Recurrent Isolated Sleep Paralysis

Recurrent isolated sleep paralysis (RISP) is characterised by repeated episodes of sleep paralysis, occurring independently of other sleep disorders. RISP can occur in otherwise healthy people without a diagnosed sleep disorder. 

According to Cambridge University Press recurrent isolated sleep disorder is relatively common. Estimates of RISP prevalence vary dramatically, and are estimated as occurring in between 6% and 40% of the population.

What is Recurrent Isolated Sleep Paralysis?

Recurrent isolated sleep paralysis (RISP) is characterised by the repeated experience of sleep paralysis episodes. Sleep paralysis itself is a state where a person is temporarily unable to move or speak while falling asleep or waking up. It typically occurs during the transition between wakefulness and sleep, often accompanied by hallucinations or a feeling of pressure on the chest.

RISP differs from isolated sleep paralysis in that it involves recurring episodes. While isolated sleep paralysis might happen to someone once or very infrequently, RISP involves multiple occurrences over time. It can be distressing for those who experience it, as it can disrupt sleep and lead to feelings of anxiety or fear.

Experiencing RISP can lead to poor-quality sleep or sleep deprivation in some cases. Poor-quality sleep can have numerous negative effects on both physical and mental health, including:

• Cognitive impairment – lack of quality sleep can impair cognitive function, leading to difficulties with concentration, memory, problem-solving and decision-making.
• Mood disturbances – sleep deprivation or poor-quality sleep can contribute to irritability, mood swings, increased stress, anxiety and even depression.
• Weakened immune system – adequate sleep is crucial for a healthy immune system. Poor sleep can weaken the immune response, making you more susceptible to infections and illnesses.
• Increased risk of chronic diseases – chronic sleep deprivation has been linked to an increased risk of developing chronic conditions such as obesity, diabetes, cardiovascular disease and hypertension.
• Impaired motor skills – sleep deficiency can impair coordination, balance and fine motor skills, increasing the risk of accidents and injuries.
• Hormonal imbalance – sleep plays a vital role in regulating hormones that control appetite, metabolism, growth and stress response. Poor sleep can disrupt these hormonal systems, leading to weight gain, increased appetite and imbalanced stress responses.
• Impaired physical performance – athletes and individuals engaged in physical activities may experience decreased performance and slower recovery times due to poor sleep quality.
• Increased risk of mental health disorders – chronic sleep problems are associated with an increased risk of mental health disorders such as anxiety disorders, depression and bipolar disorder. For further reading about the link between sleep and mental health, please see our knowledge base.
• Reduced quality of life – overall, poor-quality sleep can significantly diminish quality of life, affecting relationships, work performance and overall well-being.

Symptoms of RISP

Recurrent isolated sleep paralysis (RISP) is repeated episodes of sleep paralysis, often accompanied by a feeling of being awake but unable to move or speak. Symptoms can vary in intensity and duration from person to person, and episodes of sleep paralysis may occur sporadically or with some regularity.  

Symptoms typically include:

• An inability to move or speak – during sleep paralysis episodes, people may find themselves temporarily unable to move their body or speak, despite being conscious and aware of their surroundings.
• Sensory hallucinations – people experiencing sleep paralysis may also report hallucinations, such as seeing or hearing things that are not there. These hallucinations can range from mild sensations to vivid and frightening experiences.
• Feeling of pressure or weight on the chest – some people may experience a sensation of pressure or heaviness on their chest during sleep paralysis, which can contribute to feelings of fear or panic.
• Fear or anxiety – sleep paralysis episodes can be accompanied by intense feelings of fear, anxiety or a sense of impending doom. This emotional response is often linked to the perceived inability to move or speak during the episode.
• Difficulty breathing – in some cases, people may report difficulty breathing during sleep paralysis episodes, which can further contribute to feelings of panic or distress.
• Sense of presence – many people with sleep paralysis describe a sense of presence or the feeling of someone else being in the room with them, even though there is no one present.

If you are experiencing recurrent episodes of sleep paralysis and it is significantly impacting your quality of life, it is important to speak with a healthcare professional.

Causes and Triggers

The causes of recurrent isolated sleep paralysis are not fully understood, and researchers believe it is influenced by a combination of biological, psychological and environmental factors. Some of the causes and triggers may include:

• Sleep disruption – RISP often occurs during transitions between different sleep stages, particularly during rapid eye movement (REM) sleep. REM sleep is when dreaming predominantly occurs, and during this stage, the body experiences muscle paralysis which prevents you from acting out dreams. Sometimes, people may partially awaken during REM sleep, leading to the experience of paralysis.
• A genetic predisposition – there may be a genetic component to RISP, as it tends to run in families. Some people may inherit a tendency to experience sleep disturbances or have a genetic predisposition to conditions associated with RISP, such as narcolepsy.
• Irregular sleep patterns – disrupted or irregular sleep schedules, such as shift work, jet lag or inconsistent sleep patterns, can increase the likelihood of experiencing sleep paralysis episodes.
• Sleeping position – some research suggests that sleeping on your back may increase the risk of experiencing sleep paralysis episodes.
• Having other sleep disorders – RISP can be associated with other sleep disorders such as narcolepsy, obstructive sleep apnoea or insomnia. Treating these underlying conditions may help to reduce the frequency of sleep paralysis episodes.
• Substance or alcohol use – certain substances, such as alcohol or drugs, can disrupt sleep patterns and increase the likelihood of experiencing RISP. Substances can significantly affect sleep in various ways, depending on the substance and individual factors like metabolism, tolerance and overall health.

Diagnosis and Evaluation

The diagnosis and evaluation of recurrent isolated sleep paralysis involve a comprehensive assessment of clinical history, physical examination, sleep study findings, and consideration of differential diagnoses to rule out underlying medical or sleep disorders. 

Diagnosis and evaluation may include:

• Clinical history – the diagnosis of RISP usually starts with a detailed clinical history. Patients often report episodes of waking up unable to move or speak, usually accompanied by an intense feeling of fear or anxiety. They may also describe vivid hallucinations, such as seeing shadowy figures or feeling a presence in the room.
• Physical examination – a physical examination is usually unremarkable in people with RISP. However, it is still important to rule out any underlying medical conditions or sleep disorders that may contribute to the episodes. This may include checking your vital signs such as blood pressure, heart rate, and respiratory rate. Your provider may also examine your throat, nose and mouth for any signs of obstruction or abnormalities that could contribute to sleep disorders like sleep apnoea. A neurological examination may involve assessing your cognitive function, reflexes and coordination to rule out any neurological conditions that could affect sleep. An evaluation of your breathing patterns may also be completed. There may also be an evaluation of heart function. Since some sleep disorders, such as sleep apnoea, can be associated with cardiovascular issues, your provider may perform tests such as an electrocardiogram (ECG) to assess your heart function.
• Sleep study (polysomnography) – polysomnography is a diagnostic test used to evaluate sleep disorders. It involves monitoring various physiological parameters during sleep, including brain activity, eye movements, muscle activity and respiratory function. A sleep study can help to identify any underlying sleep disorders, such as narcolepsy or sleep apnoea, which may be contributing to the episodes of sleep paralysis.
• Diagnostic criteria – the diagnosis of RISP is based on clinical criteria outlined in the International Classification of Sleep Disorders (ICSD). The diagnostic criteria for RISP include recurrent episodes of isolated sleep paralysis, the presence of hallucinations and/or fear during episodes, and the absence of any other sleep disorder or medical condition that could explain the episodes.
• Differential diagnosis – it is essential to differentiate RISP from other sleep disorders and medical conditions that may present with similar symptoms, such as narcolepsy, sleep-related seizures or psychiatric disorders. This often requires a comprehensive evaluation, including a thorough medical history, physical examination, and sometimes additional diagnostic tests.

Coping Strategies

Experiencing recurrent isolated sleep paralysis can be distressing. During sleep paralysis, individuals are awake and conscious but unable to move or speak. This loss of control over their body can be frightening and unsettling, leading to feelings of helplessness. Being unable to move or defend oneself can trigger a primal sense of vulnerability. This feeling of being exposed and defenceless can heighten anxiety and fear during sleep paralysis episodes. For individuals who experience frequent or recurring episodes of sleep paralysis, the anticipation of future episodes can create significant anxiety and distress, impacting overall quality of sleep and well-being. 

There are coping strategies that may help alleviate its effects:

• Understanding – educate yourself about sleep paralysis. Knowing that it’s a natural phenomenon and not harmful can reduce anxiety surrounding the experience.
• Sleep hygiene – maintain a regular sleep schedule, ensuring that you get enough sleep each night. Avoiding caffeine, heavy meals and electronic screens before bedtime can also promote better sleep quality.
• Relaxation techniques – practise relaxation techniques such as deep breathing, meditation, mindfulness or progressive muscle relaxation before bed to help calm your mind and body.
• Sleep position – experiment with different sleep positions to find one that minimises the likelihood of experiencing sleep paralysis. Some people find that sleeping on their side rather than their back can reduce episodes.
• Bedroom environment – create a comfortable and calming sleep environment. Keep your bedroom dark, quiet and at a comfortable temperature in order to promote restful sleep.
• Stress management – manage stress through activities such as exercise, yoga, journaling or talking to a therapist. Stress reduction can improve overall sleep quality and decrease the frequency of sleep paralysis episodes.
• Seek support – talk to friends, family or a mental health professional about your experiences. Sharing your feelings and concerns with others can provide emotional support and perspective.
• Limit stimulants – avoiding alcohol, nicotine and recreational drugs, especially close to bedtime, can help reduce the likelihood of experiencing sleep paralysis.
• Consult a specialist – if sleep paralysis significantly impacts your quality of life or occurs alongside other sleep disorders, consider consulting a sleep specialist. They can provide personalised advice and may recommend treatments such as cognitive-behavioural therapy for insomnia (CBT) or medication in severe cases.

Remind yourself during episodes that what you’re experiencing is temporary, and that you will regain control of your body soon.

Treatment Options

Recurrent isolated sleep paralysis (RISP) can be distressing. Various treatment options and coping strategies can help manage and reduce its occurrence. In some cases, medications such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants may be prescribed to help regulate sleep cycles and reduce the occurrence of sleep paralysis. However, medication should only be used under the guidance of a healthcare professional. Addressing underlying sleep disorders is important. Conditions such as sleep apnoea, insomnia or narcolepsy can contribute to sleep paralysis. Treating these underlying sleep disorders, often with the help of a sleep specialist, can reduce the frequency of sleep paralysis episodes.

Stress and anxiety can exacerbate sleep paralysis. Learning and practising stress reduction techniques such as meditation, mindfulness, deep breathing exercises, progressive muscle relaxation or yoga can help alleviate stress and promote better sleep. Understanding the nature of sleep paralysis and knowing that it is a relatively common phenomenon can help alleviate the fear and anxiety associated with the experience. Education about sleep hygiene and healthy sleep habits can empower individuals to take control of their sleep health. 

If your experience of RISP cannot be treated or cured, the various coping strategies discussed in this article may be the most important thing to focus on if you continue to experience RISP. 

The Sleep Charity aims to provide access to high-quality information and advice to deal with most sleep issues. They also campaign for improvements to the support available as well as providing accredited training for professionals so they can offer sleep support to the people they work with.