Question:

I am a 14 year old girl. Recently, I have been having “visions” on the border of sleep. I have only had several, but they have frightened me. For the past several months, I have been hearing voices on the threshold of sleep but they usually jerk me awake. Sometimes I can`t remember what the voices say. Most of the time they laugh. They sound evil.

Perhaps all of my life I have been experiencing the “jerk” or “falling” sensation during hypnagogia. I thought this was normal.

Last night I think I experienced sleep paralysis. A voice was narrating a sequence of events and I could`t move. I heard the devil`s laughter. I tried to open my eyes partially, but when I did I saw that my bed was on the wrong side of my room. I immediately thought “Sleep paralysis!” I relaxed for a moment. After a while, the sensations of paralysis left. I opened my eyes fully. I couldn`t`t tell if I had been dreaming or not. I don`t think I was fully asleep, but I know I was experiencing at least hypnagogia. Is that sleep paralysis?

I tend to be very moody. Lately I have had symptoms of depression, but like I said, I am so moody sometimes I have no symptoms of depression at all.

Are they related? Do I need to see a doctor?

Answer:

You are describing 3 separate sleep-related issues; hearing and seeing things not present when trying to fall asleep (known as hypnagogic (sleep onset) hallucinations), sleep paralysis and sleep or hypnic jerks. All of these phenomena are not that uncommon in the general population and, in many instances, are considered normal. However, in some cases, the hallucinations and sleep paralysis may suggest a primary sleep disorder. Both hypnagogic hallucinations and sleep paralysis tend to affect younger individuals most frequently.

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 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 or, rarely, they could be part of sleep-related seizures (epilepsy). Psychiatric disease should also be included as a possibility, though assuming these hallucinations occur only after sleep onset, then this would be much less likely. Depending on the underlying cause or factors associated with the hallucinations, the hallucinations may decrease or resolve with age.

Sleep paralysis is commonly seen in young adults and often associated with stress. In most cases, these episodes do not represent a primary sleep disorder and tend to resolve over time. However, when they occur in association with sleep-related hallucinations and excessive sleepiness, narcolepsy should be considered.

It certainly sounds as though your symptoms are quite distressing to you and are having a significant impact on your daily life. It would be a good idea to discuss your problems with your Primary Care Doctor. Referral to a Sleep Specialist may be needed, depending on specifics in your history and examination. Additional testing may be required to help sort out the cause of these problems.

To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website Sleep Educaiton.com also provides plenty of good consumer friendly information. Good luck and here’s to better sleep!

For more information:

Go to the Sleep Disorders health topic.