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Sleep Disorders

Hypnagogia??

09/27/2011

Question:

Age 64 female, have sleep apnea, use CPAP with good results. The last 3 months at sleep onset or upon waking I see formed objects with my eyes closed. Usually cartoon characters moving very quickly. Other objects also. Most black and white, sometimes color, sometimes photos I have taken, but mostly cartoon characters. Happens frequently. Can also happen if I am just in a dark room. Trying to decide on neurologist or sleep disorder doc or is there another specialist? (My eyes have tested fine.) I was psych RN for 30 years---am not psychotic, no drugs, no alcohol, no smoking. Done research to find hypnagogia and wondered if this could this be it or do I have brain tumor!!! What causes this and which doc do I need to see or should I ignore it? Thanks for ANY HELP!

Answer:

Based on the information you provided in your question, it’s possible that you may be experiencing sleep-related hallucinations, also known as hypnagogic and hypnopompic hallucinations. However, the episodes of this happening in “dark room” while awake are somewhat atypical and thus, to be sure, more sleep history is needed as other conditions can present with similar symptoms (such as nightmare disorder, narcolepsy, sleep apnea, psychiatric disease, ,rarely seizure disorders and other potential neurologic disease). A visit to a Sleep Specialist would probably be worth considering to clarify whether these symptoms are related to sleep or if you need a different evaluation.

The sleep-associated symptom of feeling, hearing or seeing things that are not present often 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. Neurologic conditions affecting the visual nerves (the optic tract, the occipital lobe of the brain) could also be a consideration if these symptoms are clearly not related just to sleep.

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. Making sure your sleep apnea is under optimal control may also be beneficial in reducing the events. 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. 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