The sleep cycle is a series of various transitional states that continue to repeat themselves for as long as a person is sleeping. It is not uncommon for some individuals to get hallucinations, i.e., hearing, feeling, or seeing something that is not real, and the experience can undoubtedly be unsettling or frightening. These hallucinations are particularly common in those with certain underlying conditions, like narcolepsy, but may also occur due to a lack of sleep or substance abuse.
Hypnopompic hallucinations are a specific type of hallucination that occurs as a person is waking up.  Mostly comprising visual content, these hallucinations may feel as if a dream is continuing into a state of wakefulness, similar to the experience during lucid dreaming. Research suggests that up to 13% of people are likely to experience a hypnopompic hallucination during their lives.
If you or someone you know has been struggling with hypnopompic hallucinations, it may be helpful to understand these experiences, their possible causes, symptoms, and when to contact a doctor about them.
The Common Symptoms of Hypnopompic Hallucinations
The symptoms involved in hypnopompic hallucinations may involve visual, tactile, or auditory experiences just as a person is waking up. The content often includes the continuation of a dream that the person was having during sleep. These hallucinations are likely to last for a few seconds to a minute and may be challenging to differentiate from dreams.
Up to 85% of hypnopompic hallucinations include visual symptoms, including lots of detail and colors. Some colors that may be seen during an ongoing hypnopompic hallucination may include the following:
- Flashes of light
- Kaleidoscope patterns
Between 8% to 34% of these hallucinations include auditory symptoms, such as the following sounds:
- Sounds from a phone
- People talking
- Animal sounds
Between 25% to 44% of people who experience hypnopompic hallucinations may include changes to the sensations affecting the body, for example:
- Distortion of the body
- Perceived presence of another person in a room
Fear may not necessarily be a symptom of hypnopompic hallucinations; however, some individuals may consider these experiences terrifying. The majority of people understand that these hallucinations are not real but may still experience fear associated with sleep.
What Causes Hypnopompic Hallucinations?
There are plenty of triggers that lead to hypnopompic hallucinations, such as certain sleep disorders, using different substances, a lack of sleep, and certain physical and mental health disorders. Many researchers believe these hallucinations to be dreamlike experiences that occur during REM sleep and continue into a state of wakefulness. REM or rapid eye movement sleep is a stage of sleep that individuals cycle through every night and when most people experience dreams.
All types of hallucinations, including hypnopompic hallucinations, are formed in the brain and can have many possible causes. They may happen while withdrawing or actively using certain substances, such as alcohol, LSD, cannabis, and medications that affect the stages of sleep. Hypnopompic hallucinations are also known to frequently happen in people with narcolepsy, a rare disease with daytime sleepiness as a primary symptom.  Such people go through a disrupted sleep-wake cycle every night that negatively affects their REM sleep and causes symptoms like sleep paralysis, muscle weakness, and hallucinations.
Even though most hypnopompic hallucinations occurring during the end stages of sleep are related to narcolepsy, these hallucinations may also occur due to other causes like the following:
- Guillain-Barré syndrome
- Depression with psychosis
- Brain cancer
- Kidney failure
- Liver failure
hypnopompic hallucinations may also occur during sleep paralysis, an experience where a person wakes up from sleep but cannot move their body. This phenomenon is commonly known as hypnopompic sleep paralysis. However, this condition is much less prevalent than narcolepsy.
Hypnopompic Hallucinations and Psychiatric Conditions: What’s the Association?
Even though people with certain mental health conditions can undergo hypnopompic hallucinations, having these hallucinations does not always mean a person is having an underlying psychiatric issue. To diagnose the cause of hallucinations, an expert may consider different factors, such as a person’s health history, symptoms, and the results from any psychological or blood tests performed.
In general, hypnopompic hallucinations may present differently in people with and without mental health disorders. These differences include the following:
- Insight: Most people who experience hypnopompic hallucinations without a mental health disorder are aware that they are not real. Those with a mental health disorder, on the other hand, may lack this insight.
- Content: The content of hallucinations due to an underlying mental health issue is usually more frightening, hostile, and disturbing than the content of hypnopompic hallucinations without any triggering psychiatric issue.
- Sounds: Auditory hallucinations can be experienced by anyone; however, they are more common in individuals with underlying mental health conditions and are usually a mix of visual and auditory content. On the other hand, hypnopompic hallucinations due to medical issues, like narcolepsy, are primarily visual.
- Other Symptoms: Hypnopompic hallucinations due to an underlying mental health issue are often accompanied by other psychiatric symptoms, such as those of depression and anxiety.
How to Stop Hypnopompic Hallucinations: The Treatment Plan
Hypnopompic hallucination treatment can vary depending on the causative factor. Sometimes, treatment may focus on raising awareness and reassurance, and the episodes may resolve on their own without requiring any additional management. If a doctor believes that hypnopompic hallucinations are due to narcolepsy, they may commence appropriate treatment for this disorder to reduce the frequency. Remember that treatment for narcolepsy includes both medications and lifestyle changes.
Depending on what’s causing it, hypnopompic hallucinations may also be managed through relaxation techniques, medications, lifestyle changes, and talk therapy. All treatments are aimed at:
- Reducing or completely stopping the use of any substances contributing to hallucinations
- Treating the underlying cause
- Helping patients develop coping strategies
If an expert believes that the reason for hypnopompic hallucinations is a lack of sleep, they may also encourage patients to improve their sleep hygiene through the following tips:
- Going to bed and waking up at the same time every day
- Ensuring six to eight hours of sleep every night
- Avoiding foods, drinks, and activities that interfere with sleep
- Getting enough daily exercise, but during morning hours
- Creating a bedroom environment that is conducive to sleep
How common is the prevalence of hypnopompic hallucinations?
According to estimates, approximately 7 to 13% of people go through hypnopompic hallucinations. However, this condition is currently considered to be highly underreported as many people may not realize that they are having these hallucinations or simply avoid telling their doctor about them. Surveys suggest that hypnopompic hallucinations are more commonly seen in younger people, and females are more likely to experience them than males. Moreover, their incidence is also more common in people with certain underlying health issues.
Hypnagogic vs. hypnopompic hallucinations: what is the difference?
Both types of hallucinations have a direct association with sleep. However, hypnopompic hallucinations occur when a person is waking up from sleep, whereas hypnagogic hallucinations occur when they are going to sleep.
What is the difference between hypnopompic hallucinations and nightmares?
hypnopompic hallucinations are different from nightmares in a way that they happen as a person wakes up in the morning hours. Nightmares, on the other hand, occur during the REM sleep stage. Additionally, most hypnopompic hallucinations usually include simple sounds, sensations, or images, whereas nightmares can be a lot more complex, with storylines that easily provoke strong emotions. Some people may experience hypnopompic hallucinations while having an attack of sleep paralysis, which may make these hallucinations more frightening, similar to a nightmare.
When should I see a doctor regarding hypnopompic hallucinations?
If you have been experiencing hypnopompic hallucinations without any other symptoms, seeing a doctor is not necessary. However, if these hallucinations have started interfering with your ability to sleep or causing distress, consider getting medical help. A doctor can assess your circumstances to check if you have an underlying disorder or illness due to these hallucinations. Remember that hypnopompic hallucinations occur only when a patient is waking up. If you start experiencing them during other hours of the day, talk to a doctor, as this may indicate an underlying problem. If you have a reason to believe that you have narcolepsy, for instance, due to symptoms like loss of muscle tone, sleeping issues, and excessive tiredness, talk to a doctor, as the condition is dangerous but manageable.
What are some hypnopompic hallucinations examples?
Hypnopompic hallucinations can have variable content; for instance, it may make a person feel as if they are flying or seeing a person who is not there. In most cases, these hallucinations are the continuation of a dream a person was having while they were asleep.
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