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Sleep Disorders

Confused :(

08/07/2009

Question:

Ok, here is the thing. I believe I have hypnogogic hallucinations, but mine are visual, touch, and auditory all rolled into one. Right before I fall asleep and a "hypnogogic hallucination" occurs I`ll hear a loud ringing. Once the dream starts there is no way of waking up during the dream.  During these I get a sensation of not touch, but like something throbbing when something bad is about to happen. I have bipolar, anxiety, depression, and intermentice explosive disorder. There are 9 cases on my mothers side of schizophrenia. Are these dreams just really messed up dreams or am I developing yet another mental disorder?

Thank you for taking your time to read this.

PS: It said this happens in small children. I am 22 years old and it has been going on since I was 5. Please let me know something. Thank you.

Answer:

Based on the information you provided in your question, you are probably correct that your symptoms are sleep-related hallucinations at sleep onset, also known as hypnagogic hallucinations. However, to be sure, more sleep history would be needed as other conditions can present with similar symptoms (such as nightmare disorder, psychiatric disease, exploding head syndrome and seizure disorders). A visit to a Sleep Specialist would probably be worth considering to clarify what exactly the problem is and what can be done about it.

The sleep-associated symptom of feeling, hearing or seeing things that are not present generally represents sleep-related hallucinations. Sleep-related hallucinations can be a sign of a primary sleep disorder or possibly a psychiatric condition.

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 (hypnapompic 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 to be the cause.

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.

It certainly sounds as though your symptoms are significant. Your underlying psychiatric conditions and/or the medications used to treat these problems could be contributing factors to your symptoms. It would be a good idea to discuss her problems you’re your Psychiatrist. Further evaluation by a Sleep Specialist and/or a Neurologist may be needed, depending on specifics in your history and examination. Additional testing may be required to help sort out the cause of the hallucinations.

To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine's website at http://www.aasmnet.org/. 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 sleepeducation.com also provides plenty of good consumer friendly information. Good luck and here's to better sleep!

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Response by:

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