Six years ago, as I was sitting in my Native American literature class in college, I found myself doing that thing where your head sort of wobbles around on your neck as you try to stay awake. Every few seconds my head would fall forward and then snap back up. My eyelids felt weighted and would barely stay open. It was an early class by college standards—it started at 9:30—and I had only slept a couple hours the night before. And the night before that. And before that and before that. This had been going on for a couple of weeks.
The only thing keeping me awake during this class was an intense itchy sensation all over my legs. It was as if I was on Fear Factor, trapped in a glass case full of spiders and centipedes and all sorts of creepy-crawlies. Part way through the hour-and-a-half class, the itchiness became all I could concentrate on. I had no idea what my professor was talking about, and frankly I didn’t care.
The itchiness became unbearable as I scratched at my thighs under my desk. I started jiggling my legs and stamping my feet to make the itchiness go away, but nothing was working. I’m sure the people around me thought I was weird, but I didn’t care. I felt as if there were millions of needles stabbing me in the legs and I was afraid I was going to start crying in the middle of the lecture. I got up and went into the hallway to get my legs moving.
Out in the hallway, the itchiness quickly dissipated, much to my relief. I went back inside, took my seat, and assumed everything was fine. I tried to concentrate on what my professor was saying, but when I looked at her, something strange happened. Her short pixie cut began to grow. Her brown hair lengthened out to her shoulders, then her chest, then down towards her waist, all in a matter of seconds. My eyelids no longer felt heavy as I stared at her, wide-eyed with shock.
This is impossible, I told myself. But it looked so real. I had just witnessed something magical. I looked left and right to my classmates, but they were all staring straight ahead, completely unfazed. I looked back at my professor. Her hair was short again.
What just happened? I wondered. Then, a man entered the room. He walked past all of us students and headed straight for our professor. Something bad was about to happen. I could feel it. I looked to my peers, but no one seemed worried. I felt like I should do something, anything, to stop this man, but I stayed still. I watched in horror as the man approached my professor and stabbed her in the chest. I pushed my chair back from my desk, ready to run, but I blinked and everything was normal again. My professor, completely unharmed, continued teaching. There was no man in the room.
Something was wrong with me and I had no idea what to do.
I’ve never done drugs, but this felt like a bad trip (or what I would imagine being on a hallucinogenic drug feels like). My peers must have thought I was on something due to how bizarrely I acted. I was paranoid, my eyes were huge, and I couldn’t sit still. The rest of the class passed in a blur as I tried to figure out what just happened.
It was obvious to me that I must have hallucinated, but because this had never happened to me before, I couldn’t believe it. I knew I had been tired and groggy leading up to this, but I thought you had to be seriously sleep deprived to actually see and feel frightened by things that aren’t there.
It turns out I was, though. I had only been sleeping a few hours a night for a couple of weeks at that point. I had just gotten out of a serious long-term relationship and immediately jumped into something new. I was emotionally spent from the breakup but staying up almost all night with my new guy talking and getting to know each other; I was exhausted every day but pushed through it in an effort to pretend everything was OK. My confusion over the sadness of the breakup and the happiness of the new relationship was only compounded by my tiredness. I should have known that I needed more sleep, but logic wasn’t really working for me at the time.
According to Emmanuel During, M.D., a sleep specialist at Stanford Sleep Medicine Center trained in psychiatry and neurology, our brains don’t function as they should when we’re sleep deprived. “When we’re sleep deprived, it’s like the brain is on fire, like it’s on a stimulant drug,” he tells SELF. “Parts of the brain are working together in a chaotic way.”
Yes, sometimes this can lead to hallucinations.
Hallucinations aren’t quite as simple as just seeing something that’s not real. “It’s an experience with a perception of something that’s not present,” Dr. During explains. “At first the perception seems so real there’s no need to doubt it.”
They are different than illusions, which is when someone misinterprets what they’re seeing, such as when you mistake a coat hanging on a rack for a person. Hallucinations are also not the same as waking dreams (which is when you enter a dream state but with your eyes still open), Dr. During adds. He explains that when you hallucinate, you are still awake and conscious, not asleep.
Hallucinations are commonly experienced by people experiencing psychosis or those who have schizophrenia, people on a hallucinogen, or by people who have dementia. But it’s not unheard of for sleep deprived people to hallucinate, too.
Brandon Peters, M.D., a double board-certified neurologist and sleep medicine physician who practices at Virginia Mason Medical Center in Seattle, tells SELF that it’s actually fairly common for sleep-deprived people to hallucinate when sleep deprived for long enough. What constitutes “long enough,” though, depends on how long they’ve been awake versus asleep: With total sleep deprivation, meaning someone hasn’t slept at all overnight, hallucinations can start to occur after 24 hours but become more likely when a person is awake for 36 to 48 hours straight. When sleep deprivation occurs over time with short, intermittent periods of sleep, such as in my case, it will often take longer before hallucinations occur.
Dr. Peters, who is also an adjunct lecturer at Stanford University, says most hallucinations are visual. On rare occasions, though, they can be auditory or even tactile, such as when my legs felt itchy.
Experts don’t fully understand why hallucinations happen due to sleep deprivation.
The exact brain mechanism at play during hallucinations in general isn’t understood. The thinking is that visual hallucinations may occur when certain parts of the brain responsible for visual functioning get disrupted. Another possible reason is that it may have to do with changes in dopamine levels in the brain: “Excessive dopaminergic transmission in certain brain areas seem to be the best understood mechanism for hallucinations,” Dr. Peters explains. Or, in connection with sleep deprivation specifically, it could also be because the brain is so tired it enters a “mixed state of consciousness,” he describes.
Despite how exhausted a person may feel, they can usually tell they’re hallucinating. “There is often insight into the situation,” Dr. Peters says. In my case, I quickly realized that no one around me was seeing what I was seeing, leading me to understand that what I saw wasn’t real. (Dr. Peters notes that this use of reasoning and logic is harder to achieve for people who experience hallucinations as a result of psychosis.)
In some cases, sleep deprivation can lead to psychosis, although this is more rare. Dr. During says someone would have to be awake for around 72 hours straight before they would enter psychosis. “If you go on and continue [to stay awake], it’s possible to go into psychosis and develop delusions that will require psychiatric treatment,” he says.
But most people physically can’t stay awake that long, Dr. During points out. This means most sleep deprivation occurs over weeks and months of very little sleep, like in my situation. In hindsight, it took me a couple of weeks of only sleeping for a couple of hours each night before I hallucinated. “Most people can manage sleep deprivation for a long time,” Dr. During says. “We’re not good at gauging how much sleep we need.”
To avoid getting to the point of experiencing hallucinations, both Dr. During and Dr. Peters say people should be aware of the early signs of sleep deprivation. The most common early symptoms, they say, is a change in mood and increased irritability. People can also become impatient and short-tempered and have difficulty concentrating. You should make sleep a higher priority right away if you start noticing these symptoms.
Hallucinating was a huge wake-up call for me.
I never went to a doctor or a therapist after experiencing my hallucinations. On one hand, the episode was kind of embarrassing. I feared no one would believe me. I had never heard of anyone having hallucinations unless they were using drugs or had a serious mental health issue; If I went to the doctor, I was afraid people might make assumptions or judgments about me or think I was making everything up.
But I did begin prioritizing sleep, addressing things in my life that were causing emotional stress, and learning how to listen to my body. I never had another hallucination.
Most people can manage sleep deprivation on their own simply by getting more sleep, Dr. During and Dr. Peters agree. And even if sleep deprivation becomes serious enough that hallucinations occur, it’s usually not necessary to seek medical attention. “If it’s isolated and has a clear cause and stops when the cause is addressed, there’s no need to go to a doctor,” Dr. Peters says. “It’s a very common potential phenomena that doesn’t necessarily represent a serious condition.” (However, if you have a diagnosis for a psychiatric illness or are prone to psychosis, you should check in with your doctor when hallucinations occur.)
It made me realize how important it is to take care of myself and to listen to my body when it tells me I need more sleep. Hallucinating was terrifying not only because the things I was seeing were scary, but also because I felt like I wasn’t in control of my mind.
The solution—to get substantial, sound sleep—seems so simple, yet it’s still not always a priority for a lot of people. It wasn’t for me until this incident, so I’m much more wary of sleep deprivation today, regardless of how busy or distracted I might be. Unfortunately, I had to learn this the hard way, but it’s a lesson I’ll never forget.