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Sleep Disorders

I Can`t Tell If I Am Awake or Asleep

02/23/2009

Question:

I have a problem that I can’t tell if I am awake or asleep, and it is very scary. I am 23 and do not drink, do drugs, nor do I drink caffeine. I have dreams which usually occur in the morning after being asleep that are so vivid I am unsure if they are actually taking place or I am asleep. While in this state I question myself and can never figure out if I am asleep or not! I can smell and taste as well as feel the things that are occurring in my sleep (i.e. smelling nail polish remover I spilled in the dream and feeling it on my hands). These dreams are often chaotic and frightening and I feel as though everything is out of control. I have called two sleep clinics and no one had any answers as to what this may be. I have always had trouble falling asleep and have experienced sleep paralysis several times before but this is very different. I also will dream that I have awoken from these dreams and think I have gotten out of bed before I realize I am back in the dream and have never gotten up. I am not narcoleptic and do not suffer any mental or physical illness aside from these dreams. With these dreams also come false memories, mostly about conversations. I have to spend time the next day trying to figure out what really happened, these memories are often emotionally based (i.e. embarrassment, funny). If this sounds like a known sleep disorder I would really like to know what it could be.

Answer:

Thank you for visiting NetWellness. On this site, we try to answer general questions about sleep disorders but cannot diagnose or recommend treatment. You appear to have some very specific questions about your sleep patterns which can only be answered properly by a physician who is familiar with your history, physical exam, and test results. Your description of the events, however, is consistent with a common parasomnia called a hypnopompic hallucination.

Sleep-related hallucinations are prominent, vivid, dreams that are difficult to distinguish from reality as they appear to have visual, tactile and auditory components. They can occur at sleep onset (hypnagogic) or while waking up (hypnopompic). These events are common (reported in about 12% of the population) and may be associated with sleep paralysis. Sleep-related hallucinations may be associated with narcolepsy and are one of the phenomena commonly seen with narcolepsy. However, many people have hypnopompic or hypnagogic hallucinations without having narcolepsy, which is always associated with daytime sleepiness.

There are a number of factors that could lead to sleep-related hallucinations in individuals who do not have a primary sleep disorder. Sleep deprivation or a varying sleep schedule can be factors associated with sleep-related hallucinations, as well as other parasomnias. Certain medications, abuse of alcohol or other illicit substances, and certain psychiatric conditions can also lead to sleep-related hallucinations.

You should make sure you are keeping a regular sleep schedule with 7-8 hours of sleep per night as this can sometimes decrease the frequency of these events. These events can be quite disturbing, however, many people are able to limit or adapt to them.

If these events are persistent or disruptive, you may consider further evaluation by your primary physician and possibly a sleep specialist. A thorough history and physical examination, perhaps with additional testing, should help to sort out why these events are occurring.

If you'd like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website where they have a listing of sleep centers. Best of luck!

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Response by:

Aneesa M Das, MD Aneesa M Das, MD
Assistant Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University