Narcolepsy Nerd Alert: Sleep Paralysis and Hallucinations

What Is Sleep Paralysis?

Sleep paralysis is a phenomenon in which a person experiences a temporary inability to move or speak during the transition between sleep and wakefulness. It occurs when the body is in a state of paralysis that normally occurs during rapid eye movement or dream stage sleep but persists after the person has awakened. Some people may feel restricted breathing or crushing weight on their chest. Sleep paralysis is often, but not always, accompanied by hypnagogic or hypnopompic hallucinations.

It felt like there was this darkness and weight on top of me. It was super hard to breathe and I couldn’t scream. I couldn’t do anything.”

– Chelsea

Why Does Sleep Paralysis Happen?

If you’ve experienced sleep paralysis, it can feel very frightening and confusing. Interestingly, it is the result of a mistimed sleep mechanism.

Humans have two distinct types of sleep: slow-wave deep sleep and rapid eye movement (REM) dream sleep. As we dream during REM sleep, our brains become very active, with our eyes darting from side-to-side. The brain sends a signal to the body to paralyze all voluntary muscles (called “muscle atonia”) so that we don’t act out our dreams, as this would be quite dangerous. Important involuntary functions like breathing and circulation continue working.

This muscle paralysis should only take place when we are unconscious and unaware of it during REM sleep. However, during sleep paralysis, this paralysis occurs either too quickly (as we are still somewhat conscious and falling asleep) OR continues too long (as we are waking up and becoming aware of our body and surroundings). The mistimed paralysis leads to strange and frightening feelings of being awake but not being able to control or move one’s own body.

Hypnagogic and Hypnopompic Hallucinations

Hypnagogic (when falling asleep) and hypnopompic (when waking up) hallucinations are vivid, powerful experiences that take place around sleep, at night, and around naps. They can be visual (seeing things), auditory (hearing sounds), tactile (feeling touch), or involve other senses.

I’ve had auditory hallucinations while feeling awake. I was hearing club music in my head, people chattering, the DJ talking. The music was so loud I felt like it was pumping out of my ears.”

– Sakhara

What distinguishes these from more typical dreams or nightmares?

Hypnagogic and hypnopompic hallucinations generally differ from average “nightmares” and “dreams” in that these hallucinations often take place in the actual space where the individual is sleeping (e.g. believing you are waking up in your bed but seeing an intruder open the bedroom door). More general nightmares and dreams often occur in other places or dreamscapes (e.g. dreaming you are at the mall with friends, in someone else’s house, or running in the woods) which are generally not confused with reality.

My first hallucination was a man coming into my bedroom. I remember him reaching out toward my neck. I was terrified thinking he was about to strangle me.”

– Julie

Common themes of hypnagogic and hypnopompic hallucinations include but are not limited to: 

• An intruder
• An incubus
• A shadow figure 
• A roommate or loved one who could logically be present
• Unusual body experiences (e.g. floating or detached limbs)
• Music, hearing your name being called, random sounds (e.g. knocking on the door or window, clapping, static radio, people talking in the next room)
• Animals or insects
• Zaps, electric current, vibrating, buzzing

Hypnagogic and hypnopompic hallucinations can be confusing and hard to recognize as not “real” initially. First-hand accounts are so powerful.

I had a hallucination that there was an intruder coming in and taking my son from his bed. I also had paralysis at the same time. It was the single most scary event of my life— and it wasn’t even real.”

– Rhi

History

Sleep paralysis and hypnagogic/hypnopompic hallucinations have been described for at least 2000 years across many cultures. In the centuries preceding our medical understanding of the phenomena, these experiences were interpreted in a number of culturally-specific contexts.

Even the word nightmare is derived from the old English word maere: a hostile figure who lies upon and immobilizes or suffocates sleepers. Some of the most common spooky visitors believed to cause sleep paralysis in history and folklore include witches, ghosts, demons, vampires, and aliens.

Coping Strategies

There are currently no FDA-approved treatments specifically for sleep paralysis or hallucinations, however some treatment options (such as nighttime medications) can reduce their occurrence. Coping strategies vary person-to-person; here are some suggestions from our guests and audience members:

• Managing fear and anxiety
• Noticing environmental triggers
• Maintaining a sleep routine
• Paying attention to patterns to emotionally prepare for paralysis episodes
• Pets’ behavior is grounding for many people and makes it easier to recognize the hallucinatory nature of a scary experience
• Trying not to fight exhaustion or the urge to sleep
• Addressing fears and phobias
• Using art and poetry to process experiences and express them

I remind myself that the scary thing isn’t real, and even if it was real, I can’t do anything about it. So, I tell myself to accept it rather than fighting it. That allows me to go completely to sleep.”

– Julie S.

I’ve realized that if I’m questioning whether I’m awake or not, that means what I’m seeing is probably not happening, because I never question if I’m awake when I actually am.”

– Julie

Support

Social support and accommodations are critical for dealing with narcolepsy symptoms, including sleep paralysis & hallucinations.

• Give flexibility around timing of naps so that you have time to adjust to reality before talking to others
• Talk to a family member on the phone after coming out of an episode
• Let colleagues know that you may need to take breaks suddenly

For more ways to support loved ones, check out our Friends + Family + Narcolepsy toolkit.

For more information on this sleep paralysis and hallucinations, download the Sleep Paralysis and Hallucinations toolkit!

Sleep Paralysis and Hallucinations: Listen or Watch!

The Sleep Paralysis and Hallucinations broadcast originally aired on December 7, 2022.

Meet Our Guests

Chelsea Cataldi is a world traveler who enjoys creating things with her hands. She was diagnosed with type 1 narcolepsy with cataplexy in 2010 while living in Japan. As a speaker with Project Sleep’s Rising Voices program, Chelsea raises awareness to combat misperceptions about narcolepsy and let others know they’re not alone.

Kristyn Beecher is a storyteller and news producer from Houston, Texas. She was diagnosed with type 2 narcolepsy without cataplexy at age 24, but lived with symptoms for many years before that. A graduate of Hampton University and Rising Voices speaker, Kristyn works daily to make sure underrepresented voices are heard and their stories shared.

Connor Baker is a CDU nurse working at Rush Copley Medical Center in Aurora, Illinois. He was diagnosed with type 1 narcolepsy with cataplexy at 20 years old. Connor shares his story as a Rising Voices speaker to spread awareness and end stigmas surrounding narcolepsy.