Waking up and seeing things that aren’t really there can be an unsettling experience. However, there are a number of potential causes for this phenomenon, most of which are not serious. In this article, we’ll explore the meaning behind waking up and seeing things, when to be concerned, and what you can do about it.
Common Causes
Here are some of the most common reasons people may wake up seeing things that aren’t really there:
Hypnopompic Hallucinations
Hypnopompic hallucinations refer to hallucinations that occur as you are waking up from sleep. Up to 30% of people experience hypnopompic hallucinations at some point in their lives. These hallucinations occur during the transition from rapid eye movement (REM) sleep to wakefulness. They can involve all five senses, but visual hallucinations tend to be the most common.
Hypnagogic Hallucinations
Hypnagogic hallucinations are essentially the opposite of hypnopompic hallucinations – they occur as you are falling asleep rather than waking up. Visual hallucinations are most common, but hypnagogic hallucinations can involve sounds, tastes, smells, and touch sensations as well. These hallucinations occur during the transition from wakefulness to sleep.
Excessive Daytime Sleepiness
If you have excessive daytime sleepiness, you may be more likely to experience hypnagogic/hypnopompic hallucinations. Excessive daytime sleepiness can be caused by sleep disorders like narcolepsy, sleep apnea, or insomnia. When you are severely sleep deprived, you are more prone to experiencing brief dream-like hallucinations while falling asleep or waking up.
Medication Effects
Certain prescription and over-the-counter medications can also increase the likelihood of hypnopompic/hypnagogic hallucinations. Examples include antidepressants, opioids, anticonvulsants, stimulants, and drugs with anticholinergic effects. Withdrawing from benzodiazepines or alcohol can also trigger these brief hallucinations.
Psychological Causes
In some cases, waking up seeing things may be linked to an underlying psychological disorder. Examples include:
- Schizophrenia – visual hallucinations can occur upon waking up.
- Lewy body dementia – recurrent complex visual hallucinations are common.
- Narcolepsy – can involve dream-like hallucinations around sleep transitions.
- PTSD – nightmares may lead to waking hallucinations.
- Delirium – seeing things due to severe confusion upon waking.
If the visual hallucinations persist beyond those brief sleep transition periods, it more likely indicates an underlying neurological or psychological disorder.
When to Be Concerned
In most cases, brief hypnopompic/hypnagogic hallucinations are not considered cause for concern. However, you should seek medical advice if:
- The visual hallucinations are recurring and bothersome
- The hallucinations persist beyond those brief transitional periods around sleep
- The hallucinations are accompanied by other symptoms like paranoia, delusions, or confusion
- You have other symptoms of an underlying sleep disorder or health condition
- The hallucinations interfere with your ability to function
You should seek prompt medical attention if the visual hallucinations:
- Involve violent or threatening visions
- Are accompanied by difficulty breathing or chest pain
- Are accompanied by an inability to move or speak
These signs may indicate a neurological or psychiatric emergency requiring immediate treatment.
Evaluating the Cause
If you regularly wake up seeing things and it concerns you, there are several things your doctor may do to evaluate the cause:
Physical Exam
A physical exam allows your doctor to look for any signs of underlying conditions that could explain the hallucinations. They will listen to your heart and lungs, evaluate your nervous system, and look for evidence of things like infection.
Sleep Evaluation
Your doctor will ask you detailed questions about your sleep habits and symptoms. They may also have you complete a sleep diary for 1-2 weeks documenting your sleep patterns. This allows them to assess for red flags of a potential sleep disorder.
Psychiatric Evaluation
A psychiatric evaluation can help rule out an underlying mental health disorder associated with visual hallucinations. Your doctor will ask about your mental health history and symptoms beyond just the hallucinations themselves.
Blood and Urine Tests
These lab tests allow your doctor to check for potential medical causes like kidney disease, electrolyte abnormalities, drug side effects, and infections.
Brain Imaging
MRI or CT scans of the brain may be ordered if your doctor suspects a neurological cause like a brain tumor, stroke, or dementia. The images allow them to look for any areas of abnormality.
| Diagnostic Test | What the Doctor is Assessing |
|---|---|
| Physical exam | Signs of underlying medical conditions |
| Sleep evaluation | Patterns suggestive of a sleep disorder |
| Psychiatric evaluation | Symptoms of a potential mental health disorder |
| Blood and urine tests | Potential contributing medical causes |
| Brain imaging | Abnormalities like tumors, stroke, or atrophy |
Treatment Options
Treatment will depend on the underlying cause of your hallucinations upon waking up. Some potential treatment options include:
Treating Sleep Disorders
If the cause is a condition like sleep apnea, narcolepsy, or insomnia, addressing the sleep disorder itself can help resolve symptoms. This may include things like CPAP for apnea, medications for narcolepsy, or cognitive behavioral therapy for insomnia.
Changing Medications
If current prescription or over-the-counter medications are contributing to the hallucinations, your doctor may recommend adjusting dosages or switching to alternatives without those side effects.
Psychotherapy
For psychiatric causes like PTSD or schizophrenia, psychotherapy can help teach coping strategies for dealing with disturbing hallucinations. Antipsychotic medications may also be prescribed.
Improving Sleep Hygiene
Making healthy sleep habit changes like maintaining a consistent sleep routine, limiting blue light exposure before bed, avoiding large meals before bedtime, and reducing caffeine intake can help minimize hallucinations.
Relaxation Techniques
Learning relaxation techniques like deep breathing, guided imagery, and mindfulness meditation can help reduce anxiety and improve sleep quality, which may lessen hypnopompic/hypnagogic hallucinations.
The most effective treatment will depend on what your doctor determines to be the underlying cause of your waking hallucinations after a thorough evaluation.
Coping Strategies
If your visual hallucinations upon waking do not have a serious underlying cause, there are some simple coping strategies you can try:
- Reorient yourself – Repeat to yourself that you are awake and the hallucinations aren’t real.
- Get up slowly – Take your time fully waking up before getting out of bed.
- Turn on lights – Illuminate your room to re-anchor yourself to reality.
- Engage your senses – Feel your blankets, listen to familiar sounds, smell a scented item.
- Tell yourself it will pass – Remind yourself the hallucinations are temporary.
- Practice relaxation techniques – Try deep breathing, progressive muscle relaxation, or meditation.
- Limit naps – Taking more planned naps can reduce excessive daytime sleepiness.
- Write down hallucinations – Keeping record can help identify potential triggers.
Recurring episodes of hypnopompic/hypnagogic hallucinations can be disruptive and distressing. But utilizing some of these coping strategies may help reduce fear and manage the experience.
When to Seek Help
Here are some general guidelines for when to seek medical help for waking up hallucinations:
- Hallucinations occur frequently (more than twice a week)
- Hallucinations persist for more than a few minutes
- Hallucinations are progressively worsening
- You have trouble determining hallucinations from reality
- Hallucinations are disruptive to your functioning
- You experience other concerning symptoms along with the hallucinations
Bring up any episodes of seeing things upon waking at your next regular medical appointment. Your doctor can help determine if it’s a symptom of an underlying condition needing further evaluation.
Take Home Message
Brief visual hallucinations when waking up or falling asleep are surprisingly common and often harmless. They frequently occur due to hypnopompic/hypnagogic hallucinations related to the sleep transition. However, if episodes are frequent, persistent, or disturbing, do not hesitate to seek medical advice. Thorough evaluation of your symptoms and sleep habits can help diagnose or rule out underlying disorders. Addressing any contributing conditions, along with healthy sleep hygiene and coping strategies, will ideally help you manage and overcome any troubling waking hallucinations.
Frequently Asked Questions
What causes you to see things when waking up?
Common causes include hypnopompic/hypnagogic hallucinations during sleep transitions, underlying sleep disorders, medication side effects, excessive daytime sleepiness, withdrawal from substances, and mental health conditions like schizophrenia, narcolepsy, or PTSD.
Is it normal to hallucinate when waking up?
Occasional, brief hypnopompic/hypnagogic hallucinations can be normal, affecting up to a third of people at some point. They become concerning if persistent, long-lasting, worsening, or disturbing.
What do hallucinations feel like when waking up?
Waking hallucinations most often involve visual manifestations like people, objects, animals, or patterns. But they can also involve auditory, tactile, gustatory, and olfactory hallucinations. They tend to feel dreamlike and detached from reality.
Should I be worried if I see things when I wake up?
Brief, non-bothersome visual hallucinations when waking up are generally not worrisome on their own. But recurrent, prolonged, or worsening episodes that disrupt your life should be evaluated by your doctor.
How can I stop hallucinating when waking up?
Getting an underlying disorder like sleep apnea or PTSD under control can help. Good sleep hygiene, relaxation techniques, reducing medications, and grounding strategies upon waking can also help manage waking hallucinations.
Conclusion
Waking up seeing things can be startling, but is relatively common and not inherently dangerous. Rule of thumb is to seek medical advice if episodes are frequent, persistent, worsening, distressing, or interfere with functioning. While not always preventable, addressing any underlying conditions and honing coping mechanisms can help manage this phenomenon. With proper evaluation and treatment where needed, visual hallucinations upon waking do not have to negatively impact your life.