Does sleep paralysis cause or is it caused by mental illness?


By David Joel Miller.

More on Sleep paralysis.

Remember this is written from a therapist’s point of view. If there is any chance that you or someone you know has a medical problem, have it checked out by a doctor first. But if the doctor finds nothing medically wrong with you that does not mean you are going crazy. It might mean that you can benefit from some counseling to help you better cope with stress.

Many people who experience sleep paralysis, hypnogogic hallucinations or “exploding head syndrome,” think they are going crazy or fatally ill. Knowing that these are explainable phenomena and have simple treatment can reduce the concerns. Sleep Paralysis and many related sleep problems are often triggered by stress. More stress, good or bad stress, and the chances of an attack increases.

People who become fearful of another occurrence of Sleep Paralysis can “prime the pump” and increase the risks of a second bout in the same way people who experience panic attacks begin to worry about having another episode.

If clients describe these events as dreams the doctor is likely to reassure them that it is normal. Patients who explain these events as demons, spirits or believe they actually saw a supernatural being are likely to be prescribed a psychiatric medication. Antipsychotics, antidepressants and anti-anxiety medications (Benzodiazepines) are all believed to increase the incidence of Sleep Paralysis and Hypnogogic Hallucinations (Gangdev, 2004.)

Other things that have been reported to increase the risks of having an episode of Sleep Paralysis include being physically ill, such as having the flu, watching or experiencing emotionally upsetting events, such as having an argument.

If the paralysis or hallucinations only occur when going to sleep and waking up they are most likely sleep related and not the result of a mental illness. Gangdev in his article asked the question: “It is possible that a small proportion of patients diagnosed with schizophrenia who experience hallucinations may actually be experiencing escaped REM-related dream activity during the wakeful state?”

There is a significant overlap between sleep paralysis and Narcolepsy. Narcolepsy includes not only sleep paralysis but hypnogogic and hypnopompic hallucinations, daytime sleepiness and Cataplexy (sudden unexplained loss of muscle tone.)

Sleep Paralysis without any cataplexy or daytime sleepiness is not considered to be associated with Narcolepsy and is referred to as Isolated Sleep Paralysis (ISP.) Penn reported that 16 % of medical students reported at least one episode of sleep paralysis. That makes me think that long hours and sleep deprivation may be a major cause of many of these events.

Sleep Paralysis is far more common in African-Americans and in one study of Nigerian subjects more than half had experienced ISP. It is also common in Japanese Subjects.

People who have a Sleep Paralysis event find it helpful to get up move about and make sure they are fully awake before attempting to return to bed. People who do not get out of bed have an increased risk of having multiple episodes of sleep paralysis in the same night. Sleeping flat on your back looking up at the ceiling (supine position) is much more likely to cause a Sleep Paralysis experience than sleeping on your side.

Knowing that episodes of Sleep Paralysis and Hypnogogic Hallucinations are relatively common and most often harmless can help someone cope with these experiences.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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3 thoughts on “Does sleep paralysis cause or is it caused by mental illness?

  1. Pingback: What are Lucid Dreams? Do Lucid Dreams cure Nightmares? | counselorssoapbox

  2. what is the further treatment modality for a person who after 9 years of being suffered from isolated sleep paralysis develop symptoms resembling schizophrenia and have already received treatment for schizophrenia for last 12 years?

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    • Hi Bhaskkar, Thanks for commenting.
      Lots of possibilities here. Without seeing the person involved I am just talking hypothetically here. Treatment should always be done face to face. Here are some general thoughts.
      This person may or may not need more treatment. Someone can have a serious mental illness, say schizophrenia, and when on meds and after some therapy they may be able to work a job and could have a happy relationship. So what does this person say the problem is? If the problem is they are about to become a parent and are afraid they do not know how, that needs one kind of counseling. If they are hearing voices telling them to hurt themselves, that is a very different issue.
      First off they should talk with their medical doctor. Someone can have mental health issues and a physical issue. You need it be sure the sleep paralysis is not a medical issue. They should also be talking to their psychiatrist and or therapist about what other treatment they need. This is a very individual thing.
      Many people with a severe mental illness get that illness under control but still need help with life skills, like getting a job being in a good relationship, making friends or creating a happy life that is right for them.
      My questions for someone in this position would be how are you doing and what do you see as the problems you need help with, then we might go from there. It is always worth asking the family and friends of anyone seeking help what they think this person’s problem is. Often others in your life see your problems more clearly than you do.

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