Sleep Disorders

Updated 16 August 2016

This frightening disorder haunts many people at night

It's four o'clock in the morning and you suddenly wake up. Your heart starts pounding and from the corner of your eye you see a hooded figure . . .


Nomsa Gwala* can vividly remember the first time she suffered an attack. “It was about four o’clock in the morning and I had abruptly woken up,” she recalls that terrifying night almost three years ago.

“As I opened my eyes I could immediately feel something was wrong. I was awake, but I could not move my body. It was as if I was paralysed, and from the corner of my eye a shadow figure was slowly approaching me . . .”

Most people would think this 28-year-old newspaper reporter from Johannesburg was suffering from a hallucination, but instead Nomsa suffers from a debilitating condition called sleep paralysis.

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The American Academy of Sleep Medicine defines this condition as the temporary inability to move your body, either when you are falling asleep or when you are waking up. This paralysis can last from a few seconds to several minutes. It’s often accompanied by hallucinations on which you can’t act.

And Gwala is definitely not alone in suffering from this condition. Research from Pennsylvania State University found that 7.6% of the general population and 28.3% of students experience at least one episode of sleep paralysis during their lifetime.

‘I thought I was going mad’

Suffering from sleep paralysis can be very frightening, says Gwala. “You just have to tell yourself what you are seeing and experiencing is not real. The first time it happened to me I thought I was going mad.”

Besides being paralysed, common symptoms of sleep paralysis include:

  • Not being able to talk. Even if you want to scream for help, you aren’t able to do so.
  • Restricted breathing. Some people complain that taking deep breaths is often difficult, or that “a presence” is sitting on their chest.
  • Experience hallucinations. Although they don’t occur in every case, such hallucinations can seem very real to the sufferer.
  • Feeling extreme anxiety. Because your arms, legs and body are completely paralysed, you may experience elevated heart rate, sweating and other symptoms of anxiety.

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Why does it develop?

Although research is still murky on the exact causes of the disorder, lack of sleep, a sleep schedule that often changes, and mental stress can lead to sleep paralysis. Bipolar disorder and other psychiatric conditions are also risk factors.

Experts think sleep paralysis happens when a person wakes up before rapid eye movement (REM) sleep is finished. During this deep state, our brain has vivid dreams while the muscles of the body are essentially turned off. The person will thus still experience the dream (hallucination), but will temporarily be unable to physically act on it.


“My doctor told me to stick to a strict sleep schedule,” says Gwala. “I have no electronics in the bedroom and I read something calming as I fall asleep.”

In most mild cases, getting eight hours of sleep and going to bed at roughly the same time each night might help. Other things that might help include:

  • Cutting down on caffeine
  • Not eating or drinking before bedtime
  • Creating a restful sleeping environment

In more severe cases antidepressants such as anafranil, norpramin or Prozac might be prescribed. This can slightly alter the neurochemicals in the brain that control REM sleep and can prevent the paralysis. It can also reduce the experience of hallucinations.

* Not her real name

Read more:

Sleep apnoea linked to aggressive melanoma

Insomnia: therapy preferable to medication

Sleep issues in arthritis patients


Ask the Expert

Sleep disorders expert

Dr Alison Bentley is a general practitioner who has consulted in sleep medicine and sleep disorders, in both adults and children of all ages, for almost 30 years. She also researches and publishes on a number of sleep-related topics both in formal research journals and lay publications including as editor of Sleep Matters, an educational newsletter on sleep disorders for doctors.

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