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Sleep Disorders

Vivid hallucinations when awake but tired

06/25/2007

Question:

I am a 17 year old male and have had trouble sleeping these past few months.. I did not get enough sleep due to stress and working late and I once I hallucinated vividly for about 6-8 hours. I saw hairs falling from the ceiling, my entire room changed colours and I saw people from the corner of my eye who would interact with me. I could touch the hairs and it was as if they were real. This disappeared for a while but recently I have gotten it many times; every other night or so.. Last time I could see images when I closed my eyes and it was as if i fell in and out of dreams.. I could not move and i called for help but no words came out of my mouth.. I am very scared but hope this is simply a lack of sleep and nothing severe.. What is wrong with me?

Answer:

It sounds as though you are experiencing the symptoms of sleep-related hallucinations and sleep paralysis. Both can be brought on by a lack of adequate sleep, stress, primary sleep disorders or psychiatric conditions. Given the information you provided in your question, I suspect these may be related to a combination of lack of adequate sleep and stress. However, further information would be needed before a definite diagnosis can be made. In the absence of that, I will provide you with some additional information about these symptoms.

First, the sleep-related hallucinations:

Sleep-related hallucinations are usually visual (seeing things), though they can be auditory (hearing things), tactile (sensation of feeling something) or kinetic (feeling of motion or movement). They more commonly occur with sleep onset (known as hypnagogic hallucinations) but can happen with morning awakenings (hypnopompic hallucinations) as well. Sleep related hallucinations can be frightening and may, at times, be associated with other sleep behaviors such as sleep walking or sleep talking.

The underlying cause of sleep related hallucinations is not always clear. Factors known to bring these about or increase the frequency of occurrences include younger age, current drug use, past alcohol use, anxiety, mood disorders, insomnia and lack of sleep. Certain medications may also cause this as a side effect. In addition, these hallucinations may be a sign or symptom of another sleep disorder, such narcolepsy, a primary nightmare disorder, migraine headaches, or, rarely, they could be part of sleep-related seizures (epilepsy). Psychiatric disease (such as schizophrenia) should also be included as a possibility, though assuming these hallucinations occur only with sleep, then this would be less likely.

Depending on the underlying cause or factors associated with the hallucinations, they may decrease or resolve with age. Identifying factors associated with the hallucinations (such as alcohol use or lack of sleep) and avoiding these may help to decrease the frequency or intensity of the problem. In cases where this does not occur, specific treatments are available, though the type of treatment will depend upon the underlying cause of the hallucinations.

And second, the sleep paralysis:

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. Breathing is not affected and individuals can recall the event. The episode usually 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.

If you would like further information about sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University