Hypnopompic Hallucinations: Symptoms, Causes, & Treatment

What Are Hypnopompic Hallucinations?

Hypnopompic hallucinations are hallucinations that occur in the early hours as a person first awakens and can feel very authentic and real. They may lead a person to see or hear things, people, and noises when they first begin to wake that are not there.

Hypnopompic hallucinations vary in intensity depending on a person’s preexisting mental health or sleep disorders. A typical hypnopompic hallucination is short and happens in non-REM sleep stages. However, its duration and vividness can change based on how long it takes an individual to transition from one state of sleep to another.

Hypnagogic Vs. Hypnopompic Hallucinations

Hypnagogic and hypnopompic hallucinations are common sleep-related experiences that happen in the transition between sleep and wakefulness, called hypnagogia. While hypnagogic hallucinations occur as you fall asleep, hypnopompic hallucinations occur as you wake.

Hypnopompic and hypnagogic hallucinations are often associated with other sleep disorders. They’re often found in people who also experience sleep paralysis, narcolepsy, or insomnia.

Hypnopompic Hallucinations Vs. Other Sleep Disturbances

Hypnagogic hallucinations are different from other sleep disorders as these hallucinations in themselves are not a cause for concern. They have little risk as the feelings and sensations often dissipate when the individual wakes up or moves into the next stage of sleep. Sleep disorders, including experiences of nightmares and anxiety dreams, differ from these hallucinations as these occur in REM sleep and are often felt and remembered upon waking. If the vivid dream itself is not memorable, the feelings of fear can linger upon awakening.

Sleep paralysis and lucid dreaming are also marked by sensing perceptions that are not there. While these can occur with these types of hallucinations, they are separate experiences.

Symptoms of Hypnopompic Hallucinations

Hypnopompic hallucinations are relatively common, with up to 70% of people experiencing them at least once.¹ Typically, these hallucinations are visual, but they can also be auditory or tactile hallucinations. Additionally, unlike a dream or nightmare, it may take a moment to realize your hypnopompic hallucination wasn’t real.

Symptoms of hypnopompic hallucinations may include:

• Hearing voices
• Seeing colors or images
• Seeing people or animals
• Seeing things move
• Hearing varying noises
• Feeling weightless
• Perception of another person in the room
• Falling or flying sensations

What Causes Hypnopompic Hallucinations?

The exact cause of hypnopompic hallucinations is unknown. However, underlying conditions or activities can be risk factors for hypnopompic hallucinations and may increase their occurrence. While hypnopompic hallucinations typically aren’t a cause for concern, they can be a sign of another medical issue.

Possible causes of hypnopompic hallucinations include:

Insomnia

Sleep issues such as insomnia can contribute to the onset of these hallucinations due to frequent waking. As those with insomnia experience more time in the transition periods between sleep and wakefulness, they may be more susceptible to hypnopompic hallucinations.

Parkinson’s Disease

Parkinson’s disease commonly causes fragmented sleep, insomnia, and other conditions like rapid eye movement behavior disorder (REMBD). These sleep issues can lead to an increase in all kinds of apparitions and delusions, including hypnopompic hallucinations.

Additionally, fragmented sleep leads to more time in the transitions between sleep and wakefulness, increasing the likelihood of hypnopompic hallucinations.

Narcolepsy

Hypnagogic and hypnopompic hallucinations are common in patients with narcolepsy, occurring in 40-80% of patients with the condition. Researchers believe hallucinations are prevalent in those with narcolepsy as patients experience the phenomenon of REM sleep merging into wakefulness.²

Depression and Mood Disorders

Mental health issues such as depression and bipolar disorder can also increase the likelihood of developing hypnopompic hallucinations, as these conditions may impact sleep patterns, increase or decrease wakefulness, and lead to the use of certain medications. Specifically, the use of tricyclic antidepressants is linked with an increase in hypnopompic hallucinations.

Anxiety Disorders

While anxiety disorders don’t typically cause hypnopompic hallucinations, they can increase the likelihood of experiencing them. Those prone to anxiety and experiencing these disturbances may find them frightening, leading to increased night anxiety. Patients experiencing sleep anxiety may experience insomnia, leading to a higher chance of having further hallucinations.³

Substance Use

Alcohol or drug use can lead to a faster descent into REM sleep. However, it can also blur the lines between wakefulness and REM sleep, leading to dreams experienced as hallucinations. Additionally, those who are under the influence of drugs or alcohol may have a more challenging time discerning their sleep-related hallucination as an illusion rather than reality

Medications

Certain antibiotics and several psychiatric medications can trigger hypnopompic hallucinations. These visions can be side effects of sleep-inducing prescription medications, such as zolpidem or eszopiclone; antipsychotic medications, such as olanzapine, quetiapine, and haloperidol, or antianxiety medications like lorazepam.

Additionally, interactions between certain medications can also trigger hallucinations. Talking to your doctor about all the medications you take is important to ensure you are getting the right medication for you.⁴

How are Hypnopompic Hallucinations Diagnosed?

If you or someone you love is experiencing hypnopompic hallucinations or has sleep-related issues, speaking with a sleep specialist or therapist is a good way to begin understanding and addressing these concerns.

Medical providers, predominantly sleep specialists, typically begin with sleep studies to identify the onset and impact of these hallucinations and other sleep-related symptoms. Additionally, it can be beneficial to work with a therapist to discuss daytime stressors or co-occurring mental health symptoms that may contribute to nighttime hallucinations. Your healthcare provider may ask you self-reported questions and have you fill out surveys related to sleep, stress, mood, and health.⁵

Treatment for Hypnopompic Hallucinations

Many people experience sleep hallucinations at least once in their life. While these apparitions may be unsettling, they are not dangerous. However, increased hypnopompic hallucinations may be associated with underlying conditions, such as anxiety or depression.

Therapy is a great way to figure out what else may be contributing to sleep-related issues. Additionally, finding the right therapist who can help you with your concerns can improve both your sleep hygiene and your overall mental health.

Often, the problems and experiences we fail to address during the day show up at night time when we are trying to fall asleep.

Among the benefits of therapy is the opportunity to understand your coping mechanisms and how they affect your overall health can serve as a critical component to improving your sleep patterns. By working with an experienced therapist, you can address emotional and mental health issues that may be affecting and disrupting your sleep.

To find the right therapist, you may want to consider speaking with a sleep specialist and taking recommendations or searching online therapist directories to see who has experience with sleep issues related to mental health. Online psychiatry providers may also recommend medications for sleep stability or mood stabilization based on their evaluations.⁶

Treatment options for hypnopompic hallucinations may include:

• Cognitive behavioral therapy for insomnia (CBT-I):  CBT-I is recognized as one of the primary interventions for those with chronic sleep problems. By aiming to address the underlying causes of insomnia, CBT-I can reduce hypnopompic hallucinations without using medications that can further aggravate symptoms.
• Eye movement desensitization and reprocessing therapy (EMDR): EMDR helps patients to reprocess trauma, reducing symptoms of depression, anxiety, and other mood disorders that can trigger hypnopompic hallucinations.
• Medications: REM-suppressing antidepressants, such as Effexor, or certain SSRIs can reduce the occurrence of hypnopompic hallucinations. Additionally, medicinal interventions to treat the underlying cause of the hallucinations can also offer relief.
• Lifestyle changes: Improving sleep hygiene, regular daily exercise, and avoiding drugs and alcohol can reduce the occurrence of hypnopompic hallucinations and improve overall health.

How to Cope With Hypnopompic Hallucinations

While we can’t necessarily control hypnopompic hallucinations or when they may occur, there are ways to cope with them. These hallucinations may be distressing, but there are some strategies to improve sleep and potentially reduce their frequency.

To cope with hypnopompic hallucinations:

1. Follow a regular bedtime routine: Good sleep hygiene is important for your mind and body to know when to expect rest and can rely on this schedule.
2. Practice relaxation techniques: Relaxation techniques such as breathwork and progressive muscle relaxation can be helpful to slow your heart rate, help you stay present, and bring you back into your body.
3. Seek treatment: Therapy options for depression and bipolar disorder can also be helpful as these conditions may contribute to distressing sleep experiences.
4. Use healthy coping mechanisms: Healthy coping mechanisms, such as yoga, meditation, and socializing with friends, can improve how you interact with the world and elevate your overall quality of life.
5. Take a social media break: A social media break can improve symptoms of mood disorders or stress, resulting in a reduction in the prevalence of hypnopompic hallucinations. Additionally, limiting screen time at night can help to improve sleep quality.

• Avoid drugs and alcohol: Using drugs or alcohol can contribute to heightened symptoms of hallucinations. Limiting your consumption of these substances can  improve your quality of sleep.
• Journal during the day: Journaling throughout the day and week can be helpful to manage your stress. In addition, journaling the occurrences of your hypnopompic hallucinations can aid in identifying and understanding any correlations between your visions and other aspects of your life or signify a deeper issue.

Final Thoughts

Hypnopompic hallucinations can sometimes be distressing, but there are ways to improve sleep and reduce their occurrence. Learning about your life stressors and other factors that may be contributing can help you understand and improve your sleep health. Taking action to develop sleep routines, healthy lifestyles, and working with your healthcare providers can make a big difference in how you feel.