Auditory Hallucinations at Night: Causes, Symptoms, and Treatment
Hallucinating is defined as perceiving the presence of an object or an event through any of the five senses (sight, smell, taste, touch, or hearing) without the actual object or event existing or occurring. If you think you’re seeing - or smelling, hearing, tasting, or feeling - things when you’re asleep, you may not be dreaming. It’s possible that you’re experiencing hypnagogic hallucinations. It’s more likely if you’re waking up in extreme fear that your hallucination was real.
An older study among people ages 15 and older found that almost 25 percent experienced sleep-related hallucinations. These hallucinations are more common in teens and young adults, with the number of hallucinations decreasing with age. Women appear more likely to experience these hallucinations than men.
Hypnagogic Hallucinations
Hypnagogic hallucinations occur in the state between waking and sleeping. They are different from dreams, which occur during sleep. You may be having these if you’re seeing extremely realistic objects or events right before falling asleep. Hypnagogic hallucinations often cause confusion. This is because it can be hard to distinguish hallucinations from reality. They create strong, intricate visual images in the mind that may be distorted in an unrealistic way. As a result, these hallucinations often cause fear. In some cases, they can even cause you to jump out of bed or accidentally injure yourself.
Auditory Hallucinations Specifically
Auditory hallucinations are also common when the body is falling asleep. These hallucinations are more common when a person is under stress. Most common auditory hallucinations are simple and don’t have a real meaning or purpose. Examples include:
- Beeping
- High-pitched noises
- Random noises
- Popping noises
- Unclear noises
Severe cases of anxiety may produce more complex hallucinations. They may involve voices, which are sometimes associated with rapid thoughts. This can lead a person to believe the voices are real.
Other Types of Hallucinations
Another common type of hallucination is the vision or sensation that bugs are crawling over your body. This is most common in people who take or misuse certain drugs. Experiencing this sensation during sleep may cause a person to scratch, pick, or even cause harm to their body in an attempt to rid it from bugs.
Sleep Paralysis and Lucid Dreams
Hypnagogic hallucinations are different from other sleep-related conditions - including lucid dreams and sleep paralysis - that may cause the perception of things that aren’t real. Lucid dreams are very realistic dreams that occur when a person is asleep. Sleep paralysis is a separate condition from hypnagogic hallucinations. However, it may occur simultaneously. Sleep paralysis is a state of sleep where a person is physically immobile but mentally conscious. This condition may cause even more fear, as the physical immobility - often difficulty breathing and muscle tightness - can make a person feel as though they’re frozen in place. As a result, a person may remember a sleep paralysis and hallucination episode as a dream where they were frozen in place or unable to move. In reality, it was these two conditions working together.
Can Hypnagogic Hallucinations Cause Complications?
In cases of severe hypnagogic hallucinations, people have been known to jump out of bed and accidentally injure themselves. People may also cause themselves harm if they have a hallucination that bugs are crawling on them. So, it’s important to seek treatment if your hallucinations are severe.
Causes and Risk Factors
The exact causes of hypnagogic hallucinations aren’t well understood. Some possible risk factors include:
- Alcohol or drug use
- Insomnia
- Anxiety
- Stress
- Narcolepsy
- Mood disorders such as bipolar disorder or depression
Epileptic seizures may also cause hypnagogic hallucinations. When epilepsy is the cause, hallucinations may appear as short visual fragments.
When to Seek Help
Hypnagogic hallucinations are harmless in most cases. However, you should considering seeing a sleep specialist if these hallucinations cause you anxiety or disrupt you frequently during your sleep. If your hallucinations are accompanied by unusual sleepiness during the day, you should seek a specialist’s help right away, as you might have narcolepsy.
What to Expect During Diagnosis
If you seek help from a sleep specialist, they will begin your appointment by asking you questions such as:
- When did your hallucinations begin?
- How often do your hallucinations occur?
- How long do your hallucinations last?
- Do you have any other sleep problems, such as insomnia?
- Are you sleepy during the day?
Besides inquiring about your sleep, a sleep specialist will also ask you about your medical and psychiatric history. Remember to tell them about any past or present drug or medication use.
The sleep specialist may ask you to bring home a sleep diary for two weeks. This helps the specialist gain insight into your sleeping patterns. This insight may help them better diagnose your condition and figure out how to correct it.
The sleep specialist may also recommend a sleep study (polysomnogram) if your hallucinations are intensely disturbing to your sleep. A sleep study involves attaching wires and equipment to your head and body to chart your brain waves, heartbeat, and breathing as you sleep. It also records how your arms and legs move. This kind of study can uncover whether your hypnagogic hallucinations are related to any other type of sleep disorder.
The specialist may ask you to do a daytime nap study (multiple sleep latency test) if you’re very sleepy during the day. This test measures how quickly you fall asleep during the day and what kind of sleep you have when you nap. This test can reveal whether your hallucinations are related to narcolepsy.
Treatment Options
Treating hypnagogic hallucinations requires treating any underlying conditions that may be the cause. Often, hallucinations will decrease over time. They may also decrease if you focus on getting enough sleep. The National Sleep Foundation recommends the following:
| Age Group | Recommended Sleep Duration |
|---|---|
| Teens (13-18 years) | 8-10 hours |
| Adults (18-64 years) | 7-9 hours |
| Adults (65+ years) | 7-8 hours |
Doing the following may also help to decrease hypnagogic hallucinations:
- To avoid lying awake and thinking stressful thoughts, don’t go to bed until you feel extremely tired.
- Keep a regular sleep schedule in which you go to sleep and wake up at the same times each day.
- Practice good sleep hygiene, such as sleeping in a cool environment.
- Avoid alcohol, drugs, and medications that may be causing hypnagogic hallucinations. If the medication is prescribed, talk with your doctor before changing or stopping your dosage.
If your hypnagogic hallucinations are caused by anxiety, your doctor may recommend psychiatric treatment. Treatment for anxiety could involve talk therapy, meditation, or medication, as well as other at-home care to reduce stress. If you’re diagnosed with narcolepsy, your sleep specialist will prescribe narcolepsy medications.
Often hypnagogic hallucinations resolve on their own over time. If there’s an underlying cause to your hallucinations, seeking treatment for the condition can help prevent future hallucinations from occurring.
Exploding Head Syndrome
"Exploding Head Syndrome" redirects here. Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or are waking up, have a strong, often frightened emotional reaction to the sound, and do not report significant pain; around 10% of people also experience visual disturbances like perceiving visual static, lightning, or flashes of light. The pattern of the auditory hallucinations is variable.
Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient. However, it has been suggested that the earliest written account of EHS was described in the biography of the French philosopher René Descartes in 1691. The phrase "snapping of the brain" was coined in 1920 by the British physician and psychiatrist Robert Armstrong-Jones. A detailed description of the syndrome and the name "exploding head syndrome" was given by British neurologist John M. S.