregular sleep schedule, sleep disorders such as narcolepsy, and genetic factors, Walker and Jalal said.
Obstructive sleep apnea, substance use disorder and some medications — such as those for attention deficit hyperactivity disorder — can also raise risk, according to the Cleveland Clinic.
As scary as sleep paralysis may sound, it's not actually dangerous, experts said. But depending on how recurring it is, sleep paralysis can be a sign of an underlying sleep disorder, Jalal said.
Regular episodes can also lead to anxiety around sleep and then avoidance of sleep, Jalal said. This pattern can interfere with your daily energy and ability to function. And if you often have frightening hallucinations, that can lead to anxiety or trauma-like symptoms.
Sleep paralysis can be significantly alleviated with several practices or treatments, Walker said — starting with healthy sleep habits, for one. That includes seven to nine hours of restful sleep nightly.
Maintaining a sleep schedule consistent in quality and quantity 'acts like tuning your internal clock, reducing the chance of disruptive wake-sleep overlaps — much like ensuring all parts of an orchestra are synchronized for perfect harmony,' Walker said.
Also prioritize stress management, by using, for example, mindfulness and relaxation exercises, Walker said. Therapies can relieve certain underlying issues triggering sleep paralysis, including cognitive behavioral therapy, especially the version for people with insomnia.
In more serious situations, medications are sometimes used, Walker said. Those include SSRI (selective serotonin reuptake inhibitor) or tricyclic antidepressants that can help manage a smooth flow between sleep stages or even reduce the REM phase of sleep.
Generally, boosting the brain's serotonin levels somehow compensates for the loss of the REM phase, Jalal said. But rarely, long-term antidepressant use has been linked with REM sleep behavior disorder.
While the aforementioned treatments can help reduce the frequency or length of sleep paralysis episodes, there isn't yet a gold-standard treatment that can stop an episode once it's happening.
Jalal has been trying to officially create one over the past decade, though, and it's self-inspired. Called meditation relaxation therapy, the treatment reduced sleep paralysis by 50% after eight weeks for six people with narcolepsy, compared with a control group of four participants, found a small pilot study Jalal published in 2020. He currently has another study of the same treatment with more participants underway at Harvard. And the steps of Jalal's therapy are as follows:
Cognitively reappraise the meaning of the attack. Close your eyes and remind yourself that your experience is common and you won't die from it.
Emotionally distance yourself from it. Tell yourself that since your brain is just playing tricks on you, there's no reason for you to be scared or risk the situation getting worse because of your own negative expectations.
Focus on something positive. Whether it's praying or imagining a loved one's face, this refocusing can make thoughts more pleasant rather than monstrous.
Relax your muscles and don't move. Some experts say trying to slightly move your fingers or toes one by one may help you come out of an episode sooner. But Jalal's fourth step advises against this movement since you'd still be sending signals to paralyzed muscles and maybe triggering hallucinations.
Viewing your own biology in a more objective way by learning more about the scientific basis of sleep paralysis is also helpful, Jalal said.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
21 minutes ago
- Medscape
PCPs as Frontline in Dyspnea
When a patient calls a primary care provider due to shortness of breath symptoms, recommending an in-office examination is generally warranted. Your patient may explain how they are out of breath from everyday activities like using stairs, getting winded from walking the dog, or just not being able to catch their breath. 'All new episodes of shortness of breath should be evaluated in real time by a clinician, ideally in person,' said Panagis Galiatsatos, MD, a pulmonologist and associate professor in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins School of Medicine in Baltimore. 'The only time I can see foregoing an immediate clinic visit is if a known cardiopulmonary diagnosis exists.' For example, if a diagnosis is already known (eg, chronic obstructive pulmonary disease [COPD]) and their dyspnea (shortness of breath) is in accordance with prior episodes of similar breathlessness, a phone call or virtual discussion could be enough. Such episodes could also be managed by an action plan that has already been discussed at prior clinic visits, Galiatsatos said. If a patient, already in the office for another concern, casually mentions episodes of shortness of breath, how should the primary doctor proceed? Even if dyspnea is mentioned nonchalantly, it warrants a thorough history and focused physical exam, especially if this is new or worsening. This could be an early sign of a more serious problem, according to Lijo Illipparambil, MD, a pulmonologist and assistant professor of clinical thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia. When discussing symptoms, Illipparambil recommends these questions: • Start the discussion related to context: When do episodes occur — exertion or rest? • How long have these symptoms been occurring? • Inquire about associated symptoms such as fatigue, chest tightness, wheezing, cough, or swelling. • Review exercise limitations: are they able to climb stairs, and if so, how many? Is walking across a room or doing daily chores causing them to be dyspneic? How can primary care doctors serve as frontline partners in managing patients' shortness of breath? Primary care doctors are essential in identifying early signs of cardiopulmonary disease. 'Generally, they are the first physicians who meet the patients and do most of the work-up initially,' said Illipparambil. 'They coordinate care, especially with specialists, provide lifestyle counseling, and monitor chronic conditions like COPD, asthma, and congestive heart failure.' In many ways, they are the real central component for care for patients with dyspnea, he said. 'They also have the advantage of longitudinal relationships, allowing them to notice changes over time and engage in shared decision-making to create sustainable health strategies and earlier intervention if needed,' Illipparambil explained. Assessment Protocol Usually, a thorough physical exam, including checking vital signs (especially oxygen saturation and heart rate) is next, according to Illipparambil. Additional testing should also be considered, including chest x-ray, EKG, and laboratory work-up, as well as referral to specialists if necessary. Red flags that warrant further testing include: • Dyspnea at rest: This is always a reason for further testing, according to Illipparambil. 'It is not normal to be short of breath at rest; it is most often a sign of significant impending decompensation,' he said. Worsening shortness of breath over days or weeks can demonstrate a progressive process, Illipparambil added. Difficulty walking short distances or performing basic activities (eg, walking in the supermarket, pushing a stroller), especially as a change from their baseline, can be a sign of an active problem. • Orthopnea or paroxysmal nocturnal dyspnea are signs of heart failure that need further investigation. • Unilateral leg swelling should always have a differential that includes deep venous thrombosis and, when a patient is short of breath, possible pulmonary embolism, Illipparambil said. Expert Assessments and Symptoms Consider the shortness of breath assessments below, according to Galiatsatos with Johns Hopkins. Airway diseases. COPD or asthma are examples. 'I would recognize due to inability to walk incline or when holding groceries, not walking through the grocery store, but once their arms are engaged, their breathlessness is noticeable,' he said. Cardiac rhythm issues. Especially at low heart rates, most people notice this breathlessness even after walking just a few dozen feet on a flat surface, he noted. Pulmonary embolism (lung blood clot). This tends to occur more acutely, and patients often describe a heaviness and discomfort in their chest. 'This is often accompanied by something that provoked the blood clot — long hours of sitting (for example, during a long flight) — or trauma to the legs,' Galiatsatos said. Heart failure. The key symptom here is the inability to lay down flat. Patients will note having to sleep with several pillows — propping their head and upper torso in an upright position — or abandoning their bed altogether in favor of a recliner, he explained. How can a primary doctor discuss lifestyle changes, medications, or strategies to reduce shortness of breath? The key is to be empathetic, collaborative, and goal oriented. 'This is indeed a delicate yet vital conversation,' Illipparambil said. There are several causes for shortness of breath and approaching patients this way can encourage openness and discussion. One thing that helps is the use of motivational interviewing techniques. For instance, Illipparambil recommends asking permission to discuss weight, tobacco use, or other lifestyle habits that may be affecting shortness of breath. Another approach is to focus on functions, such as walking without getting winded and changing habits toward a healthy lifestyle, rather than just the number on the scale. Offering resources and referrals for issues like nutrition, sleep, and physical therapy can also go a long way, Illipparambil said. 'Medications, of course, can help, especially inhalers in COPD and asthma patients,' he said. 'Antihypertensives, other medications that help modify heart disease, and goal-directed medical therapy have been shown to improve symptoms in patients with heart failure.' How does obesity affect with shortness of breath? Obesity is often linked to cardiopulmonary deconditioning, according to Trishul Siddharthan, MD, a pulmonologist and associate professor of medicine with the University of Miami Miller School of Medicine, Miami, and the University of Miami Health System. 'Extra weight is a significant cause of shortness of breath in the general population and interacts with respiratory diseases, like asthma, to worsen symptoms,' Siddharthan said. 'I think most patients understand how weight can impair respiratory status, particularly if they are having shortness of breath. Lifestyle changes and other strategies to cope are a shared decision. I ensure I address the underlying medical condition while addressing enablers and barriers to weight loss.'
Fast Company
21 minutes ago
- Fast Company
3 signs you suffer from ‘hyper-ambition' (and how to overcome it)
It's true that personal ambition fuels success. But we can reach a dangerous tipping point when healthy drive becomes 'hyper-ambition'—a compulsive cycle of excessive striving that becomes self-defeating. Unlike healthy ambition that energizes you, hyper-ambition can leave you perpetually unsatisfied, overextended, and grinding to exhaustion. The cost isn't just personal—hyper-ambition eventually undermines the very professional success it promises. Here's how to recognize if you've crossed into the danger zone—and take practical steps to realign toward healthy ambition. 1. You Feel Like You've Never Achieved Enough and Are Never Satisfied Are you on a professional achievement treadmill, immediately shifting focus to your next goal after hitting a milestone? While accomplishments and rewards can provide short-term satisfaction, the challenge to getting into such a rhythm is that you may pursue goals without considering what you truly want. This can catch up to you when you realize you've met external expectations but never connected to your internal motivation, leaving you dissatisfied. Putting all your attention against the pursuit of professional validation can also lead to ignoring key areas of one's life that affect long-term happiness and well-being, such as your personal relationships, your health, and activities that fulfill and restore you. To realign to healthy ambition, orient your goals toward internal motivation first—it's a better predictor of engagement and success. Research has shown that putting attention and focus on personal success linked to fulfillment, satisfaction, and happiness begets external success, while the opposite focus doesn't hold true. Start with your values: test if a goal is aligned with what is important and matters to you, rather than solely meeting external expectations. Academic studies have shown that aligning our goals with our values leads to more satisfaction, higher persistence, and more goal attainment. Expand your ambition to include meaningful life goals and challenge what success truly means in your life. Studies confirm that once our basic needs are met, more income, wealth, or possessions don't correlate with lifelong happiness. Plus, Gallup research finds that well-being isn't tied just to career or finances, but also encompasses physical, social, and community well-being. 2. You Feel Constantly Over-Extended and Frustrated You Can't 'Do It All' Do you say yes to every opportunity without strategic prioritization, then feel stretched thin and frustrated by your inability to pursue them all effectively? This suggests you either think more is always better, leading to overload and overwhelm, or you may not have an approach to help you choose where to put your time and attention when faced with seemingly equally valid goals. To shift toward focusing on what matters, use strategic methods to make conscious choices. Create and visualize a goal system by identifying your core priorities and mapping how other goals connect. This can reveal if you're pursuing too much, show how aligned actions serve multiple goals, and reduce perceived friction between supposedly competing goals. You can maximize goal attainment by creating these positive connections, minimizing conflicts, and better understanding trade-offs you may make. When faced with choices, apply the urgency–energy filter. Ask, 'What has urgency, and do I have energy for it?' This reveals several strategies: Prioritize: Commit to high-urgency, high-energy ambitions Reinterpret: For high-urgency, low-energy goals, find ways to achieve the same outcome with less time and effort Postpone: Back-burner lower-priority ambitions Let go: With self-compassion, release goals that no longer serve you Learn to compromise wisely by focusing on what matters at this time rather than trying to do everything. 3. You're Grinding Hard All the Time Without Recovery How often do you find yourself compulsively working, putting in excessive hours without recovery time, leaving you exhausted? Operating in a persistent high-performance mode leads to unproductive stress, causing your physical and mental health to suffer. Ironically, your productivity declines and your work suffers, too. To break this pattern, be strategic about managing your effort and prioritizing recovery. Our ambitions aren't created equal. Be discerning about the effort put against your goals by asking three key questions: Aspiration: How good do I want to be at this? Determination: What is worth the hard work? Motivation: How much effort do I want to put in and what's required? Additionally, manage perfectionism. Be conscious about where you apply excellence and give yourself permission to say 'this is good enough' for lower-stakes areas. Finally, make recovery a leadership imperative. Doris Kearns Goodwin, the celebrated presidential biographer, has said: 'The most underappreciated leadership strength is the ability to relax and replenish energy.' Research shows we paradoxically neglect recovery practices when we need them most. We need a deliberate plan to sustain ourselves for the work that matters and to prioritize time to psychologically disconnect from work. Sustainable success comes from strategic ambition, not hyper-ambition. The idea that you have to choose between being ambitious and being well is a false choice. The goal shouldn't be to eliminate ambition, but to keep it in a healthy zone where it energizes rather than depletes you—allowing you to achieve what you really want both professionally and personally.
Medscape
an hour ago
- Medscape
Ovarian Cancer Risk Rises Soon After IBS Diagnosis
TOPLINE: Women with a new diagnosis of irritable bowel syndrome (IBS) have a significantly higher risk for ovarian cancer at 3 months and 6 months post-diagnosis, but this risk is no longer elevated beyond 8 months. METHODOLOGY: Ovarian cancer often presents with nonspecific symptoms overlapping those of IBS. The frequency of misdiagnosis remains unknown, and not all IBS guidelines recommend screening for ovarian cancer. Researchers conducted a retrospective cohort study using US administrative claims data to compare ovarian cancer incidence in adult women with and without a new IBS diagnosis. Diagnostic codes were used to identify cases of IBS and ovarian cancer. TAKEAWAY: The cohort comprised 9804 women with IBS and 79,804 women without IBS, identified between January 2017 and December 2020. Women with IBS had a significantly higher risk for ovarian cancer at 3 months (hazard ratio [HR], 1.71; P = .02) and 6 months (HR, 1.43; P = .02), but not beyond 8 months post-diagnosis. Women with both IBS and endometriosis had an even greater risk for ovarian cancer at 3 months (HR, 4.20; P = .01), 6 months (HR, 3.52; P = .01), and after 1 year (HR, 2.67; P = .04). Increasing age was significantly associated with higher ovarian cancer incidence only in women younger than 50 years (HR, 1.07; P < .01), regardless of IBS status. IN PRACTICE: 'Identifying patient-specific risk factors, such as chronic pelvic pain or endometriosis, could help develop tailored risk profiles and improve the approach to personalized care in women with IBS-type symptoms,' the authors wrote. SOURCE: This study was led by Andrea Shin, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles. It was published online in Alimentary Pharmacology & Therapeutics. LIMITATIONS: The use of diagnostic codes for identifying IBS may have led to misclassification or reflected symptoms rather than confirmed and validated diagnosis. DISCLOSURES: This study received support from the National Institutes of Health. Some authors reported serving as consultants, advisors, and/or receiving research support from pharmaceutical and healthcare companies; one author reported having stock options. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
