sleep paralysis
Enable an AI agent to recognise reported sleep paralysis, assess episode resolution and recurring burden, and select appropriate documentation, support or clinical review.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
Researched by: Codex
Purpose and description
Enable an AI agent to recognise reported sleep paralysis, assess episode resolution and recurring burden, and select appropriate documentation, support or clinical review.
It can be Elicit and record an episode account while preserving uncertainty about timing and awareness.; Compare the account with recognition criteria and flag conflicting features.; Track recurrence, distress and functional effects across explicit observation windows.; Explore within-person associations with sleep context without claiming causation.; Offer sourced explanations and document agreed support or clinical review.; Prepare a concise clinical handoff containing atypical features, associated symptoms and unresolved questions..
Distinguishing features
Establish whether awareness and inability to move or speak coincided specifically with falling asleep or awakening; a frightening dream alone does not establish this combination. [NHS sleep paralysis](https://www.nhs.uk/conditions/sleep-paralysis/)
Check whether unusual perceptions accompanied immobility; perceptions alone are insufficient, and their absence does not exclude sleep paralysis. [NHS sleep paralysis](https://www.nhs.uk/conditions/sleep-paralysis/)
Distinguish transition-related immobility from emotion-triggered loss of muscle control suggestive of cataplexy; record daytime sleep attacks separately when considering narcolepsy. [NHLBI narcolepsy](https://www.nhlbi.nih.gov/health/narcolepsy)
Check recovery and distribution of weakness: persistent weakness after awakening or focal deficits require assessment beyond a sleep-paralysis explanation. [NHS paralysis](https://www.nhs.uk/symptoms/paralysis/)
Scope
+ Awareness and inability to move or speak at a sleep-wake transition
+ Episode onset, duration, termination and recovery
+ Accompanying perceptions, bodily sensations and distress
+ Recurrence, sleep context and effects on daily functioning
+ Evidence supporting identification and decisions about support or referral
- Narcolepsy diagnosis and longitudinal management
- Nightmares, night terrors and dream enactment as independent phenomena
- Seizures, stroke and other causes of weakness or altered awareness
- Sleep apnea and other respiratory disorders
- Independent psychiatric diagnoses and their treatment
- Medication prescribing and comprehensive sleep treatment plans
Characteristics
- Sleep transition
- falling asleep | awakening | outside a recognised transition | uncertain Anchors recognition and exposes a potentially mismatched label.
- Experienced awareness
- reported present | fluctuating | reported absent | uncertain Separates remembered awareness during immobility from retrospective inference.
- Voluntary control
- Record movement and speech separately: unavailable | partial | intact | unknown Preserves what the person actually could and could not do.
- Episode duration
- seconds or minutes, with estimate range and timing method Supports comparison without treating subjective elapsed time as measured time.
- Recovery
- ongoing | fully resolved | residual symptoms | unknown Determines whether routine follow-up or further assessment is appropriate.
- Accompanying experience
- Person-described sensory perceptions and bodily sensations; none | present | uncertain Captures the experience without asserting that its perceived explanation was externally verified.
- Episode recurrence
- episode count and affected sleep periods per stated observation window Distinguishes multiple episodes in one sleep period from episodes across many nights.
- Distress and interference
- Separate person-rated 0-10 scores with stated anchors, plus concrete effects Tracks personal change without presenting an informal rating as a diagnostic threshold.
- Associated condition
- Linked condition with status: reported | suspected | clinician-confirmed | assessed absent | unknown Prevents an episode from becoming an unsupported diagnosis of its possible underlying condition.
- Identification status
- unassessed report | compatible account | atypical or unresolved account | clinician-assessed Makes the limits of an agent's classification visible.
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 5 bundles · 10 layers · 10 findings · 28 questions.
Transition and immobility The evidence that the reported event fits sleep paralysis.
Recognition depends on the conjunction of sleep timing, experienced awareness and impaired voluntary control.
Sleep-wake placement
Locate the event within the person's transition into or out of sleep.
Transition sequence
Record the sequence before immobility, during awareness and after recovery.
- Was the person falling asleep, awakening or already continuously awake when immobility began? boundary
- Which parts of that sequence are remembered directly, witnessed or inferred afterward? provenance
Awareness and control
Separate perceived wakefulness from the abilities available during the event.
Attempted voluntary action
Capture attempts to move or speak and their reported results.
- What did the person perceive or understand while unable to act? definition
- Which movements or speech attempts failed, and which remained possible? measurement
- Was inability to act experienced during awareness or only described as part of a remembered dream? boundary
Experienced episode and recovery What happened during the event and how it ended.
The model must represent frightening or unusual experiences without confusing them with verified external events.
Perceptions and sensations
Document the person's sensory and bodily experience in their own terms.
Experience and interpretation
Keep reported sensations, their personal meaning and independent observations distinguishable.
- What, if anything, did the person see, hear, feel or sense during immobility? measurement
- Which details describe a perception, which describe its interpretation, and which have independent corroboration? provenance
Termination and residual state
Establish elapsed time, restoration of control and remaining symptoms.
Return of control
Record the endpoint separately from fear or other effects that continued afterward.
- How long did immobility last, and was that duration timed or estimated? measurement
- Did movement and speech return fully, and what symptoms remained after full awakening? boundary
- What occurred immediately before recovery, without assuming that it caused recovery? provenance
Recurrence and sleep context The episode pattern and circumstances surrounding affected sleep periods.
A single event, a cluster and a sustained pattern require different records and follow-up questions.
Episode pattern
Count episodes consistently and retain gaps in observation.
Frequency and clustering
Represent both event counts and the number of affected sleep periods.
- How many episodes and affected nights or naps occurred within the stated interval? measurement
- What separates two episodes: documented recovery between them or only a change in remembered experience? definition
- Does the count come from contemporaneous records or retrospective recall, and which periods are missing? provenance
Preceding sleep context
Record candidate associations as observations requiring comparison.
Affected and unaffected sleep
Compare context across sleep periods rather than labelling every preceding circumstance a trigger.
- What sleep timing, sleep quantity and body position were reported for affected sleep periods? measurement
- Were the same circumstances present during sleep periods without paralysis? boundary
- Which contextual details were recorded at the time and which were reconstructed later? provenance
Clinical boundaries and burden Information needed to avoid premature attribution and assess the person's need for care.
Identifying a compatible episode does not establish its cause or measure its consequences.
Associated and alternative conditions
Link relevant symptoms and assessments without absorbing neighbouring diagnoses.
Explanatory status
Preserve what has and has not been assessed before describing episodes as isolated.
- Are daytime sleep attacks, emotion-triggered weakness or an existing narcolepsy assessment reported? boundary
- What features conflict with a sleep-transition episode, including focal weakness or symptoms persisting into wakefulness? boundary
- Who assessed alternative explanations, and what evidence supports the current classification? provenance
Episode and between-episode burden
Separate immediate distress from subsequent changes in sleep and functioning.
Fear and functional effects
Record the person's priorities and effects they attribute to the episodes.
- How distressing was the episode using the person's stated rating anchors? measurement
- Has anticipation of another episode changed sleep behaviour, daytime functioning or willingness to sleep? measurement
- Which effect does the person most want help addressing? action
Support and review Choose a proportionate response and evaluate what happens afterward.
An agent needs explicit grounds for explanation, follow-up or escalation rather than treating a label as an action plan.
Response selection
Connect the current episode account and burden to an appropriate next step.
Support or assessment
Recurrent episodes with sleep-related anxiety or persistent tiredness merit clinical review. [NHS sleep paralysis](https://www.nhs.uk/conditions/sleep-paralysis/)
- Does the record support explanation and monitoring, routine clinical review or an urgent assessment pathway for atypical symptoms? action
- What evidence and unresolved features justify that response? provenance
- What explanation or support has the person agreed to receive? action
Response follow-up
Evaluate an agreed response against the person's episode pattern and priorities.
Observed change after support
Track outcomes without treating improvement after an action as proof of efficacy.
- What support or clinician-directed intervention was used, when and with what consistency? provenance
- How did episode frequency, distress and sleep avoidance change over comparable observation windows? measurement
- What new symptoms, lack of improvement or remaining burden should trigger reassessment? action
What the second pass must settle
- Which authoritative diagnostic criteria should govern the distinction between recurrent episodes and recurrent isolated sleep paralysis as a disorder?
- Which episode-duration and recovery patterns warrant specialist assessment, and how should unreliable subjective timing affect that decision?
- Which distress and impairment instruments are validated for sleep paralysis across ages, languages and cultural interpretations?
- What evidence supports specific techniques used during an episode, and what limits should an agent place on recommending them?
- What minimum clinical assessment is needed before classifying episodes as isolated rather than associated with another disorder, medication or substance?