Hypnopompic

C. The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better accounted for by another mental disorder (e.g., delirium, dementia. Schizophrenia) or hypnopompic hallucinations. 

Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes... 

Hypnagogic, hypnopompic onset and offset of sleep (often associated with nightmares) - beta-blockers, benzodiazepine withdrawal... 

If your answer to any of these questions is yes, you already understand our natural tendency to dissociate—to be in one conscious state but to experience in it properties of another. I will show that when amplified this normal process can lead to such exceptional states as sleep walking and hypnopompic hallucinations, and that these exceptional states can become models for understanding out of body experiences, extrasensory perceptions, or alien abductions All of these exotic experiences can— and usually do—occur in the privacy and safety of our bedrooms. 

Many narcoleptic patients show a marked intensification of sleep onset REM physiology, making the enhancement of hypnagogic hallucinations easily understandable. Because narcolepsy is also associated with the occurrence of hallucinations on awakening from REM sleep, I will defer discussion of the clinical aspects of the disorder until we have considered these hypnopompic extensions of dreaming into the wake state. 

But why are hypnopompic hallucinations even more unwelcome than hypnagogic ones Probably because most people find that falling asleep is easily understood as a time of increasing disorder of the brain-mind and, as such, better tolerated because it is also a time of diminishing awareness of internal experience. Waking up, on the other hand, is a time when increasing orderliness is expected, and waking is followed by persistent awareness that allows critical self-reflection. 

Hypnopompic hallucinations clearly illustrate the continuation of REM sleep dreaming into subsequent waking. That is, instead of arising out of the blue (out of thin air, as we say), they simply continue an ongoing—and perfectly normal—sleep-related hallucinatory process across the line into waking. Practically everyone has had some experience with uncoordinated state transitions on arousal from sleep. Sleep walking, being unable to move, and persistent anxiety after arousal from a chase dream are some common examples. 

The d-ASCs experienced by almost all ordinary people are dreaming states and the hypnagogic and hypnopompic states, the transitional states between sleeping and waking. Many others experience another d-ASC, alcohol intoxication. 

The prevalence of narcolepsy with cataplexy is 1 in 10,000 or 0.02% to 0.16% worldwide (69). Patients usually present with complaints of excessive daytime sleepiness before the onset of hypnogogic/hypnopompic hallucinations, sleep... 

Dinges DF. Are you awake Cognitive performance and reverie during the hypnopompic state. 1990 159-175. 

Ohayon MM, Priest RG, Caucet M (1996) Hypnagogic and hypnopompic hallucinations. A pathological phenomenon Br J Psychiatry 169 459-467... 

Monitoring parameters for pharmacotherapy of narcolepsy include reduction in daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis. Patients should be evaluated regularly during medication titration, then every 6 to 12 months to assess adverse drug events (e.g., mood changes, sleep disturbances, and cardiovascular abnormalities). If symptoms increase during therapy, PSG should be done. 

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