Depression, Anxiety, Stress, and Sleep Paralysis: Moderating Role of Personality among University Students of Pakistan
Contributors
-
Fiza Rehman
Senior Lecturer/PhD Fellow, Department of Clinical Psychology, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
https://orcid.org/0009-0007-9103-8440
- Sundus Khattak PhD Fellow, Department of Clinical Psychology, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
- Dr. Wardah Ishfaq Assistant Professor, Department of Clinical Psychology, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Abstract
Sleep paralysis, a phenomenon characterized by temporary muscle immobility during the transition between sleep and wakefulness, is often associated with heightened stress, anxiety, and other psychological factors. This present study investigates the relationship between depression, anxiety, stress, and sleep paralysis, considering personality’s moderating effects. Data was collected using purposive sampling. A total of 200 students, aged 18 to 26 completed standardized measures including the Depression, Anxiety, and Stress Scale, the Big Five Personality Test, and a subset of the Unusual Sleep Experiences Questionnaire. Results showed that there is a significant relationship between anxiety and sleep paralysis, (r = .244, p<.01) and stress and sleep paralysis (r = .161, p<.01). Additionally, agreeableness was found to significantly moderate the relationship between depression, anxiety, stress, and sleep paralysis. Furthermore, chi-square test of independence showed insignificant association between genders and sleep paralysis with χ2 (3, N=200) = 2.137, p=.544. This research contributes to the existing literature by providing insights for clinicians and highlight the importance of considering both psychological distress and individual personality differences when examining sleep paralysis among young adults.
References
Aledili, F. J., Alsharidah, A. S., Alhammadi, A. M., Alenezi, A. M., Alshammari, M. A., & Alrashed, A. A. (2021). Perceived awareness of sleep paralysis phenomenon (Old Hag Syndrome) and its most common risk factors among people from Al-Ahsa, Saudi Arabia. Saudi Medical Journal, 42(12), 1365–1372. https://doi.org/10.15537/smj.2021.42.12.20210641
Allport, G. W. (1937). Personality: A psychological interpretation. Henry Holt.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing.
Avidan, A. Y., & Zee, P. C. (Eds.). (2011). Handbook of sleep medicine (2nd ed.). Lippincott Williams & Wilkins.
Benham, G. (2022). Sleep paralysis in college students. Journal of American College Health, 70(5), 1286–1291. https://doi.org/10.1080/07448481.2020.1799807
Colombo, C., Sarlo, M., & Cellini, N. (2024). Lifetime prevalence and characteristics of sleep paralysis in Italian university students population. Sleep Medicine, 122, 106–112. https://doi.org/10.1016/j.sleep.2024.08.013
Denis, D., & Poerio, G. L. (2017). Terror and bliss? Commonalities and distinctions between sleep paralysis, lucid dreaming, and their associations with waking life experiences. Journal of Sleep Research, 26(1), 38–47. https://doi.org/10.1111/jsr.12441
Denis, D., French, C. C., & Gregory, A. M. (2018). A systematic review of variables associated with sleep paralysis. Sleep Medicine Reviews, 38, 141–157. https://doi.org/10.1016/j.smrv.2017.05.005
Dias, B. G., Banerjee, S. B., Goodman, J. V., & Ressler, K. J. (2013). Towards new approaches to disorders of fear and anxiety. Current Psychiatry Reports, 15(10), Article 370. https://doi.org/10.1007/s11920-013-0370-2
Goldberg, L. R. (1999). A broad-bandwidth, public-domain, personality inventory measuring the lower-level facets of several five-factor models. In I. Mervielde, I. Deary, F. De Fruyt, & F. Ostendorf (Eds.), Personality psychology in Europe (Vol. 7, pp. 7–28). Tilburg University Press.
Hefnawy, M. T., Amer, B. E., Amer, S. A., Moghib, K., Khlidj, Y., Elfakharany, B., Mouffokes, A., Alazzeh, Z. J.,
Soni, N. P., Wael, M., & Elsayed, M. E. (2024). Prevalence and clinical characteristics of sleeping paralysis: A systematic review and meta-analysis. Cureus, 16(1), e53212. https://doi.org/10.7759/cureus.53212
Hengstebeck, N. D. (2011). The occurrence of sleep paralysis in a college sample. Creating Knowledge: The LA&S Student Research Journal, 4, 66–71.
Ijaz, A., Saeed, M. M., Aftab, R. K., Altaf, B., Ahmad, A., & Ali, F. (2021). Prevalence of sleep paralysis in the medical students of a local medical college. MedERA – Journal of CMH LMC and IOD, 3(2), 4–7. https://doi.org/10.61982/medera.v3i2.63
Ikhlaq, A., Bint E Riaz, H., Bashir, I., Ijaz, F., & Aftab, R. K. (2021). Association of sleep paralysis with PTSD symptoms, pathological worry and perceived stress. International Journal of Pulmonary & Respiratory Sciences, 4(5), 96–99. https://doi.org/10.19080/IJOPRS.2021.04.555648
Jalal, B., & Hinton, D. E. (2015). Sleep paralysis among Egyptian college students: Association with anxiety symptoms (PTSD, trait anxiety, pathological worry). The Journal of Nervous and Mental Disease, 203(11), 871–875. https://doi.org/10.1097/NMD.0000000000000382
Lovibond, S. H., & Lovibond, P. F. (1995). Depression Anxiety Stress Scales (DASS--21, DASS--42) [Database record]. APA PsycTests. https://doi.org/10.1037/t01004-000
Monroe, S. M., & Simons, A. D. (1991). Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychological Bulletin, 110(3), 406–425. https://doi.org/10.1037/0033-2909.110.3.406
Muzammil, M. A., Syed, A.-R., Farooq, M. H., Ahmed, S., Qazi, M. H., Patel, T., Khatri, M., Zaman, M. U., Nadeem, T., Tanveer, F., Kumar, U., Varrassi, G., & Shah, A. A. (2023). Frequency and factors of sleep paralysis among medical students of Karachi. Cureus, 15(7), e41722. https://doi.org/10.7759/cureus.41722
Nair, D., et al. (2013). Isolated sleep paralysis and generalized anxiety disorder: A case report and review. Case Reports in Psychiatry, 2013, Article 987612. https://doi.org/10.1155/2013/987612
Otto, M. W., Simon, N. M., Powers, M. B., Hinton, D., Zalta, A. K., & Pollack, M. H. (2006). Rates of isolated sleep paralysis in outpatients with anxiety disorders. Journal of Anxiety Disorders, 20(5), 687–693. https://doi.org/10.1016/j.janxdis.2005.07.002
Paradis, C., Friedman, S., Hinton, D. E., McNally, R. J., Solomon, L. Z., & Lyons, K. A. (2009). The assessment of the phenomenology of sleep paralysis: The Unusual Sleep Experiences Questionnaire (USEQ). CNS Neuroscience & Therapeutics, 15(3), 220–226. https://doi.org/10.1111/j.1755-5949.2009.00098.x
Ramsawh, H. J., Raffa, S. D., White, K. S., & Barlow, D. H. (2008). Risk factors for isolated sleep paralysis in an African American sample: A preliminary study. Behavior Therapy, 39(2), 178–184. https://doi.org/10.1016/j.beth.2007.11.002
Sharpless, B. A., & Barber, J. P. (2011). Lifetime prevalence rates of sleep paralysis: A systematic review. Sleep Medicine Reviews, 15(5), 311–315. https://doi.org/10.1016/j.smrv.2011.01.007
Sharpless, B. A. (2016). A clinician’s guide to recurrent isolated sleep paralysis. Sleep Medicine Reviews, 26, 94–101. https://doi.org/10.1016/j.smrv.2015.05.001
Spanos, N. P., McNulty, S. A., DuBreuil, S. C., Pires, M., & Burgess, M. F. (1995). The frequency and correlates of sleep paralysis in a university sample. Sleep, 18(7), 536–541. https://doi.org/10.1093/sleep/18.7.536
Sudais, M., Saddar, A., & Khalid, M. A. (2022). Effects of sleep paralysis on human psychology. Journal of Forensic Psychology, 7(1), 203. https://doi.org/10.35248/2475-319X.22.7.203
Szklo-Coxe, M., Young, T., Finn, L., & Mignot, E. (2007). Depression: Relationships to sleep paralysis and other sleep disturbances in a community sample. Journal of Sleep Research, 16(3), 297–312. https://doi.org/10.1111/j.1365-2869.2007.00600.x
Corresponding Author
Fiza Rehman
Senior Lecturer/PhD Fellow, Department of Clinical Psychology, Shifa Tameer-e-Millat University, Islamabad, Pakistan.

