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Sleep Disorders

Feeling Like Muscles `Forgot` How to Breathe

01/06/2009

Question:

I have a very strange problem. When I sleep on my back, not in any other position, I sometimes wake up and am unable to take a breath. I am aware of needing, REALLY needing to take a breath, but it is as though my muscles "forgot" how to do that. Sometimes I try to push my stomach out because that seems like a breathing motion. It is very VERY scary. Every time it happens I am afraid I will suffocate before my body remembers "how" to take a breath. By the time I start breathing again my heart is pounding a at a very high rate.

I do not think this is "sleep apnea." I do not snore. It is not a physical obstruction of my breathing, it`s that the muscles to do the breathing just don`t do the action, and I can`t consciously take a breath because its like the breathing muscles are disconnected from my brain. Does that make any sense? I have had this problem for years and always sleep on my stomach or my side to try to avoid it, but sometimes I must roll over onto my back in my sleep and that`s when it happens - not every single time I wake up on my back, but often enough to be really scary.

Am I completely nuts, or does this make sense, and what can I do about it besides trying to make sure I only sleep on my stomach?

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 and tends to resolve on its own. Occasionally, the episode will end if the person is touched or spoken to.

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 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:

James   Knepler, MD James Knepler, MD
Formerly, Assistant Professor
College of Medicine
University of Cincinnati