Sleep Paralysis

Introduction

Sleep paralysis is a peculiar and often frightening experience characterized by a temporary inability to move or speak despite being fully conscious. This unsettling phenomenon typically occurs during the transitional phases between wakefulness and sleep. For centuries, sleep paralysis has been shrouded in mystery, with various cultures attributing it to supernatural encounters. From tales of demonic attacks to ghostly visitations, these historical interpretations reflect humanity's long-standing struggle to understand this unusual state. The "Night Hag" in Newfoundland, "ghost oppression" in China, and the "incubus" or "succubus" in various cultures are just a few examples of how sleep paralysis has been woven into folklore. The persistence of these supernatural explanations underscores a fundamental human tendency to interpret unfamiliar and terrifying experiences through the lens of existing cultural beliefs. This historical context emphasizes the importance of providing a clear, evidence-based understanding of sleep paralysis to dispel lingering fears and misconceptions.

Despite its often frightening nature, sleep paralysis is a relatively common experience, with a significant portion of the population reporting at least one episode in their lifetime. Estimates of its prevalence vary, ranging from 8% to as high as 50% across different studies. This variation in reported prevalence likely stems from differences in how studies are conducted, the specific populations they examine (for instance, students and psychiatric patients tend to report higher rates ), and the precise definition of sleep paralysis used in the research. Some studies might only include episodes accompanied by hallucinations, while others encompass any instance of temporary paralysis during the sleep-wake transition. This suggests that while the experience is widespread, the exact number of individuals affected remains a subject of ongoing investigation.

What Is Sleep Paralysis?

The core characteristic of sleep paralysis is a distinct disconnect between a fully conscious mind and a temporarily immobilized body. Individuals experiencing an episode are typically aware of their surroundings but find themselves completely unable to move or speak. This often leads to intense feelings of fear and vulnerability. The sensation is frequently described as being "stuck between sleep phases" or a "mixed state of consciousness and sleep". This suggests that sleep paralysis is not merely waking up with a paralyzed body, but rather a unique state where elements of both the rapid eye movement (REM) stage of sleep and wakefulness overlap. During REM sleep, the body is naturally paralyzed to prevent individuals from acting out their dreams. Sleep paralysis occurs when the brain becomes conscious during this phase, or as the body transitions into or out of it, but the muscle paralysis persists. This blending of REM atonia and conscious awareness creates the distinctive and often unsettling experience.

During an episode, individuals may experience a range of distressing sensations and feelings. The inability to move or speak is often accompanied by intense fear and, in many cases, a profound sense of an "evil" or "dangerous" presence. This feeling of a nearby threat could be the brain's way of interpreting the unusual and helpless state of being conscious yet paralyzed. The brain's threat detection mechanisms might become activated in this vulnerable state, leading to the hallucination of a sinister presence. Commonly reported symptoms of sleep paralysis include:

• The inability to move any part of the body, although eye movement might still be possible.
• The inability to speak or cry out for help.
• Experiencing vivid hallucinations, which can be visual (seeing shadowy figures or threatening entities), auditory (hearing voices or strange noises), or tactile (feeling touched or held down).
• Sensations of pressure on the chest or a feeling of being choked, often referred to as the "incubus" phenomenon.
• Intense emotional responses such as fear, panic, and a feeling of helplessness.
• Other unusual sensations such as a sensed presence, feeling dragged out of bed, sensations of flying, numbness, tingling, or vibrations.

Causes and Risk Factors

Several factors can increase the likelihood of experiencing sleep paralysis:

• Sleep Deprivation and Irregular Sleep Patterns: A significant connection exists between insufficient sleep, inconsistent sleep schedules (such as those experienced by shift workers or due to jet lag), and a higher risk of sleep paralysis. Disruptions to the normal sleep cycle can significantly impact the mechanisms that regulate the transitions between REM sleep and wakefulness.
• Stress and Anxiety: High levels of psychological stress, anxiety disorders (including generalized anxiety and panic disorder), and post-traumatic stress disorder (PTSD) are strongly associated with an increased likelihood of sleep paralysis. This connection might be bidirectional, with stress and anxiety disrupting sleep and sleep paralysis itself contributing to increased anxiety and fear of sleep.
• Underlying Sleep Disorders: Conditions such as narcolepsy, insomnia, and obstructive sleep apnea have been identified as significant risk factors for sleep paralysis. The frequent co-occurrence with narcolepsy suggests a shared underlying mechanism related to the regulation of REM sleep.
• Mental Health Conditions: Associations have been noted with various mental health conditions, including PTSD, anxiety disorders, depression, and bipolar disorder. This suggests that psychological distress and emotional dysregulation can impact sleep patterns and increase susceptibility to sleep paralysis.
• Genetics and Family History: There is evidence suggesting a genetic predisposition to sleep paralysis, with a higher risk observed among individuals who have a family history of the condition. While a specific genetic basis has not been definitively identified, these familial patterns indicate a potential hereditary component influencing sleep cycle regulation.
• Lifestyle Factors: Certain lifestyle factors can also play a role, including sleeping position (sleeping on the back is often linked to a higher incidence of sleep paralysis) , substance use (alcohol consumption can disrupt sleep cycles) , and the use of certain medications (such as those for ADHD or antidepressants). The association between sleeping on the back and increased sleep paralysis might be related to breathing patterns and a potential link with mild sleep apnea or upper airway resistance in this position, leading to disrupted sleep.

Symptoms and Experiences

Individuals experiencing sleep paralysis may encounter a variety of symptoms:

• Inability to Move or Speak (Atonia): This is the defining symptom, characterized by a temporary paralysis of the voluntary muscles while the individual remains conscious.
• Vivid Hallucinations: These can manifest in several forms:
  • Visual: Seeing shadowy figures, menacing creatures, or other disturbing images , including flashing lights or patterns.
  • Auditory: Hearing voices, whispers, footsteps, buzzing sounds, or static.
  • Tactile: Feeling touched, restrained, or a sense of pressure on the body.
  • Olfactory: Experiencing strange or unpleasant smells.
  • Vestibular-motor: Sensations of movement, such as floating or having an out-of-body experience.

• Sensations of Pressure: A common symptom is the feeling of something heavy pressing down on the chest or a sensation of being choked.
• Emotional Responses: Episodes are frequently accompanied by intense feelings of fear, panic, and a profound sense of helplessness.
• Other Sensations: Some individuals report out-of-body experiences, a tingling sensation, or a feeling of a presence in the room.

How Sleep Paralysis Differs from Other Sleep Disorders

Sleep paralysis shares some features with other sleep disorders, but key differences help distinguish it:

• Narcolepsy: While sleep paralysis is a recognized symptom of narcolepsy, this neurological disorder is characterized by additional symptoms such as excessive daytime sleepiness, sudden and uncontrollable sleep attacks, and cataplexy, which is a sudden loss of muscle tone triggered by strong emotions. Cataplexy, in particular, is a distinguishing feature of narcolepsy type 1 and does not occur in isolated sleep paralysis. Furthermore, sleep paralysis in narcolepsy can occur during wakefulness, unlike isolated sleep paralysis which typically happens during the transitions to or from sleep.
• Night Terrors: Night terrors are distinct from sleep paralysis as they occur during deep non-REM sleep, typically in the early part of the night. Individuals experiencing night terrors often wake up abruptly with screaming, fear, and physical activity, but unlike sleep paralysis, they usually have no memory of the event. Sleep paralysis, on the other hand, is linked to REM sleep and occurs closer to morning, with vivid recall of the frightening experience.
• REM Sleep Behavior Disorder: In contrast to sleep paralysis, where muscle atonia persists into wakefulness, REM sleep behavior disorder involves a lack of the normal muscle paralysis that occurs during REM sleep. This results in individuals physically acting out their dreams, often with vocalizations and movements, without being aware of their actions. Sleep paralysis involves an inability to move, while REM sleep behavior disorder involves excessive movement during sleep.
• Nightmares: While both nightmares and sleep paralysis can be frightening and occur during REM sleep, the key difference lies in the presence of paralysis. After waking from a nightmare, an individual can typically move freely. Sleep paralysis involves being conscious but unable to move, often with accompanying hallucinations that are distinct from the dream content of a nightmare.

Coping Strategies and Treatments

Several strategies can help individuals cope with and manage sleep paralysis:

• Improving Sleep Hygiene: Establishing good sleep habits is crucial. This includes creating a comfortable sleep environment that is dark, quiet, and cool, maintaining a consistent sleep schedule (going to bed and waking up at the same time each day, even on weekends), avoiding electronic screens before bed, limiting caffeine and alcohol intake, and engaging in regular exercise, but not too close to bedtime.
• Relaxation Techniques: Practicing relaxation techniques such as deep breathing exercises, meditation, and progressive muscle relaxation before going to bed can help reduce stress and promote relaxation, which may decrease the likelihood of sleep paralysis episodes. During an episode, focusing on slow, deep breaths can also be helpful.
• Cognitive-Behavioral Therapy (CBT): CBT, particularly Cognitive-Behavioral Therapy for Insomnia (CBT-I) and specific protocols for sleep paralysis (CBT-ISP), can be effective in managing anxiety related to sleep and improving overall sleep patterns. CBT can help individuals reframe their experiences with sleep paralysis and develop coping mechanisms to reduce fear and distress.
• When to Seek Medical Help: It is advisable to consult a doctor or a sleep specialist if episodes of sleep paralysis occur frequently, cause significant distress, are accompanied by other concerning symptoms, or if there is a suspicion of an underlying sleep disorder such as narcolepsy.
• Potential Medical Treatments: In some cases, particularly when sleep paralysis is associated with narcolepsy or anxiety disorders, medical treatments such as antidepressants (SSRIs or tricyclic antidepressants) may be prescribed to help regulate sleep cycles and reduce the frequency of episodes. Additionally, focused-attention meditation combined with muscle relaxation (MR therapy) has shown some promise as a direct treatment for sleep paralysis.

Conclusion

Sleep paralysis, while often a terrifying experience, is generally a temporary and harmless phenomenon. It is characterized by a transient inability to move or speak while being fully aware, and it can sometimes be accompanied by vivid and unsettling hallucinations. Understanding the nature of sleep paralysis, its triggers, and how it differs from other sleep disorders can help to alleviate the fear and anxiety associated with these episodes. Prioritizing good sleep hygiene and managing stress are essential steps in preventing sleep paralysis. However, if episodes become frequent, cause significant distress, or are accompanied by other concerning symptoms, seeking guidance from a healthcare professional is recommended to rule out any underlying conditions and explore appropriate management strategies.

Frequently Asked Questions

Q: Is sleep paralysis dangerous?

A: Generally, sleep paralysis is considered harmless and doesn't cause physical harm. However, it can be emotionally distressing.

Q: What are the main symptoms?

A: The main symptoms are the inability to move or speak while awake, often accompanied by vivid hallucinations and feelings of pressure or fear.

Q: What are some common causes?

A: Common causes include sleep deprivation, irregular sleep patterns, stress, anxiety, and certain underlying sleep disorders like narcolepsy.

Q: How can I cope with it?

A: Practicing good sleep hygiene, managing stress, and trying relaxation techniques can help. During an episode, try to remain calm and focus on moving small body parts.

Works cited

1. Sleep paralysis - Wikipedia, accessed May 7, 2025, https://en.wikipedia.org/wiki/Sleep_paralysis
2. Sleep Paralysis | Aurora Health Care, accessed May 7, 2025, https://www.aurorahealthcare.org/services/sleep-disorders/sleep-paralysis
3. Sleep Paralysis: What It Is, Causes, Symptoms & Treatment - Cleveland Clinic, accessed May 7, 2025, https://my.clevelandclinic.org/health/diseases/21974-sleep-paralysis
4. Sleep Paralysis: Symptoms, Causes, and Treatment, accessed May 7, 2025, https://www.sleepfoundation.org/parasomnias/sleep-paralysis
5. Sleep Paralysis: Causes, Symptoms, Treatment, and Prevention - WebMD, accessed May 7, 2025, https://www.webmd.com/sleep-disorders/sleep-paralysis
6. What to know about the scary sensation of sleep paralysis - UCLA Health, accessed May 7, 2025, https://www.uclahealth.org/news/article/what-to-know-about-the-scary-sensation-of-sleep-paralysis
7. Sleep paralysis: Causes, symptoms, and tips - Medical News Today, accessed May 7, 2025, https://www.medicalnewstoday.com/articles/295039
8. Sleep Paralysis | Stanford Health Care, accessed May 7, 2025, https://stanfordhealthcare.org/medical-conditions/sleep/nighttime-sleep-behaviors/sleep-paralysis.html
9. Sleep paralysis: What is it, and how can you cope with it?, accessed May 7, 2025, https://www.medicalnewstoday.com/articles/321569
10. Sleep paralysis: The devil, the ghost & the old hag - Sleep Education, accessed May 7, 2025, https://sleepeducation.org/sleep-paralysis-unable-to-move/
11. The Science Behind Sleep Paralysis—5 Facts About This Strange Sleep Phenomenon - Brooklyn Bedding, accessed May 7, 2025, https://brooklynbedding.com/blog/the-science-behind-sleep-paralysis-5-facts-about-this-strange-sleep-phenomenon
12. Why Sleep Paralysis Makes You See Ghosts | TIME, accessed May 7, 2025, https://time.com/6259846/sleep-paralysis-ghosts/
13. Sleep paralysis and folklore - PMC, accessed May 7, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC5167075/
14. The terror and the bliss of sleep paralysis | Aeon Essays, accessed May 7, 2025, https://aeon.co/essays/the-terror-and-the-bliss-of-sleep-paralysis
15. Sleep Paralysis: A Brief Overview of the Intersections of Neurophysiology and Culture, accessed May 7, 2025, https://psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2023.180401
16. Sleep paralysis – causes, symptoms and treatment | healthdirect, accessed May 7, 2025, https://www.healthdirect.gov.au/sleep-paralysis
17. Global Incidence and Clinical Characteristics of Sleeping Paralysis: A Systematic Review and Meta-analysis (P10-9.004) - Neurology.org, accessed May 7, 2025, https://www.neurology.org/doi/10.1212/WNL.0000000000205742
18. Exploring Recurrent Isolated Sleep Paralysis - NeurologyLive, accessed May 7, 2025, https://www.neurologylive.com/view/exploring-recurrent-isolated-sleep-paralysis
19. What Is Sleep Paralysis? - Consensus: AI Search Engine for Research, accessed May 7, 2025, https://consensus.app/home/blog/what-is-sleep-paralysis/
20. Sleep Paralysis - StatPearls - NCBI Bookshelf, accessed May 7, 2025, https://www.ncbi.nlm.nih.gov/books/NBK562322/
21. www.sleepfoundation.org, accessed May 7, 2025, https://www.sleepfoundation.org/parasomnias/sleep-paralysis#:~:text=The%20defining%20symptom%20of%20sleep,helplessness%20during%20sleep%20paralysis%20episodes.
22. Sleep paralysis - NHS, accessed May 7, 2025, https://www.nhs.uk/conditions/sleep-paralysis/
23. Prevalence and Clinical Characteristics of Sleeping Paralysis: A Systematic Review and Meta-Analysis - PubMed, accessed May 7, 2025, https://pubmed.ncbi.nlm.nih.gov/38425633/
24. Sleep Paralysis Hallucinations: Demons, Sounds, Lights - Verywell Health, accessed May 7, 2025, https://www.verywellhealth.com/symptoms-of-sleep-paralysis-3014781
25. Isolated sleep paralysis Information | Mount Sinai - New York, accessed May 7, 2025, https://www.mountsinai.org/health-library/diseases-conditions/isolated-sleep-paralysis
26. What Are Sleep Paralysis Signs and Symptoms? - Health, accessed May 7, 2025, https://www.health.com/sleep-paralysis-symptoms-7966391
27. Can Anxiety Cause Sleep Paralysis? Understanding the Connection - Good Health Psych, accessed May 7, 2025, https://goodhealthpsych.com/blog/can-anxiety-cause-sleep-paralysis/
28. Recent Insights Into Sleep Paralysis: Mechanisms and Management - PMC, accessed May 7, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11344621/
29. Sleep Paralysis: Definition, Symptoms, Coping - Verywell Mind, accessed May 7, 2025, https://www.verywellmind.com/what-is-sleep-paralysis-6891255
30. Sleep paralysis and narcolepsy: Link and how to stop it - Medical News Today, accessed May 7, 2025, https://www.medicalnewstoday.com/articles/sleep-paralysis-narcolepsy
31. Narcolepsy - Symptoms - NHS, accessed May 7, 2025, https://www.nhs.uk/conditions/narcolepsy/symptoms/
32. What Are the Symptoms of Narcolepsy? - Sleep Foundation, accessed May 7, 2025, https://www.sleepfoundation.org/narcolepsy/symptoms
33. Sleep Paralysis As A Symptom of Narcolepsy | More Than Tired™, accessed May 7, 2025, https://www.morethantired.com/symptoms-of-narcolepsy/sleep-paralysis/
34. Narcolepsy: What It Is, Causes, Symptoms & Treatment - Cleveland Clinic, accessed May 7, 2025, https://my.clevelandclinic.org/health/diseases/12147-narcolepsy
35. Symptoms of Narcolepsy: Sleep Paralysis & Hallucinations - Psychiatric Times, accessed May 7, 2025, https://www.psychiatrictimes.com/view/symptoms-of-narcolepsy-sleep-paralysis-hallucinations
36. Sleep Paralysis Unveiled: A Comprehensive Examination of Night Terrors - Hiwell, accessed May 7, 2025, https://www.hiwellapp.com/en/blog/sleep-paralysis
37. Understanding Sleep Paralysis and Night Terrors - Rupa Health, accessed May 7, 2025, https://www.rupahealth.com/post/understanding-sleep-paralysis-and-night-terrors
38. Are sleep paralysis and false awakenings different from REM sleep and from lucid REM sleep? A spectral EEG analysis | Journal of Clinical Sleep Medicine, accessed May 7, 2025, https://jcsm.aasm.org/doi/10.5664/jcsm.9056
39. Sleep Paralysis: Symptoms, Treatment and Prevention - Healthline, accessed May 7, 2025, https://www.healthline.com/health/sleep/isolated-sleep-paralysis
40. Sleep Paralysis: Causes, Symptoms, Prevention According to a Primary Care Doctor in Fairfield, CT - Docs Medical Group, accessed May 7, 2025, https://docsmedicalgroup.com/docsurgentcare/sleep-paralysis-causes-symptoms-prevention-according-to-a-primary-care-doctor-in-fairfield-ct/
41. Sleep paralysis: Symptoms, causes, and treatment | SingleCare, accessed May 7, 2025, https://www.singlecare.com/blog/sleep-paralysis/
42. Managing Sleep Paralysis Symptoms: A Guide - BetterHelp, accessed May 7, 2025, https://www.betterhelp.com/advice/sleep/how-to-sleep-paralysis-in-5-easy-steps/
43. Sleep paralysis: your questions answered | Live Better - Medibank, accessed May 7, 2025, https://www.medibank.com.au/livebetter/health-brief/health-guide/sleep-paralysis-your-questions-answered/
44. How to Wake up from Sleep Paralysis: 4 Tips - Healthline, accessed May 7, 2025, https://www.healthline.com/health/how-to-wake-up-from-sleep-paralysis
45. Unanswered Questions Concerning Sleep Paralysis - Psychology Today, accessed May 7, 2025, https://www.psychologytoday.com/us/blog/dream-catcher/202006/unanswered-questions-concerning-sleep-paralysis
46. Sleep Paralysis Most Common Questions, Brain Scientist Explains - YouTube, accessed May 7, 2025, https://m.youtube.com/watch?v=f_3FUzwGHBA
47. Sleep Paralysis: Causes, Symptoms, and Treatment - HelpGuide.org, accessed May 7, 2025, https://www.helpguide.org/wellness/sleep/sleep-paralysis-causes-symptoms-and-treatment
48. What Causes Sleep Paralysis and How Can You Prevent It? - The Insomnia and Sleep Institute of Arizona, accessed May 7, 2025, https://sleeplessinarizona.com/what-causes-sleep-paralysis-and-how-can-you-prevent-it/
49. 5 Spooky Sleep Disorders - Integrated Neurology Services, accessed May 7, 2025, https://www.integratedneurologyservices.com/blog/5-spooky-sleep-disorders
50. Feelings of Presence in Sleep Paralysis and Other Conditions - Psychology Today, accessed May 7, 2025, https://www.psychologytoday.com/us/blog/dream-factory/201912/feelings-presence-in-sleep-paralysis-and-other-conditions
51. Spontaneous and induced out-of-body experiences during sleep paralysis: Emotions, "AURA" recognition, and clinical implications - PubMed, accessed May 7, 2025, https://pubmed.ncbi.nlm.nih.gov/36053735/
52. Nightmare Disorder and Isolated Sleep Paralysis - PMC - PubMed Central, accessed May 7, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8116464/
53. Parasomnias: What They Are, Symptoms, Treatment & Types - Cleveland Clinic, accessed May 7, 2025, https://my.clevelandclinic.org/health/diseases/12133-parasomnias--disruptive-sleep-disorders
54. Narcolepsy - Symptoms and causes - Mayo Clinic, accessed May 7, 2025, https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497
55. Narcolepsy and Sleep Paralysis: Is There a Connection Between Them? - Healthline, accessed May 7, 2025, https://www.healthline.com/health/narcolepsy-and-sleep-paralysis
56. Narcolepsy | National Institute of Neurological Disorders and Stroke, accessed May 7, 2025, https://www.ninds.nih.gov/health-information/disorders/narcolepsy
57. Characteristics of Sleep Paralysis and Its Association with Anxiety Symptoms, Perceived Stress, PTSD, and Other Variables Related to Lifestyle in Selected High Stress Exposed Professions, accessed May 7, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9265794/
58. Sleep Paralysis — Seattle Anxiety Specialists - Psychiatry, Psychology, and Psychotherapy, accessed May 7, 2025, https://seattleanxiety.com/sleep-paralysis
59. A clinician's guide to recurrent isolated sleep paralysis - PMC, accessed May 7, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4958367/
60. Cognitive-Behavioral Therapy in the Treatment of Recurrent Isolated Sleep Paralysis, accessed May 7, 2025, https://irispublishers.com/ann/fulltext/cognitive-behavioral-therapy-in-the-treatment-of-recurrent-isolated-sleep-paralysis.ID.000760.php
61. www.mayoclinic.org, accessed May 7, 2025, https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497#:~:text=In%20narcolepsy%2C%20you%20may%20suddenly,you're%20awake%20or%20sleepy.
62. Is It Sleep Paralysis or a Night Terror? - Verywell Health, accessed May 7, 2025, https://www.verywellhealth.com/is-it-sleep-paralysis-or-a-night-terror-3014767
63. REM Sleep Behavior Disorder (RBD) - Aurora Health Care, accessed May 7, 2025, https://www.aurorahealthcare.org/services/sleep-disorders/rem-sleep-behavior-disorder-rbd
64. REM Sleep Behavior Disorder - Henry Ford Health, accessed May 7, 2025, https://www.henryford.com/services/sleep-disorders/conditions/rem-disorders
65. Treatment for Sleep Paralysis - Dawn Health, accessed May 7, 2025, https://www.dawn.health/blog/treatment-for-sleep-paralysis
66. Parasomnia - Emerald Sleep Disorders Center, accessed May 7, 2025, https://www.emeraldsleep.com/common-sleep-disorders/parasomnias.html
67. www.verywellhealth.com, accessed May 7, 2025, https://www.verywellhealth.com/is-it-sleep-paralysis-or-a-night-terror-3014767#:~:text=Night%20terrors%20come%20out%20of,results%20in%20the%20characteristic%20symptoms.
68. Everything You Need to Know About Sleep Terrors - Healthline, accessed May 7, 2025, https://www.healthline.com/health/sleep-terror
69. Quick Dose: What Happens in the Brain During Nightmares, Night Terrors and Sleep Paralysis? | Northwestern Medicine, accessed May 7, 2025, https://www.nm.org/healthbeat/healthy-tips/qd-what-happens-brain-nightmares-night-terrors-sleep-paralysis
70. Parasomnias: Understanding and Managing Distinct Types - Sleep Foundation, accessed May 7, 2025, https://www.sleepfoundation.org/parasomnias
71. my.clevelandclinic.org, accessed May 7, 2025, https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd#:~:text=Normally%2C%20most%20of%20your%20body's,temporary%20paralysis%20doesn't%20happen.
72. REM sleep behavior disorder - Symptoms and causes - Mayo Clinic, accessed May 7, 2025, https://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/symptoms-causes/syc-20352920
73. REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment - Cleveland Clinic, accessed May 7, 2025, https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd
74. REM Sleep Behavior Disorder - Sleep Foundation, accessed May 7, 2025, https://www.sleepfoundation.org/parasomnias/rem-sleep-behavior-disorder
75. REM Behavior Disorder | Stanford Health Care, accessed May 7, 2025, https://stanfordhealthcare.org/medical-conditions/sleep/nighttime-sleep-behaviors/rem-behavior-disorder.html
76. Relaxation Exercises to Help Fall Asleep - Sleep Foundation, accessed May 7, 2025, https://www.sleepfoundation.org/sleep-hygiene/relaxation-exercises-to-help-fall-asleep
77. Sleep paralysis: what it is, why it happens, and how to cope — Calm Blog, accessed May 7, 2025, https://www.calm.com/blog/sleep-paralysis
78. Sleep disorders and problems (insomnia): Learn More – What can you do if you have trouble sleeping? - NCBI, accessed May 7, 2025, https://www.ncbi.nlm.nih.gov/books/NBK279320/
79. Tips to improve your sleep - Mind, accessed May 7, 2025, https://www.mind.org.uk/information-support/types-of-mental-health-problems/sleep-problems/tips-to-improve-your-sleep/
80. How To Avoid Sleep Paralysis - Mega We care, accessed May 7, 2025, https://www.megawecare.com/good-health-by-yourself/sleep-health/how-to-avoid-sleep-paralysis
81. Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview - Sleep Foundation, accessed May 7, 2025, https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
82. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills - Mayo Clinic, accessed May 7, 2025, https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677
83. Sleepless Nights? Try Stress Relief Techniques | Johns Hopkins Medicine, accessed May 7, 2025, https://www.hopkinsmedicine.org/health/wellness-and-prevention/sleepless-nights-try-stress-relief-techniques
84. Sleep Therapy: Treating Sleep Problems with CBT - HelpGuide.org, accessed May 7, 2025, https://www.helpguide.org/wellness/sleep/therapy-for-sleep-disorders