Hallucinations scare people. At least they do in most of the Western world. For us, hallucinations mean insanity, or signal drug use. But there are many places in the world where seeing or hearing things that are not there is considered normal. Even in the West, visions upon waking up are common, especially in children. Most experts consider sleep hallucinations in children to be part of normal development. We estimate that between 10-25% of the population has sleep hallucinations during their lifetime.
What are Sleep Hallucinations?
Children who report seeing things usually do so when waking up. Smaller numbers do so when falling asleep. If you hook the child up to an EEG, as you would during a sleep study, you would find that the child is technically asleep when having a vision. It’s most useful, however, to think of the hallucinator as hovering between sleep and wakefulness.
These episodes can be especially frightening for a child because they are often associated with “sleep paralysis”. The child reports seeing a scary image but is unable to move! Most children who have sleep hallucinations along with sleep paralysis eventually being diagnosed with narcolepsy.
Reality or Fantasy?
Children younger than 7 often have difficulty figuring out if what they have seen is real or was a dream. The child will often report to parents that they’ve seen bizarre or impossible things in their room as they woke up. She may be convinced that what she saw was real.
I once saw a 9-year old girl who had sleep hallucinations. Her parents had consulted me because of excessive daytime sleepiness. In the course of asking questions, the girl offered that she would see Jesus Christ hovering over her bed every morning. She had even told her parents about this.
This story put me in an difficult position as a sleep coach. I could not tell the family that I thought the girl’s visions were not normal. Doing so would surely offend them. But at the same time, I believed that her sleep hallucinations were related to the sleep problem she was having. She turned out to have obstructive sleep apnea (OSA). Her sleep-wake cycles were totally disrupted by her difficulty breathing at night. As a result, she became more susceptible to parasomnias like sleep hallucinations.
The girl eventually had her tonsils and her adenoids removed. Her daytime sleepiness went away, and so did her visions.
Causes of Sleep Hallucinations
In addition to conditions like OSA, stress and sleep-deprivation can make sleep hallucinations more common. Certain medications, particularly anti-histamines, seem to make children more susceptible as well.
Anxiety and sleep hallucinations are a bad combination. An anxious child who is scared by her visions may balk at going to sleep. Many anxious children are mistakenly prescribed medications to help them fall asleep. This is usually not a good idea. Sedative-hypnotic drugs and anti-anxiety medications tend to make parasomnias worse, not better!
Most children with sleep hallucinations do not need particular treatment. Many children who report seeing things actually sleep quite well. Nevertheless, it’s a good idea to investigate whether some correctable condition may be playing a role. This was the case in the 9-year old girl with OSA. Often we uncover a source of underlying stress, in which case we refer the family to a therapist.
As with most sleep problems in children, the best way to start managing sleep hallucinations is to return to the basics:
- Establish a regular bedtime. The remainder of the day should be as regular and as predictable as possible.
- Make sure the child gets plenty of vigorous exercise.
- They should eat a healthy diet with plenty of protein and vegetable-based carbohydrates.
- Make the hour(s) between dinner and bedtime as quiet, calm, and un-stimulating as possible.
If you need any help doing these things, contact me!