False awakening

False awakening is an experience in which individuals falsely believe that they have woken up, only to discover subsequently that the perceived awakening was part of a dream. Like sleep paralysis, false awakenings are reported to be highly realistic ¹ and can lead to anxiety in some cases ².

False awakenings are sometimes confused with sleep paralysis, which can occur either when waking up or falling asleep. Normally your brain causes your muscles to relax and be still as you sleep. This is called “atonia.” Sleep paralysis seems to be when this atonia occurs while you are awake. Sleep paralysis is “isolated” when it appears without any other signs of narcolepsy.

Sleep paralysis is categorized as a type of parasomnia. Parasomnias are abnormal behaviors during sleep. Because it is connected to the rapid eye movement (REM) stage of the sleep cycle, sleep paralysis is considered to be a REM parasomnia.

Standard REM sleep involves vivid dreaming as well as atonia, which helps prevent acting out dreams. However, under normal circumstances, atonia ends upon waking up, so a person never becomes conscious of this inability to move.

An episode of paralysis may cause you to be unable to speak. It can also make you unable to move your arms and legs, body, and head. You are still able to breathe normally. You are also fully aware of what is happening. An episode can last for seconds or minutes. The episode usually ends on its own. It may also end when someone touches you or speaks to you. Making an intense effort to move can also end an episode. Sleep paralysis may occur only once in your life. It may also happen many times in a year.

It can be very scary when you are unable to move. You may feel anxious and afraid. Some people also hallucinate during an episode. They may see, hear or feel things that are not there. They may even think that another person is in the room with them. These hallucinations may also appear without the sleep paralysis.

Sleep paralysis tends to first appear in the teen years. It then occurs most often when you are in your 20s and 30s. It may continue into your later years. It is not a serious medical risk.

Sleep paralysis can be one sign of narcolepsy. Other signs include disturbed sleep at night and falling asleep suddenly during the day. Recurrent isolated sleep paralysis does not disturb your sleep.

In the medical literature, two terms are commonly used to categorize cases of sleep paralysis ³:

1. Isolated sleep paralysis is when the episodes are not connected to an underlying diagnosis of narcolepsy, a neurological disorder that prevents the brain from properly controlling wakefulness and often leads to sleep paralysis.
2. Recurrent sleep paralysis involves multiple episodes over time.

In many cases, these two defining characteristics are combined to describe a condition of recurrent isolated sleep paralysis (RISP), which involves ongoing instances of sleep paralysis in someone who does not have narcolepsy.

Sleep Stages

Sleep occurs in 2 main phases, Non-Rapid Eye Movement (NREM) sleep, which has three stages (N1, N2, and N3), and Rapid Eye Movement (REM) sleep ⁴. Each sleep phase and stage of sleep includes variations in muscle tone, brain wave patterns, and eye movements. Your body cycles through all stages approximately 4 to 6 times each night, averaging 90 minutes for each cycle ⁵. Each sleep stage serves different functions, from the light transition into sleep (N1), to the restorative deep sleep (N3) and the active dreaming of REM sleep.

Sleep Stages ⁶, ⁷:

• Stage 1 (N1 or light sleep) is the lightest stage of sleep and occurs as a person first falls asleep. This brief stage is when your drowsiness gives way to falling asleep. Your heartbeat and breathing start to slow down, but it’s still pretty easy to wake you up during this stage. Average length 1 to 7 minutes.
• Stage 2 (N2 or intermediate sleep) is where the body starts to relax more deeply. Your body temperature drops, your muscles relax, and your breathing and heart rate slow even more. Average length 10 to 25 minutes.
• Stage 3 (N3 or deep sleep) is the deepest and more restorative sleep, allowing your body to recover and grow. In stage 3 sleep, your breathing and pulse are slow and steady. Average length 20 to 40 minutes.
• Stage 4 (REM Sleep) is where most dreaming occurs, brain activity increases almost as if you were awake, and your muscles become temporarily paralyzed. Your heart rate and respiration speed up and become more erratic, and your eyes move quickly behind your eyelids. Dreams are most vivid during the REM stage. Average length 10 to 60 minutes.

Although the sleep stages are described numerically, you don’t always progress through them in this exact order. For example, in many sleep cycles, you transition from stage 3 sleep back to stage 2 sleep before beginning a period of REM sleep.

Sleep occurs in 5 stages: Wake, Non-Rapid Eye Movement (NREM) stage N1, then progress through N2 and N3, and after N3 you enter REM sleep ⁴. You then return to NREM stages, often starting again at N2. Throughout the night, the REM periods lengthen, and deep N3 sleep decreases, with most N3 sleep occurring in the first half of the night, with each stage leading to progressively deeper sleep. Approximately 75% of sleep is spent in the NREM (Non-Rapid Eye Movement) stages, with the majority spent in the N2 stage ⁸. A typical night’s sleep consists of 4 to 5 sleep cycles, with the progression of sleep stages in the following order: N1, N2, N3, N2, REM ⁹. A complete sleep cycle takes roughly 90 to 120 minutes. The first REM period is short, and as the night progresses, longer periods of REM and decreased time in deep sleep (NREM) occur ⁴. With each new cycle, you spend increasing amounts of time in REM sleep, so most of your REM sleep takes place in the second half of the night.

Sleep isn’t uniform. Sleep cycles can vary from person to person and from night to night based on a wide range of factors such as your age, recent sleep patterns, and alcohol consumption. Over the course of the night, you go through several rounds of the sleep cycle, which is composed of four stages. In a typical night, a person goes through four to six sleep cycles ⁴. Not all sleep cycles are the same length, but on average they last about 90 minutes each.

The first sleep cycle is often the shortest, ranging from 70 to 100 minutes, while later cycles tend to fall between 90 and 120 minutes. In addition, the composition of each cycle — how much time is spent in each phase of sleep — changes as the night goes along.

Figure 1. Sleep Stages

Footnotes: A sleep episode begins with a short period of NREM stage N1 progressing through stage N2, followed by stage N3 and finally to REM. However, individuals do not remain in REM sleep the remainder of the night but, rather, cycle between stages of NREM and REM throughout the night. NREM sleep constitutes about 75 to 80 percent of total time spent in sleep, and REM sleep constitutes the remaining 20 to 25 percent. The average length of the first NREM-REM sleep cycle is 70 to 100 minutes. The second, and later, cycles are longer lasting—approximately 90 to 120 minutes ¹⁰. In normal adults, REM sleep increases as the night progresses and is longest in the last one-third of the sleep episode. As the sleep episode progresses, stage 2 begins to account for the majority of NREM sleep, and stages 3 and 4 may sometimes altogether disappear.

[Source ⁶ ]

Figure 2. Typical Sleep Pattern in Young Adults 

Footnotes: Average times and sequences of sleep cycles during the night. Over the course of a period of sleep, NREM and REM sleep alternate cyclically. The function of alternations between these two types of sleep is not yet understood, but irregular cycling and/or absent sleep stages are associated with sleep disorders ¹¹. For example, instead of entering sleep through NREM, as is typical, individuals with narcolepsy enter sleep directly into REM sleep ¹². Rapid eye movement (REM) sleep occurs cyclically throughout the night every 90 to 120 minute. Brief periods of wakefulness (stage W) occur periodically.  Sleep time is spent as follows:

• Stage N1: 2–5%
• Stage N2: 45–55%
• Stage N3: 13–23%
• REM: 20–25%

[Source ¹³ ]

Figure 3. EEG activity of the four stages of sleep

Footnotes: EEG activity during wakefulness with eyes open and closed and during the different stages of sleep. Brainwave activity changes drastically over the course of the different stages of sleep. REM sleep brain activity most closely resembles brain activity while awake.

• Alpha activity is a smooth electrical activity of 8-12 Hz recorded from the brain; generally associated with a state of relaxation during wakefulness.
• Beta activity is a irregular electrical activity of 13-30 Hz recorded from the brain; generally associated with a state of alertness during wakefulness.
• Theta activity is EEG activity of 3.5-7.5 Hz that occurs intermittently during lighter stages of NREM sleep.
• Delta activity is a regular, synchronous electrical activity of less than 4 Hz recorded from the brain; occurs during the deepest stages of slow-wave sleep.
• Sleep spindle is a short burst of 12 to 14 cycle per-second waves observed during NREM sleep, decrease brain’s sensitivity to sensory input and keeps person asleep.
• K complex are single delta waves, sudden sharp wave forms, 1 per minute but can be triggered by noise.

[Source ¹⁴ ]

Your sleep-wake cycle is regulated by the circadian rhythm (your body’s natural internal 24-hour clock that manages your sleep-wake cycle and other vital functions, like hormone release and body temperature, by synchronizing with the day-night cycle), which is driven by the suprachiasmatic nucleus (SCN) of the hypothalamus that acts as a “master clock” or “circadian pacemaker”, receiving light cues from your eyes to control the circadian rhythm ¹⁵, ¹⁶, ¹⁷. The circadian rhythm also controls the nocturnal release of adrenocorticotropic hormone (ACTH), prolactin, melatonin, and norepinephrine (NE) ¹⁸. External factors like light exposure, meal timing, and activity can influence the circadian rhythm, and disruptions to the circadian rhythm, such as from shift work or jet lag, can negatively affect your health.

The suprachiasmatic nucleus (SCN) of the hypothalamus receives input from nerve cells in the retina that detect light to regulate the circadian rhythm and sleep via multiple pathways that cause the nocturnal release of adrenocorticotropic hormone (ACTH), prolactin, melatonin, and norepinephrine ¹⁹. One of the most commonly recognized pathways by which this occurs is via the stimulation of norepinephrine release by the suprachiasmatic nucleus (SCN), which in turn stimulates the pineal gland to release melatonin ²⁰, ¹⁷. Wakefulness is maintained by subcortical structures and pathways activating the cortical system ²⁰. This system is termed the “ascending arousal system” and utilizes several major neurochemicals, including:

• Norepinephrine (locus ceruleus)
• Serotonin (midline raphe nuclei)
• Histamine (tuberomammillary nucleus)
• Dopamine (ventral periaqueductal gray matter)
• Acetylcholine (pedunculopontine tegmentum and laterodorsal tegmentum of the pons)
• Orexin (perifornical area)

Transitions between sleep and wake states are influenced by multiple brain structures, including ⁴:

• Hypothalamus: controls onset of sleep
• Hippocampus: memory region active during dreaming
• Amygdala: emotion center active during dreaming
• Thalamus: prevents sensory signals from reaching the cortex
• Reticular formation: regulates the transition between sleep and wakefulness
• Pons: helps initiate REM sleep. The extraocular movements (eye movements) that occur during REM sleep are due to the activity of PPRF (paramedian pontine reticular formation/conjugate gaze center).

Although it is apparent that humans need sleep, the current understanding of why sleep is an essential part of life is still yet to be determined ⁴. The current hypotheses on the function of sleep include ²¹:

• Neural maturation
• Facilitation of learning or memory
• Targeted erasure of synapses to “forget” unimportant information that might clutter the synaptic network
• Cognition
• Clearance of metabolic waste products generated by neural activity in the awake brain
• Conservation of metabolic energy.

Wake or Alert Stage

The first stage is the wake stage or stage W, which further depends on whether your eyes are open or closed. During wakefulness, the EEG is characterized by waves of low amplitude and high frequency. This kind of EEG pattern is known as low-voltage fast activity or activated. During eye-open wakefulness, beta waves predominate. Alpha waves (8–13 Hz) become the predominant pattern as you become drowsy and close your eyes, particularly in occipital regions ²². The Electromyography (EMG, a test that measures the electrical activity of muscles) reveals tonic muscle activity with additional phasic activity related to voluntary movements.

EEG recording: beta waves – highest frequency, lowest amplitude (alpha waves are seen during quiet/relaxed wakefulness)

Non-Rapid Eye Movement (NREM) Sleep Stages

• Stage N1 (Light Sleep): This is the transition between wakefulness and sleep, characterized by slowing heart rate and breathing.
• Stage N2 (Intermediate Sleep): Your heart rate and body temperature decrease further, and your body relaxes.
• Stage N3 (Deep Sleep): This is the deepest stage of Non-Rapid Eye Movement (NREM) sleep, when your body performs restorative work, and it is crucial for feeling rested.

Stage 1 or N1 Sleep

NREM Stage 1 (N1) or Light Sleep serves a transitional role in sleep-stage cycling. This is the lightest stage of sleep and begins when more than 50% of the alpha waves are replaced with low-amplitude mixed-frequency (LAMF) activity. Muscle tone is present in the skeletal muscle, and breathing occurs regularly. This stage lasts around 1 to 7 minutes in the initial cycle, comprising 5% of total sleep time and is easily interrupted by a disruptive noise.

Brain activity on the EEG in stage 1 transitions from wakefulness (marked by rhythmic alpha waves) to low-voltage, mixed-frequency waves. Alpha waves are associated with a wakeful relaxation state and are characterized by a frequency of 8 to 13 cycles per second ¹².

EEG recording: Theta waves – low voltage.

Stage 2 or N2 Sleep

NREM Stage 2 (N2) represents deeper sleep as the heart rate and body temperature drop ⁴. The presence of sleep spindles, K-complexes, or both characterizes it ⁴. Sleep spindles are brief, powerful bursts of neuronal firing in the superior temporal gyri, anterior cingulate, insular cortices, and thalamus, inducing calcium influx into cortical pyramidal cells. This mechanism is believed to be integral to synaptic plasticity. Numerous studies suggest that sleep spindles are essential in memory consolidation, specifically procedural and declarative memory ²³. Individuals who learn a new task have a significantly higher density of sleep spindles than those in a control group ²⁴.

K-complexes are long delta waves that last approximately one second and are known to be the longest and most distinct of all brain waves. K-complexes are shown to function in maintaining sleep and memory consolidation ²⁵.

Stage 2 sleep lasts approximately 10 to 25 minutes in the initial cycle and lengthens with each successive cycle, eventually constituting between 45 to 55 percent of the total sleep episode. Stage 2 sleep is when bruxism (teeth grinding) occurs. An individual in stage 2 sleep requires more intense stimuli than in stage 1 to awaken. Brain activity on an EEG shows relatively low-voltage, mixed-frequency activity characterized by the presence of sleep spindles and K-complexes.

EEG recording: Sleep spindles and K complexes.

Stage 3 or N3 Sleep (Deepest Non-REM Sleep)

Sleep stage 3 or N3 sleep is also known as slow-wave sleep (SWS). This is considered the deepest stage of sleep and is characterized by signals with lower frequencies and higher amplitudes, known as delta waves ⁴. Sleep stage 3 or N3 sleep is the most difficult to awaken from; for some people, loud noises (> 100 decibels) will not lead to an awake state ⁴. As people age, they spend less time in this slow, delta-wave sleep and more time in stage N2 sleep ⁴. Although this stage has the greatest arousal threshold, if someone is awoken during this stage, they will have a transient phase of mental fogginess, known as sleep inertia ⁴. Cognitive testing shows that individuals awakened during this stage tend to have moderately impaired mental performance for 30 minutes to 1 hour ²⁶. Sleep stage 3 or N3 sleep stage is when the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system. Sleep stage 3 or N3 sleep is also the stage when sleepwalking, night terrors, and bedwetting occur ²⁷.

Sleep stage 3 or N3 sleep lasts only a few minutes and constitutes about 3 to 8 percent of sleep. The EEG shows increased high-voltage, slow-wave activity.

EEG recording: Delta waves – lowest frequency, highest amplitude.

Rapid Eye Movement (REM) Sleep Stage

Rapid eye movement sleep or REM sleep is the fourth and final stage of sleep and is when you have your most vivid and intense dreams. During REM sleep your brain activity increases to near-waking levels, your eyes dart quickly under your eyelids with fluctuating in your breathing and heart rate and most vivid dreams occur in this phase of sleep. Your muscles become limp (atonia) to prevent you from acting out your dreams. EEG recording shows beta waves – similar to brain waves during wakefulness. You experience your first period of REM sleep about 60 to 90 minutes after falling asleep ¹⁹.

REM sleep is defined by the presence of desynchronized (low-voltage, mixed-frequency) brain wave activity, muscle atonia, and bursts of rapid eye movements ¹². “Sawtooth” wave forms, theta activity (3 to 7 counts per second), and slow alpha activity also characterize REM sleep ¹⁰. During the initial cycle, the REM period may last only 1 to 5 minutes; however, it becomes progressively prolonged as the sleep episode progresses ¹⁰.

Most adults need about 2 hours of REM sleep each night, which contributes to brain development, brain function, memory consolidation, and emotional health ²⁸, ²⁹.

Infants and children need more REM sleep, because their brains are still rapidly developing. For example, newborn babies spend around eight hours in REM sleep each day.

How much time you actually spend in REM sleep can vary from night to night. On a night when you’re short of sleep, your total REM time can get cut short. This can trigger your brain to initiate more REM sleep the following night, which is known as a REM rebound ³⁰. Some research also suggests that REM sleep may increase after learning new information ³¹.

Because REM sleep enables better brain function, memory, and emotional regulation, a lack of REM sleep can cause a range of issues. On top of that, a lack of REM sleep circumvents healthy sleep overall, contributing to sleep deprivation. In the short term, signs of sleep deprivation can include ³²:

• Difficulty concentrating
• Excessive daytime sleepiness
• Forgetfulness or poor memory
• Irritability or frustration
• Greater risk of accidents

Over the long term, insufficient sleep can weaken your immune system and raise your risk of conditions like heart disease, diabetes, depression, and anxiety.

How Much Deep Sleep Do I Need?

Different people need different amounts of sleep. Most adults need 7 to 8 hours of sleep a night for good health and mental functioning. Some adults need up to 9 hours a night ³³. During a healthy night’s sleep for most adults, deep sleep (stage 3 or N3 sleep) makes up between 10% and 20% of total sleeping time ³⁴. People who sleep less than approximately 7 hours a night are at a greater risk for heart disease, stroke, asthma, arthritis, depression, and diabetes. Nearly 20% of all car crashes, both fatal and nonfatal, are attributed to drowsy driving. Without enough sleep, your brain may struggle to perform basic functions. You may find it hard to concentrate or remember things. You may become moody and lash out at co-workers or people you love.

If you’re not sure about how much sleep you really need, you can use an online Sleep Calculator (https://www.sleepfoundation.org/sleep-calculator). However, your doctor is in the best position to make a detailed sleep recommendation for you based on your age, your overall health and your unique situation.

Table 1. Recommended Sleep Duration

	Age Range	Recommended Daily Sleep
Infant	4–12 months	12-16 hours (including naps)
Toddler	1–2 years	11-14 hours (including naps)
Preschool	3–5 years	10-13 hours (including naps)
School-age	6-12 years	9-12 hours
Teens	13-18 years	8-10 hours
Adults	18 years and older	7 or more hours

[Source ³⁵ ]

Just as your brain needs sleep to restore itself, so does your body. When you do not have enough sleep, your risk goes up for several illnesses.

• Diabetes. Your body does not do as well controlling blood sugar when you do not get enough sleep.
• Heart disease. Lack of sleep can lead to high blood pressure and inflammation, two things that can damage your heart.
• Obesity. When you do not get enough rest from sleep, you are more prone to overeat. It is also harder to resist foods high in sugar and fat.
• Infection. Your immune system needs you to sleep so it can fight colds and keep you healthy.
• Mental health. Depression and anxiety often make it hard to sleep. They also can become worse after a string of sleepless nights.

The cancer research branch of the World Health Organization has determined that disruption of regular sleep is “probably carcinogenic to humans”, putting it in the same risk category as the infectious agents malaria and human papillomavirus (HPV), as well as the biochemical weapon mustard gas. Sexual health is affected by sleep deprivation as well, as men with the worst sleeping habits have significantly lower sperm counts, decreased circulating testosterone, and even testicular shrinkage.

Adults generally need about 1.5 to 2 hours of deep sleep per night, which equates to roughly 13-23% of their total recommended sleep time. This stage of sleep is crucial for physical recovery, immune function, and cognitive health, so ensure you are getting sufficient overall sleep and practicing healthy sleep habits to obtain enough deep sleep

Why Deep Sleep is Important?

While all stages of sleep are necessary for good health, deep sleep is important because it is when your body undergoes essential physical restoration, immune system strengthening, and hormone production, while your brain processes and stores memories, consolidates learning, and clears waste products ⁷. During deep sleep, your body works to build and repair tissue, muscles, and bones, including by producing high levels of growth hormone ³⁶. Achieving sufficient deep sleep helps you wake feeling refreshed, promotes long-term physical and mental health, and supports healthy weight and cardiovascular function ⁷. Deep sleep also promotes immune system functioning. Research suggests that it helps you build stronger immune responses and reduce unwanted chronic inflammation ³⁷.

Slow-wave sleep also helps regulate blood sugar levels. As a result, the risk of developing type 2 diabetes may be higher if you don’t get enough deep sleep ³⁸. And a shortage of deep sleep has also been linked to high blood pressure ³⁹.

Deep sleep is important for cognitive function and memory. Although brain activity slows during deep sleep, this may actually facilitate learning by keeping the brain from becoming oversaturated with information. Evidence suggests that deep sleep also helps eliminate waste material from the brain, which may help protect against dementia ⁴⁰.

Because deep sleep is an essential component of your nightly rest, a shortage of deep sleep contributes to broader impacts of sleep deprivation. In addition to causing tiredness, a shortage of deep sleep can cause general symptoms of sleep deprivation, including ⁴¹:

• Reduced alertness and attention
• Trouble learning and remembering things
• Irritability
• Symptoms of depression or anxiety
• Increased likelihood of accidents and injuries

On top of these immediate effects, a chronic lack of quality sleep can increase the likelihood of multiple health problems, such as:

• Infections and reduced immune system function
• Obesity
• Type 2 diabetes
• Cardiovascular problems, including high blood pressure, stroke, and heart disease
• Kidney disease

If you want to get more deep sleep, focus on enhancing your overall sleep. If your sleep quality and quantity are good, it usually means you’re getting plenty of restorative deep sleep. You get the most deep sleep during the early part of the night.

One of the most reliable ways to improve your sleep is by practicing good sleep hygiene. Good habits include ⁴²:

• Establishing a consistent bedtime and wake-up time
• Ensuring you have a quiet, cool, and dark sleep environment
• Creating a relaxing bedtime routine to wind down in the evening
• Reducing caffeine intake in the afternoon and evening
• Limiting use of mobile devices, tablets, laptops, and other screens for 30 minutes or more before bedtime

There are some additional steps you can try to encourage more deep sleep:

• Take a warm bath: Some research suggests that heating your body with a warm bath before bedtime may induce more slow-wave sleep ⁴³. A warm bath raises body temperature, which promotes blood circulation, and the subsequent cooling may help ease the transition to sleep.
• Change your diet: What you eat and drink before bedtime impacts your sleep. One small study found that people eating a diet high in saturated fats obtained less slow-wave sleep ⁴⁴. People who ate more fiber were more likely to have increased amounts of deep sleep.
• Listen to binaural beats: Binaural beats are created by listening to two slightly different tones, one in each ear. The difference between the frequencies of those tones creates a perceived third tone, or binaural beat. Limited research suggests that listening to certain binaural beats may contribute to more stage 3 sleep ⁴⁵.

False awakening causes

There’s no scientific consensus on the cause of false awakenings. As with sleep paralysis, false awakening is related to disrupted REM sleep ⁴⁶. A few suggested explanations for false awakenings include: sleep disorders, such as insomnia and sleep apnea. Anticipation, or knowing you need to wake up early for a specific reason. Noise and other disturbances that interrupt your sleep without fully waking you up.

It is also important to know if there is something else that is causing your sleep problems. False awakening may be a result of one of the following:

• Another sleep disorder such as narcolepsy
• A medical condition
• Medication use
• A mental health disorder
• Substance abuse

Sleep paralysis can affect men and women of any age group. The average age when it first occurs is 14 to 17 years. It is a fairly common sleep problem. Estimates of how many people have it vary widely from 5% to 40%. You may be more likely to have it if a relative also has it.

A lack of sleep can make you more likely to have sleep paralysis. It is also more likely if you have a sleep schedule that often changes. Mental stress may also be a factor. It seems to occur more often when you sleep on your back. It may also be related to any of the following factors:

• Bipolar disorder
• The use of certain medications
• Sleep related leg cramps

False awakening and sleep paralysis diagnosis

Recurrent isolated sleep paralysis is fairly common. In most cases, it does not affect your sleep or overall health. Talk to your doctor if episodes of sleep paralysis make you anxious. You should see a sleep specialist if the episodes keep you up at night or make you very tired during the day.

The doctor will need to know when the sleep paralysis started. He or she will want to know how often it occurs and how long it lasts. The doctor will need to know your complete medical history. Be sure to inform him or her of any past or present drug and medication use.

Also tell your doctor if you have ever had any other sleep disorder. Find out if you have any family members with sleep problems. It will also be helpful if you fill out a sleep diary for two weeks. The sleep diary will help the doctor see your sleeping patterns. This data gives the doctor clues about what is causing your problem and how to correct it.

Doctors do not need any tests to treat most patients with recurrent isolated sleep paralysis. Your doctor may have you do an overnight sleep study if your problem is disturbing your sleep. This study is called a polysomnogram. It charts your brain waves, heart beat, and breathing as you sleep. It also records how your arms and legs move. An electromyogram (EMG) recording will show the level of electrical activity in your muscles. This level will be very low during an episode of sleep paralysis.

If you tend to be very sleepy during the day, then your doctor may also have you do a daytime nap study. This is called a Multiple Sleep Latency Test (MSLT). The MSLT will measure how fast you fall asleep during the day. It will also show what kind of sleep you have when you take a nap. It will help to show if your sleep paralysis is a sign of narcolepsy.

False awakening and sleep paralysis treatment

A first step in treating sleep paralysis is to talk with a doctor in order to identify and address underlying problems that may be contributing to the frequency or severity of episodes. Treatment of sleep paralysis is aimed at whatever causes it to occur. Sleep deprivation may trigger sleep paralysis. In this case, try to get at least six to eight hours of sleep per night. People with psychiatric problems may suffer from sleep paralysis. An example is someone who has bipolar disorder. This person would need ongoing treatment with medication. This would be overseen by a physician or psychiatrist. You may notice sleep paralysis occurring with leg cramps. It may also happen after a change in your medicines. Discuss these issues with your doctor.

People with narcolepsy often have sleep paralysis. They normally need an antidepressant medication to reduce or eliminate dream sleep. This will help to ease the sleep paralysis. Taking an antidepressant drug does not mean that you are depressed. It is simply a method to help reduce sleep paralysis.

Overall, there is limited scientific evidence about the optimal treatment for sleep paralysis. Many people don’t know that the condition is relatively common and thus see themselves as crazy or shameful after episodes. As a result, even just the acknowledgement and normalization of their symptoms by a doctor can be beneficial.

Because of the connection between sleep paralysis and general sleeping problems, improving sleep hygiene is a common focus in preventing sleep paralysis. Sleep hygiene refers to a person’s bedroom setting and daily habits that influence sleep quality.

Examples of healthy sleep tips that can contribute to better sleep hygiene and more consistent nightly rest include:

• Following the same schedule for going to bed and waking up every day, including on weekends.
• Keeping a set pre-bed routine that helps you get comfortable and relaxed.
• Outfitting your bed with a comfortable mattress and pillow.
• Setting up your bedroom to have limited intrusion from light or noise.
• Reducing consumption of alcohol and caffeine, especially in the evening.
• Putting away electronic devices, including cell phones, for at least a half-hour before bed.

Improving sleep hygiene is frequently incorporated into cognitive behavioral therapy for insomnia (CBT-I), a type of talk therapy that works to reframe negative thoughts and emotions that detract from sleep.

A specific form of CBT has been developed for sleep paralysis ⁴⁷, but more research is needed to validate its effectiveness. CBT has an established track record ⁴⁸ in addressing mental health conditions like anxiety and PTSD that may be factors influencing the risk of sleep paralysis.

Some medications are known to suppress REM sleep ⁴⁹, and these may help to stop sleep paralysis. These medications can have side effects, though, and may cause a rebound in REM sleep when someone stops taking them. For these reasons, it’s important to talk with a doctor before taking any medication in order to discuss its potential benefits and downsides.

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