Befriending the old hag: A primer on sleep paralysis

Folklore, causes and approaches to treatment and prevention

In Newfoundland, they tell stories of her: a terrifying creature said to live in the ocean and torment those who dare to sleep near the shore. In a typical account, a fisherman returns home exhausted from a long day at sea, lays down to rest and starts to drift off to sleep. But as he does so, he feels a heavy weight and can’t move or speak. Sitting heavily on his chest, is the dreaded Sea Hag, a wild woman with ragged clothes, straggly hair and long, sharp nails. She returns night after night until he arms himself with a crucifix and gathers the strength to command her to leave him be, in the name of God.

Tales of the Sea Hag are legendary in Newfoundland, one of the stories now told on the St. John’s Haunted Hike tour. The legend of the Sea Hag emerged as a way to make sense of sleep paralysis, a temporary inability to move or speak during the sleep-wake transition. As legend had it, the only way to defeat the Sea Hag was by invoking the name of God.

The history and folklore surrounding sleep paralysis can be traced back to ancient civilizations, and not understanding it, many cultures attributed it to supernatural forces. The Sea Hag is a variant of the “old hag” dating back to medieval Europe, a demonic entity that would sit on a person’s chest, a way to explain the pressure and immobility of sleep paralysis.

 

What causes sleep paralysis?

An episode can occur while falling asleep (hypnagogia) or in the transition from sleep to waking (hypnopompia). Symptoms include an inability to move, often accompanied by pressure on the chest or back, hallucinations and the sense of doom or an evil presence. Sleep paralysis often occurs during sleep cycle disruptions (ie from shift work, jet lag, insomnia), but can also coincide with mental health issues. This fairly common, mostly benign condition affects about 8% of the general population at some point in their lives.

During REM sleep, to protect us from thrashing around and enacting our dreams, our body goes into a state of muscle atonia. The exact mechanism, which inhibits the motor neurons in the spinal cord, is not fully understood. It is thought to involve a combination of factors, including changes in brain chemistry and activation of inhibitory neurons.

The body naturally shifts out of paralysis upon waking, and external stimuli such as touching or speaking to the person can trigger the shift as well. In sleep paralysis, the shift to the natural ability to move simply happens in the wrong order; we are supposed to wake up after our movement is restored to normal, not before.

 

How to treat sleep paralysis

Lauren was plagued with nightmares as a child, and as she grew older this shifted to frequent, terrifying sleep paralysis. She tried some of the most common ways to treat the problem, including changing her sleeping position, taking melatonin, practicing good sleep hygiene. What finally helped most was to turn toward the experience and relax into it rather than resisting and struggling to move. She reminded herself that she was not in any danger, and that she could still breathe – so she focused on slow, relaxing breaths, and the calmer she got, the less intense the sensations became. Over a few weeks of practicing relaxing into the transition to sleep, she was able to break the cycle.

The way to treat sleep paralysis depends on what may be causing it. While sleep paralysis can affect anyone, those with psychiatric disorders, a history of trauma, sleep disorders and disrupted sleep patterns are more likely to experience it. Therefore, effectively treating trauma, anxiety and/or depression may help those with psychological causes.

Disrupted sleep can come from shift work, sleep apnea, or too much late-night partying. This is why sleep paralysis is not uncommon among post-secondary students who stay up way too late studying or socializing. Sleep apnea also causes disrupted sleep, and sometimes sleep paralysis.

Overall, what helps:

  • practice good sleep hygiene, a regular bedtime and ideally a cool, dark quiet bedroom
  • sleep on your stomach or side, not your back
  • reduce stress
  • medication, such as melatonin or antidepressants
  • treat underlying causes: ie therapy for a history of trauma, anxiety or depression, sleep medicine for apnea

 

What to do during an episode

Sometimes, despite one’s best efforts, sleep paralysis will occur. If this happens, following Lauren’s example of relaxing into the process can make a real difference. Once you understand what’s happening, you can tell yourself, it’s okay, I am safe in my bedroom and still in the dream state. If you want to wake up calmly, focus on slow, deep breaths and begin to wiggle your fingers and toes, waiting until the paralysis dissipates. Although it may feel like an eternity, the transition is usually just a minute or two.

If you want to go back to into sleep rather than waking, you might try lucid dreaming. In fact, during an episode, you are in a lucid dream – as defined by being both awake and in a dream state. You might want to experiment with relaxing back into sleep and creating a dream scenario that feels empowering rather than scary. You might imagine into flying away from the source of your fear and into a beautiful landscape. Or you could conjure the presence of an ally or friend.

To give one example, Marian tried many things to alleviate her sleep paralysis before turning to lucid dreaming. She was desperate at this point, and decided to set an intention before sleeping that if she experienced paralysis, she would recognize she was dreaming. It took a few weeks, but after an initial exhilarating experience of flying in her dream, she got more adept at becoming lucid. This coincided with a shift toward better, more refreshing sleep and a whole new relationship to her dreams.

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In my complete course on nightmares for clinicians, I offer much more information about the origins, theories and treatment of nightmares. Click here to learn more.