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Sleep Disorders

Waking Out of REM #4 Stage to Dread and Fear

10/29/2009

Question:

I have been experiencing waking up to visual and emotional halusinations of entities and thoughts or awareness of danger and dread of being stuck, suffocated, buried alive, underground, non-phsyical, objects that I thought were there are not there, objects that are there have moved. Waking up expecting another person to be there in other room and realize they`re not there!? I have to physically leave out of my room to the other parts of the house and turn on all the lights!

I then get over the spell and go back for round 2 ,... round 3 ... 4 .. etc... What am i dealing with here? Am I losing my mind?

- Sleep Deprived

Answer:

Based on the information you provided in your question, it sounds as though you are experiencing sleep-related hallucinations upon, also known as hypnopompic hallucinations. However, to be sure, more sleep history would be needed as other conditions can present with similar symptoms (such as nightmare disorder, narcolepsy, sleep apnea, psychiatric disease, and rarely 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.

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 or anxiety) 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. A careful review of you history, medical problems and medications would be helpful. 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 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 Education.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