Sleep Psychosis: What To Know About Nighttime Hallucinations

Medically reviewed by Nikki Ciletti, M.Ed, LPC
Updated October 29, 2024by BetterHelp Editorial Team

Sleep can be seen as surrender — a nightly act of trust and the quiet belief that the world on the other side of closed eyes will hold a familiar shape. But sometimes, the boundary between sleep and wakefulness dissolves. Shadows may writhe into unwelcome figures. Muffled whispers can pierce the silence. Reality itself may become a shifting, uncertain thing. This unsettling phenomenon can be referred to as sleep psychosis.

Though not a formal diagnosis, sleep psychosis can describe the experience of psychotic symptoms intertwined with sleep deprivation or disruption. These episodes can leave an individual feeling disoriented and frightened, unsure of their own senses. However, understanding this phenomenon is often the first step toward finding the right support and a path back to restful nights. Often, treatment for sleep psychosis involves a medical evaluation and sleep study, as well as therapy.

An elderly man in a blue button down shirt sleeps on his back on the couch with a yellow pillow under his head.
Getty/shapecharge
Experiencing nighttime hallucinations or sleep paralysis?

The impact of sleep on mental health

How sleep and mental well-being interact can be considered a complex puzzle that scientists are still piecing together. However, mounting evidence suggests that sleep disturbances and psychotic symptoms can become entangled under certain circumstances. Here are a few ways this connection might manifest:

Sleep deprivation

Research indicates a prolonged lack of sleep can disrupt the brain's normal functions. In some cases, it increases the risk of psychotic experiences, even for individuals with no prior history of mental health conditions.

Existing conditions worsened

If you have a diagnosed psychotic disorder like schizophrenia, sleep problems can act as fuel on the fire, intensifying hallucinations or delusions.

A shared vulnerability to sleep problems and developing a psychotic disorder

Research hints that certain pathophysiological mechanisms might predispose individuals to both sleep problems and an increased risk of developing psychotic disorders.

While sleep disturbances can raise your risk of sleep psychosis, not everyone who struggles with sleep will experience these episodes. Still, if you consistently find strange phenomena creeping in during those hazy moments between sleep and waking, it may warrant professional help.

The many faces of sleep psychosis

Sleep psychosis often strikes in the twilight zone between dreaming and wakefulness. Experiences can be unique to the individual, but some common threads include the following:

  • Hypnagogic hallucinations: These can be thought of as eerily realistic sensory experiences that occur as you drift off to sleep. Flickering figures, strange sounds, or unsettling sensations might seem to invade your senses.

  • Hypnopompic hallucinations: These may be described as the dream world's lingering tendrils. You might find upon waking that figures or imagery from your dreams persist, blurring the line with reality.

  • Sleep paralysis: Imagine waking and being unable to move or speak. Sleep paralysis can be scary and is sometimes accompanied by auditory or visual hallucinations that may further amplify the fear.

  • Confusion and disorientation: Sleep deprivation can interfere with your ability to think clearly. Distinguishing dreams from memories and the world around you can become a bewildering task.

Those first strange experiences can leave you feeling shaken and afraid to close your eyes. Many people experience fear and confusion. Understanding what sleep psychosis is and prioritizing sleep may offer a glimmer of hope.

Seeking answers and finding relief from sleep problems

If sleep psychosis has become an unwelcome nightly companion, relief may begin by finding the reason behind it. This multi-pronged approach often involves seeking guidance from both medical and mental health professionals.

  • Medical evaluation: A doctor can be helpful in ruling out physical conditions with symptoms mirroring psychosis, like certain sleep disorders, neurological conditions, or medication side effects.

  • Mental health assessment: A mental health professional can uncover whether a diagnosed mental health condition could be contributing to your sleep troubles and fueling psychotic experiences. They may also explore other factors, like stress, trauma, and substance use.

  • Sleep study: If an underlying sleep disorder is suspected, a specialist might recommend a sleep study. Think of it as a deep dive into your slumber, pinpointing exactly what's disrupting your rest.

The path to more peaceful nights often involves a team effort. Doctors, mental health professionals, and sleep studies may pinpoint the specific causes of your sleep psychosis. This knowledge can offer hope, opening doors to treatments that can lead to restful nights and better mental health.

A man wearing headphones sleeps on the couch with his cellphone and hand resing  on his chest.
Getty/Dejan_Dundjerski

Treatment options: Your path toward restful nights

Understanding the root cause of sleep psychosis can guide you toward the most effective treatment approach. While there's not necessarily a magical cure, the right combination of approaches can make a difference in managing your symptoms. 

Different strategies, personalized to fit your needs, can offer a path forward. Finding what works best for you may be the key to banishing disruptive nighttime experiences. Here's where to start:

Addressing medical conditions

If a doctor discovers that a medical condition is fueling your sleep problems, treating the underlying issue often leads to a significant reduction in psychotic experiences.

Therapy for mental health disorders or any diagnosed mental illness

If you have a diagnosed mental illness like schizophrenia or bipolar disorder, cognitive behavioral therapy (CBT) can be helpful. CBT usually teaches skills to manage disruptive thoughts and promote healthier sleep patterns.

Improving sleep hygiene

The phrase "Sleep hygiene" might sound overly clinical, but it typically involves a set of simple habits to promote restful nights. These may include a consistent bedtime, a relaxing sleep environment, and limited screen time before bed.

Medication

In certain cases, a doctor might prescribe medication to manage an underlying mental health condition or specifically target sleep problems. However, it's usually best to see a sleep med as one tool alongside other strategies, not as a cure-all.

Finding restful nights might mean exploring a combination of approaches. Medical support, therapy, and improved sleep habits can all offer ways to reduce disruptive symptoms and prioritize rest.

Managing sleep psychosis: Mental health tips and strategies

Sometimes, the short-term use of sleep medication can be helpful, especially if severe sleep deprivation is a major contributor to your psychotic symptoms. Discussing side effects and long-term use with a doctor can be beneficial, as some of these medications can be habit-forming or lead to other problems, like rebound insomnia.

Finding the right treatment approach might involve some trial and error. If you are at high risk for psychosis, some medications can worsen symptoms. Chronic sleep deprivation usually increases psychosis risk, meaning that promoting healthier sleep patterns is often a cornerstone of treatment.

While seeking professional help is usually recommended, here are some coping mechanisms that can provide additional support.

Reducing anxiety

The fear of what might happen when you close your eyes can worsen sleep problems. Mindfulness techniques, light exercise earlier in the day, and a calming bedtime routine may ease the mind.

Creating a safe haven for sleeping

Turning your bedroom into a sanctuary can promote relaxation. Soft lighting, comfortable bedding, and minimal distractions can improve sleep onset and reduce nighttime disturbances.

Documenting your experiences with sleep psychosis

Keeping a journal of your sleep psychosis episodes can help you and your doctors identify patterns or potential causes. If a sleep disturbance occurs, jotting down a brief description can also reduce anxiety about the experience.

Finding a support system

Isolation can worsen the distress caused by sleep psychosis. Leaning on trusted loved ones or finding a support group can help you connect with others who are navigating similar experiences.

Getty/AnnaStills
Experiencing nighttime hallucinations or sleep paralysis?

Overcoming sleep psychosis and sleep deprivation

Managing sleep psychosis is often an ongoing journey. However, your voice matters in shaping your treatment plan. Proactively sharing your experiences and concerns with your healthcare team can empower you to find personalized solutions for restful nights and better overall mental health.

Overcoming prolonged sleep deprivation and psychosis often requires specialized care. Online therapy can expand your options. It frequently offers greater flexibility in scheduling, more affordable options, and access to therapists who truly understand what you're experiencing. This personalized understanding can facilitate a treatment plan tailored to your specific needs, potentially boosting your chances of finding relief.

Findings suggest that online therapy has benefits for sleep-related issues. According to one study, specialized online programs typically helped participants experience better quality sleep, longer sleep duration, and improvements in overall mental health. These details can highlight the potential of online therapy in supporting those navigating conditions like sleep psychosis.

While managing sleep psychosis can pose challenges, it doesn't have to define you. With appropriate support, many individuals experience a reduction in sleep dysfunction symptoms or find that the episodes disappear entirely. 

Takeaway

Even if you’re currently experiencing forms of sleep psychosis, such as hypnagogic or hypnopompic hallucinations or sleep paralysis, restful sleep is possible. Finding the path back to peaceful nights may allow for clearer days, paving the way for a life where sleep is a safe haven rather than a source of fear or distress. It may be helpful to see your doctor, undergo a sleep study, and practice good sleep hygiene. Online therapy can complement other treatment approaches, providing specialized support to help you overcome sleep psychosis and prioritize your mental health.
Are you living with symptoms of psychosis?
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
Get the support you need from one of our therapistsGet started