Sleep related hallucinations
Hypnagogic and hypnopompic hallucinations are vivid sensory experiences occurring during sleep transitions. They can be linked to various conditions and medications. Treatment primarily addresses daytime sleepiness and cataplexy, which can indirectly improve hallucinations. Non-pharmacological approaches include sleep hygiene and napping. Medications like modafinil, armodafinil, solriamfetol, and others are used to manage symptoms, while REM sleep-suppressing drugs like venlafaxine or sodium oxybate may also be considered.
2024-01-01 00:19:01 - Editor
Introduction to Hypnagogic and Hypnopompic Hallucinations
Hypnagogic and hypnopompic hallucinations are believed to result from intrusion of rapid eye movement (REM) sleep. Hypnagogic hallucinations are vivid, often frightening visual, tactile, or auditory hallucinations which occur as the patient is falling asleep. Hypnopompic hallucinations refer to the period when a person wakes up. Hypnopompic hallucinations can occur in narcolepsy, Guillain-Barré syndrome (GBS), Parkinson disease, or schizophrenia. Also, medications, such as, serotonergic and anticholinergic antidepressants can induce such hallucinations. They are commonly associated with excessive daytime sleepiness, sleep paralysis, and cataplexy. (1, 2, 3)
Treatment Approaches for Hallucinations
Treatment is usually focused on the more disabling symptoms of daytime sleepiness and cataplexy, and hypnagogic and hypnopompic hallucinations often improve with these interventions. Most patients require non-pharmacological measures and pharmacological therapy.
Non-Pharmacological Interventions
Non-pharmacological interventions include napping and sleep hygiene. Sleep deprivation may worsen the problem and therefore patients should be counselled to maintain a regular and adequate sleep schedule. Instructions on various sleep hygiene techniques, such as, going to sleep and waking up at the same time each day, no use of alcohol or caffeine before bed, avoidance of sleep in a supine or prone position are recommended. Certain medications, such as, benzodiazepines, opiates, antipsychotics, and prazocin, should be avoided. Also patients often benefit from participation in support groups that focus on coping skills and identification of community resources to assist with administrative and medical issues. (4)
Pharmacological Therapies
Medications include modafonil (starting at a dose of 200 mg daily in the morning), armodafinil (150mg daily), solriamfetol (starting at 75 mg orally daily in the morning), pitolisant (starting at 8.9 mg daily), methylphenidate (10 mg twice daily), or dextroamphetamines (5mg twice daily). (5, 6)
Also, REM sleep- suppressing drugs, such as, antidepressants including venlafaxine (37.5- 75mg), or sodium oxybate (3 g, twice per night) may be beneficial. (7)
References
1- Broughton WA, Broughton RJ. Psychosocial impact of narcolepsy. Sleep.
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2- Szucs A, Janszky J, Holló A, et al. Misleading hallucinations in unrecognized narcolepsy. Acta Psychiatr Scand. 2003;108(4):314–316.
3-Frauscher B, Ehrmann L, Mitterling T, et al. Delayed diagnosis, range of severity, and multiple sleep comorbidities: a clinical and polysomnographic analysis of 100 patients of the innsbruck narcolepsy cohort. J Clin Sleep Med 2013; 9:805.
4- Vourdas A, Shneerson JM, Gregory CA, et al. Narcolepsy and psychopathology: is there an association? Sleep Med. 2002;3(4):353–360.
5-Kondziella D, Arlien-Soborg P. Diagnostic and therapeutic challenges in narcolepsy-related psychosis. J Clin Psychiatry. 2006;67(11):1817– 1819Kondziella D, Arlien-Soborg P. Diagnostic and therapeutic challenges in narcolepsy-related psychosis. J Clin Psychiatry. 2006;67(11):1817–1819.
6-Ballon JS, Feifel D. A systematic review of modafinil: potential clinical uses and mechanisms of action. J Clin Psychiatry. 200667(4):554–566.
7-The Xyrem® International Study Group. A double-blind, placebocontrolled study demonstrates sodium oxybate is effective for the treatment of excessive daytime sleepiness in narcolepsy. J Clin Sleep Med. 2005 Oct 15;1(4):391–397.