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Sleep Disorders

Difficulty Coming Out of Sleep

04/09/2009

Question:

Occasionally, it seems difficult to come fully awake. I can hear things around me, but must concentrate very hard to come fully awake. I am unable to move or speak, but hear myself moaning. My hearting is beating fast when I finally I become fully conscious.

Answer:

Feeling like you cannot move when you awaken can be a frightening and anxiety producing sensation. Surprisingly, up to 15-40% of young adults experience this at least once in their lifetime and as many as 5-6% have this occur recurrently.

There are a number of different potential causes for the sensations you describe, though this most likely represents a phenomenon known as “sleep paralysis”. Sleep paralysis is usually described as the inability to perform voluntary movements either at sleep onset or upon awakening. Individuals often report an inability to speak or move the limbs, trunk or head. Though there may be a sensation of an inability to breath, breathing and the breathing muscles are actually not affected. Individuals usually can recall the event. The episode typically only lasts for seconds up to a few minutes though may feel much longer to the individual experiencing it. Sleep paralysis tends to resolve on its own. Occasionally, the episode will end if the person is touched or spoken to. To those someone in sleep paralysis, they look they are asleep

Episodes of sleep paralysis can be very anxiety producing. Hallucinations, whether hearing or seeing things that are not present, can accompany the event. All-in-all, the experience can be somewhat frightening. Sleep paralysis can be seen in isolation or it can run in families. It tends to be brought on by lack of adequate sleep, keeping an irregular sleep schedule and being under excessive stress. While most of the time sleep paralysis is not associated with other medical conditions, it can be one of the signs of narcolepsy (individuals with this condition are also very sleepy).

Sleep paralysis usually first appears in young adults and tends to disappear with aging. Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

Other medical conditions that can appear with similar symptoms to sleep paralysis include compressed nerves, cataplexy (sudden loss of muscle control in emotionally charged situations such as laughing), seizures, and panic attacks. Most of these conditions can be separated from sleep paralysis by specific factors from the medical history.

If you are concerned about your symptoms or would like to exclude the other possibilities mentioned above, I recommend you discuss your problems with your primary care doctor. They can then decide if referral to a Sleep Specialist is needed for further evaluation.

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Response by:

Meena S Khan, MD Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University