What causes sleep paralysis?

Illustration by Slug Signorino

Cecil replies:

Jeepers, P., I dunno. Could be it’s a relatively harmless phenomenon called “early sleep paralysis,” which occurs in about 15-20 percent of the population. On the other hand, it could be a symptom of narcolepsy, epilepsy, or, for that matter, dietpepsy, which results from excessive consumption of sugar-free beverages. (Sorry, couldn’t help it.) Signs of narcolepsy include sleep paralysis and “hypnagogic hallucinations” — “extremely vivid dreamlike experiences that occur as the individual is falling asleep [e.g., descending black clouds, one supposes]. Such dreams are often difficult to distinguish from waking experiences” (W.C. Orr, in The Sleep Disorders, 1982). Also sez here that “normal subjects may have an occasional sleep paralysis when awakening; [sleep-onset-only] paralysis suggests narcolepsy.” By far the most common symptom of narcolepsy, however, is excessive daytime sleepiness, including frequent “sleep attacks.” If you’ve got that too, you poor guy, hustle over to a sleep-disorder specialist for a confirmed diagnosis. Not that it’s going to help you much; narcolepsy has no cure.

On the other hand, maybe what you’ve got is epilepsy. Epileptic seizures are often preceded by a brief period of altered consciousness called an “aura,” which could be the “energy” you claim you feel prior to the arrival of the cloud. Terrifying hypnagogic hallucinations are also a sign of this disease. Again, find a sleep-disorder specialist. Call a university medical center if you don’t know where to start looking.

The Teeming Millions want a second opinion

Dear Cecil:

Shame on you, Cecil! How dare you tell that poor fool to see a doctor! This man was obviously experiencing astral phenomena resulting from the projection of the astral body! Epilepsy, huh? Where the hell did you get that? You’re liable to worry the poor fellow to death! When someone comes to you with a question about the unexplainable you’ve gotta realize that science and medicine, no matter how modern and up to date they are, cannot explain that stuff! Next time before you tell some unsuspecting slob to blow his life savings on somebody’s couch, go to the nearest spiritualist bookstore and find out what it’s all about! The best book I’ve found on this subject is The Projection of the Astral Body by Muldoon and Carrington. It will explain most if not all of this curious phenomenon.

— K.M., West Hollywood, California

“Poor fool”? “Unsuspecting slob”? Hey, at least I didn’t insult the guy.

Definite trend begins to emerge

Dear Cecil:

Why do we insist on believing the myth of “scientific” explanations, expecially when such explanation teach us to fear? P.S. began his letter by saying that initially he “felt great”! The black cloud he saw frightened him, but it didn’t hurt him, did it? If I were responding to P.S., I would tell him not to fear these experiences, and certainly not to struggle to escape from them. Instead I would simply let them happen and observe. These nascent “astral projections” (one of many names given to them outside the “scientific” community) may eventually lead to a lot more exciting, and more pleasant, experiences than ominous black clouds.

— Robert M., Washington, D.C.

Yeah, and they could lead to an outright seizure, too. I don’t want to exaggerate the danger, but several members of Cecil’s family suffer from epilepsy, and one once had a seizure while cruising down the highway at 60 MPH. He was saved from disaster only by the quick action of a passenger. He takes medication now to prevent a recurrence. P.S. may well be perfectly healthy, but I’d rather give him the facts than fill him full of nutty ideas about astral projection.

A word from somebody who’s been there

Dear Cecil:

In your recent column concerning paralytic dreams, you suggested that the cause might be narcolepsy, which has the additional symptoms of daytime sleepiness and frequent sleep attacks. You also said that even if the poor fellow or gal does get a narcolepsy diagnosis, it wasn’t going to help much because narcolepsy has no cure.

I am not a doctor or medical authority. However, I have been a longtime experiencer of paralytic dream states and from childhood I have experienced excessive daytime sleepiness and frequent sleep attacks. It is not true that nothing can be done for victims of this condition.

After three decades of a low energy, indolent lifestyle, I have found relief. I hopped on down to my local sleep disorder center and was told to have a sleep test to see if I had narcolepsy. The test involves being wired up and measured as you sleep. Being the nervous type, I was not able to get a good sleep during the test. I was told I didn’t have narcolepsy and I thought I was doomed to a life of paralytic dreams and frequent sleep attacks as well as extreme nervousness if I didn’t get my naps in.

I asked my doctor if he could provide me with whatever he would have prescribed if I had tested positive on the sleep test. He prescribed Ritalin, a drug that is used not to cure narcolepsy but to control the symptoms. I’ll tell you, it really made a difference in my life. I am actually able to work a full day now without nodding off during work or at lunch. I can watch a movie without falling asleep. I mean, I have fallen asleep during rock concerts and left the place with my ears ringing because of the loud sounds and yet not remembered the performance because I had nodded off.

Cecil should suggest his reader get his doctor to prescribe Ritalin even if the test for narcolepsy is negative. I know the reader didn’t complain about sleepiness, but if he or she is experiencing sleepiness along with paralytic dreams, this would be the route to try.

— Eugene S., Evanston, Illinois

You know, Eugene, in some ways a low-energy, indolent lifestyle doesn’t sound half bad. But I suppose this is no time for levity. Ritalin, a non-amphetamine stimulant, is probably the most common drug prescribed for narcolepsy. As you note, it does not cure the condition, it only alleviates the symptoms. My medical sources tell me it does not have much effect on paralytic dreams. For people suffering from such dreams, doctors often prescribe from a class of drugs known as “tricyclic antidepressants.” The American Narcolepsy Association announced the other day that a new drug made by Stuart Pharmaceuticals called Vivalan is now being tested which also promises to help.

Cecil Adams

Send questions to Cecil via cecil@straightdope.com.