Hypnagogic hallucinations: Description, Causes and Risk Factors:Hypnagogic hallucinations are visual, tactile, auditory, or other sensory events, usually brief but occasionally prolonged, that occur at the transition from wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic). The phenomenon is thought to have been first described by the Dutch physician Isbrand Van Diemerbroeck in 1664.There could be a number of causes of hypnagogic hallucinations, including side effects of drug addiction, ingesting or inhaling various toxic substances, and sometimes prescription or over-the-counter medications. Most commonly these hallucinations are experienced by individuals who are victims of various sleep disorders, or have some psychological problems, in the past or at present. Sleep paralysis could also be the reason for the hypnagogic hallucinations, which might occur simultaneously or separately. Sleep paralysis is the state where the mind awakens, preventing the person from falling into a deep enough of a sleep to actually dream.Hypnagogic hallucinations tend to be more common in young people, especially children, which may be because their minds are still developing and forming pathways, which can occasionally lead to some crossed wires.The final case for these hallucinations can be as simple as head or back injuries that are impinging the nerves that lead into the brain. A head or spinal injury can also cause the chemicals within the brain to stop functioning properly, especially if specific nerves are pinched. As stated before, that is why a medical provider must be consulted when hypnagogic hallucinations become a problem. Even though the basic symptoms may be nothing more than a nuisance, the underlying problem may be more serious and it should be isolated and eliminated.If someone experiences numerous hypnagogic hallucinations, repetitive or not, it is a good idea to see a doctor to check for health problems which could be related to the experiences. If no cause is evident, a psychologist or similar mental health professional might be able to explore the subconscious causes and help the patient deal with the hallucinations. Consulting a psychologist can also yield useful tips for people who are shaken or upset by hypnagogic hallucinations, even if the hallucinations continue to occur.Hypnagogic hallucinations can occur without narcolepsy. People may be reluctant to admit to them for fear of being thought mentally ill. Sex ratio is equal. A telephone interview of nearly 5,000 people aged 15 to 100 in the UK showed that 37% of the sample reported experiencing hypnagogic hallucinations and 12.5% reported hypnopompic hallucinations. Both types of hallucinations were significantly more common among subjects with symptoms of insomnia, excessive daytime sleepiness or mental disorders. Hypnagogic and hypnopompic hallucinations were much more common than expected, with a prevalence that far exceeds that which can be explained by the association with narcolepsy. Hypnopompic hallucinations may be a better indicator of narcolepsy than hypnagogic hallucinations in subjects reporting excessive daytime sleepiness.Symptoms:Signs and symptoms:Hypnagogic hallucinations can occur at the onset of sleep, either by day or at night. They are usually quite vivid and visual.
Visual hallucinations usually consist of simple forms such as colored circles or parts of objects that may be constant or changing in size. A formed image of an animal or a person may appear and it is often in color.
Auditory hallucinations are common but other senses are seldom involved. Auditory hallucinations can range from a few sounds to an elaborate melody. Threats or criticism are also reported.
Another type of hallucination that is sometimes reported at the onset of sleep involves elementary cenesthopathic feelings (such as experiencing picking, rubbing, or light touching), changes in location of body parts (such as an arm or a leg), or feelings of levitation or extracorporeal experiences (like moving the body in space or floating above the bed) that may be quite elaborate.
There may be a history of narcolepsy with the ability to fall asleep if at all tired or bored, often with social embarrassment. It may lead to the inability to hold down a job.
Diagnosis:Differential Diagnosis:It is important to decide if this is narcolepsy as it is a treatable condition.
Schizophrenia can cause hallucinations including derogatory auditory remarks. In people who experience hypnagogic or hypnopompic images but do not have narcolepsy, the tendency towards psychosis is greater than in others.
Musical release hallucinations are complex auditory phenomena, affecting mostly the deaf elderly population, in which individuals hear vocal or instrumental music. Progressive hearing loss from otosclerosis disrupts the usual external sensory stimuli necessary to inhibit the emergence of memory traces within the brain, thereby "releasing" previously recorded perceptions.
There may be drug abuse.
Sleep terrors in children.
Investigations:Blood tests and imaging are likely to be normal.
Referral to a special sleep laboratory may be required to diagnose narcolepsy.
Treatment:A quick medical evaluation should be sought, if someone starts to hallucinate and is disconnected from reality because many medical conditions that can cause hallucinations may quickly become emergencies. People who are hallucinating may become nervous, paranoid, and frightened and should not be left alone.With regard to the underlying disorder the hallucinations are treated. Depending on the disorder, treatment may involve anticonvulsant, antidepressant medications, or antipsychotic; brain or ear surgery; psychotherapy; or therapy for drug dependence.Hallucinations associated to normal sleeping and waking are not a cause for concern.A psychologist or psychiatrist should treat hallucinations that are symptomatic of a mental illness such as schizophrenia.Antipsychotic medication such as thioridazine (Mellaril), chlorpromazine (Thorazine), clozapine (Clozaril), haloperidol (Haldol), or risperidone (Risperdal) may be prescribed. In many cases, medications can control chronic hallucinations caused by schizophrenia or some other mental illness.Psychosocial therapy can be helpful in teaching the patient the coping skills to deal with them, if hallucinations persist. Hallucinations due to sleep deprivation or severe stress generally stop after the cause is removed.NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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