What Is Sleep Paralysis (Karabasan)? Causes and Ways to Cope

What causes sleep paralysis, known in Turkey as karabasan, and is it dangerous? Learn the brain mechanism, the triggers and ways to reduce the fear.

In the middle of the night you open your eyes; you can see your room, the curtain, the gap in the door. But you cannot move. You want to raise your arm, shout, even call out to the person next to you; your body does not obey. A weight on your chest, a feeling that someone is in the room, and intense fear... After a few seconds or a few minutes everything passes, but your heart is still pounding. This experience is called sleep paralysis; in Turkish folk tradition it has been known for centuries as "karabasan" (the "dark presser"), or in some regions as "al basması". It can be extremely frightening; medically, however, it is mostly harmless and comes from a small "timing error" in the brain's transition between sleep and wakefulness. In this article we explain what sleep paralysis is, why it happens, what you can do during an episode and how to reduce repeat episodes.

What Is Sleep Paralysis?

Sleep paralysis is a temporary inability to move or speak while falling asleep or waking up, even though consciousness is switched on. Eye movements and breathing usually continue, but the arms, legs and trunk feel as if they are locked. An episode generally lasts between a few seconds and a few minutes and ends by itself.

Many people experience this at least once at some point in life. Some have it once or twice in their whole lives, while for others it can become more frequent in certain periods. On its own it is not a sign of a mental disorder or a dangerous illness.

What Happens During an Episode? The Mechanism in the Brain

Our sleep is made up of different stages that follow one another through the night. One of them is REM (rapid eye movement) sleep, when dreams are most vivid. During REM sleep, the brain temporarily relaxes most of the muscles so that we do not actually perform the movements we make in a dream. Thanks to this protective mechanism, we do not run in bed when we run in a dream.

During an episode, consciousness wakes up but this muscle relaxation specific to REM sleep continues for a short while longer. In other words, your mind is awake, but your body is still in dream mode. Because the dreaming system has not completely switched off at this point, experiences can occur in which reality and dream are interwoven.

What Are the Symptoms of Sleep Paralysis?

This is not only about being unable to move. Experiences commonly reported during an episode include:

• Being unable to move or speak: Consciousness is open but the body does not respond.
• A feeling of pressure on the chest: A feeling that someone is sitting on you or pressing on your chest. This feeling is linked to breathing being shallower in REM sleep and to the muscles not responding when a person tries to take a deep breath.
• Sensing a presence in the room: A sense that an unseen presence is standing nearby, watching you.
• Visual and auditory hallucinations: Shadows, figures, footsteps, whispers or humming. These are dream images appearing while you are awake.
• A feeling of intense fear or terror: The brain's threat system perceives being unable to move as danger.
• A sense of leaving the body or floating: Some people describe feeling as if they are seeing themselves from above.

These experiences can be so realistic that a person may even find it hard to understand afterwards that they were dream imagery. For this reason, telling someone you trust about what you experienced, or briefly noting it down after an episode, can help you make sense of it.

Why Does Karabasan Feel So Real?

During karabasan, the parts of the brain that process emotions and threat can be very active, while the parts that make rational judgements have not yet fully come into play. For this reason the person lives the feeling that someone is in the room directly instead of questioning it. It is no coincidence that different cultures have explained this experience with jinn, spirits or creatures sitting on the chest: people made sense of this intense experience, which they could not explain, in the language of their own culture. Today we know that it relates to the transition between sleep and wakefulness.

What Causes Karabasan? Triggering Factors

There is no single cause for this experience; however, some factors can raise the risk:

• Sleep deprivation and insufficient sleep: Sleeping too little for a long time disturbs the pattern of REM sleep.
• Irregular sleep times: Frequently changing bed and wake times, shift work, frequent travel and jet lag.
• Sleeping on your back: Many people report that they have episodes mostly when lying on their back.
• Intense stress and anxiety: In tense periods sleep is more broken and lighter.
• Traumatic experiences: These episodes can be more common in people with post-traumatic stress symptoms.
• Daytime naps and screen use late into the night: These can shift the sleep rhythm.
• Some sleep disorders: Sleep paralysis is more common in narcolepsy in particular.

Sleep and Karabasan in Today's Conditions

Working extra jobs because of the high cost of living, long hours, work messages that stretch late into the night and shift work are disrupting many people's sleep patterns. Scrolling news feeds and social media in bed at night both delays bedtime and keeps the mind stimulated. After the 6 February 2023 earthquakes, many people described intense fear and physical alertness, especially when waking in the night. This kind of alertness can make the experience of an episode even more frightening. If your sleep problems have increased in general, our article on how to overcome insomnia may also help you.

Is Sleep Paralysis Dangerous?

On its own, sleep paralysis does not harm the body. There is no danger during an episode of suffocating, the heart stopping or "not coming back"; episodes always end by themselves. The real problem is the fear the experience arouses. Some people start to avoid sleeping, leave the light on or put off falling asleep out of fear of having another episode. This increases sleeplessness and, ironically, can make new episodes more likely. In this way, fear and episodes can turn into a cycle that feeds itself.

Sleep paralysis is your brain experiencing a small timing difference during waking; however frightening it feels, it is temporary and ends by itself.

How Does an Episode Pass? What You Can Do During and After

Although what can be done in the moment of an episode seems limited, some methods can help the experience feel less frightening and pass sooner.

1. Remind yourself what you are experiencing

Say to yourself inwardly: "This is sleep paralysis. My body is still in sleep mode. I am not in danger. It will pass in a moment." Having memorised this sentence beforehand makes it easier to reach during an episode.

2. Slow your breathing

When you feel pressure on your chest, struggling to take a deep breath can increase panic. Instead, focus on breathing out in a calm, natural rhythm. Remember that breathing in continues automatically.

3. Start with a small movement

Instead of trying to move the whole body, try wiggling a single finger or toe, blinking your eyes rapidly or moving your facial muscles. Small movements can speed up the shift to wakefulness.

4. Don't fight the hallucinations

Struggling with the figure or sound in the room magnifies the fear. Label them as "dream images" and give your attention to your breath or to a single bodily sensation. Many people say that when they notice and accept the fear instead of resisting it, the episode passes more quickly.

5. Soothe yourself after the episode

When the episode has passed, instead of trying to fall asleep again immediately, sit up for a few minutes, switch the light on briefly and drink a glass of water. Let your body calm down.

What Can Be Done to Prevent Episodes?

There is no guaranteed way to prevent episodes completely; however, the following steps can help reduce repeats:

• Set up a regular sleep schedule: Go to bed and get up at similar times every day, including at weekends.
• Get enough sleep: Long-term sleep debt is one of the most common triggers of episodes.
• Change your sleeping position: If you have episodes when lying on your back, try sleeping on your side.
• Stay away from screens before bed: Spending the half hour to an hour before sleep without screens helps the mind slow down.
• Watch caffeine and alcohol: Especially when consumed in the evening, they can damage sleep quality.
• Manage stress during the day: Short walks, breathing exercises and writing the day's worries on paper before bed can work.
• Keep a sleep diary: Note on which nights, after how much sleep and in which position episodes occur. Seeing patterns lets you notice triggers.

A Two-Week Sleep Routine Trial

Instead of trying the suggestions one by one, you can make a small two-week trial plan. In the first week, simply fix your bed and wake times; set the alarm for the same time every day and get a few minutes of daylight as soon as you get up in the morning. In the second week, add a screen-free half hour before bed and sleeping on your side. Every morning, write in your sleep diary how many hours you slept, whether you woke in the night and whether you had an episode. At the end of the two weeks, when you review your notes, you can see more clearly which change made a difference for you. This small experiment also helps you see karabasan not as an uncontrollable event but as something you have some influence over.

When Should You Seek Professional Support?

Occasional sleep paralysis does not usually need treatment. However, we recommend consulting a specialist in the following situations:

• If episodes have become more frequent and happen several times a week,
• If you avoid sleeping or keep putting off bedtime because of fear of an episode,
• If you have excessive daytime sleepiness, sudden sleep attacks, or sudden loss of muscle strength when you laugh or get excited; in this case, an assessment by a neurologist or sleep disorders specialist is important,
• If the episodes are accompanied by intense anxiety, panic attack-like attacks or symptoms after a traumatic experience,
• If the experience clearly affects your daytime life and mood.

If a medical sleep disorder is suspected, a doctor's assessment should come first. The parts relating to anxiety, fear and sleep pattern can be addressed in psychotherapy. Work in the field of anxiety and panic can help with this.

How Is This Problem Approached in Therapy?

The fear and avoidance that accompany sleep paralysis can be addressed using the principles of Cognitive Behavioural Therapy (CBT). CBT approaches adapted specifically for this problem are also being developed.

Psychoeducation

The first step of therapy is understanding what the episodes are and why they are harmless. Knowing the mechanism considerably softens thoughts such as "something is going terribly wrong" or "I'm losing my mind".

A Plan for the Moment of the Episode

Together with the client, a personal plan is prepared for use during an episode: the sentence to say to oneself, the breathing rhythm, small movements and where to direct attention. This plan is rehearsed mentally in sessions.

Working with Frightening Interpretations

Interpretations such as "One day I won't be able to wake up" or "There really is someone in the room" are questioned in the light of the evidence. The person's cultural and religious explanations are respected; the aim is not to judge beliefs but to develop a balanced perspective that reduces the intensity of the fear.

Sleep Pattern and Underlying Stress

Sleep hygiene, a regular sleep schedule and skills for coping with stress during the day are worked on together. If the episodes are linked to a traumatic experience or to intense anxiety, these underlying problems also become the focus of therapy.

Frequently Asked Questions

Is having these episodes a sign of mental illness?

No. This is an experience that many healthy people have, and on its own it is not a sign of a mental disorder. However, because it can increase with stress, anxiety and sleeplessness, it is important to pay attention to your general wellbeing.

Is it possible to die during an episode?

No. This experience is medically harmless and episodes always end by themselves. However real the pressure on the chest feels, breathing continues.

Does it also occur in children?

Sleep paralysis most often begins in adolescence and young adulthood; however, it can also occur in children. When a child describes such an experience, it is important to listen to them, not to belittle their fear and to explain calmly what is happening. If night terrors or sleep problems continue, it is helpful to consult a specialist.

Are sleep paralysis and a nightmare the same thing?

No. A nightmare is a frightening dream that occurs during sleep and usually ends with waking. In sleep paralysis, the person is awake and aware of their surroundings but cannot move. Because the word "karabasan" is used in everyday speech for both, confusion can arise.

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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