[en] BACKGROUND: Few studies have investigated hallucinations that occur at the onset/offset of sleep (called hypnagogic/hypnopompic hallucinations; HHHs), despite the fact that their prevalence in the general population is reported to be higher than the prevalence of daytime hallucinations. We utilized data from an epidemiological study to explore the prevalence of HHHs in various modalities. We also investigated phenomenological differences between sleep-related (HHHs) and daytime hallucinations in the auditory modality. We hypothesized that individuals with only HHHs would not differ from controls on a range of mental health and wellbeing measures, but that if they occur together with daytime hallucinations will pose a greater burden on the individual experiencing them. We also hypothesize that HHHs are qualitatively different (i.e. less severe) from daytime hallucinations.
METHODS: This study utilized data from a cross-sectional epidemiological study on the prevalence of hallucinations in the Norwegian general population. The sample (n = 2533) was divided into a control group without hallucinations (n = 2303), a group only experiencing sleep-related hallucinations (n = 62), a group only experiencing daytime hallucinations (n = 57), and a group experiencing both sleep-related as well as daytime hallucinations (n = 111). Prevalence rates were calculated and groups were compared using analyses of variance and chi-square tests where applicable.
RESULTS: The prevalence for HHHs in the auditory domain was found to be 6.8%, whereas 12.3% reported multimodal HHHs, and 32.2% indicated out-of-body experiences at the onset/offset of sleep. Group comparisons of hallucinations in the auditory modality showed that individuals that experienced only auditory HHHs scored significantly (p < 0.05) lower than those who also experienced daytime auditory hallucinations on a range of variables including mental health, anxiety, childhood happiness, and wellbeing. In addition, individuals with only auditory HHHs reported significantly (p < 0.05) less frequent hallucinations, less disturbing hallucinations, more neutral (in terms of content) hallucinations, hallucinations with less influence over their behavior, and less hallucination-related interference with social life compared to those individuals that experience daytime hallucinations. We also found that purely auditory HHHs had a significantly higher age of first onset of hallucinations than the purely daytime and the combined daytime and auditory HHHs groups (28.2 years>20.9 > 19.1).
CONCLUSIONS: Sleep-related hallucinations are common experiences in the general population, with the auditory modality being the least common. They occur mostly in combination with daytime hallucinations. However, some individuals (2.4%) experience only (auditory) sleep-related hallucinations and this group can be seen as more closely related, on a range of health-related factors, to non-hallucinating individuals than individuals who experience daytime hallucinations. Finally, there is a clear need for more research in this field, and ideas for future studies are presented.
Disciplines :
Neurosciences & behavior
Author, co-author :
Bless, Josef J; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway, NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. Electronic address: josef.bless@uib.no
Hugdahl, Kenneth; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway, NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
Kråkvik, Bodil; St. Olavs University Hospital, Nidaros District Psychiatric Center, Trondheim, Norway
Vedul-Kjelsås, Einar; Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway, Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
Kalhovde, Anne Martha; Jaeren District Psychiatric Center, Bryne, Norway
Grønli, Janne; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
Laroi, Frank ; Université de Liège - ULiège > Psychologie et Neuroscience Cognitives (PsyNCog)
Language :
English
Title :
In the twilight zone: An epidemiological study of sleep-related hallucinations.
NTNU - Norges Teknisk-Naturvitenskapelige Universitet ERC - European Research Council
Funding text :
We would like to thank Dr. Sam Wilkinson for his comments on the manuscript. The present research was funded by a grant from the Norwegian University of Science and Technology (småforsk grant # 70247100 ). Part of the research was funded by an ERC Advanced Grant ( ERC AdG #693124 ) to Kenneth Hugdahl.
McDonald, C., A clinical study of hypnagogic hallucinations. Br J Psychiatry 118:546 (1971), 543–547.
Jones, S.R., Fernyhough, C., Meads, D., In a dark time: development, validation, and correlates of the Durham hypnagogic and hypnopompic hallucinations questionnaire. Personal Individ Differ 46:1 (2009), 30–34.
Speth, C., Speth, J., The borderlands of waking: quantifying the transition from reflective thought to hallucination in sleep onset. Conscious Cogn 41 (2016), 57–63.
Ohayon, M.M., Priest, R.G., Caulet, M., Guilleminault, C., Hypnagogic and hypnopompic hallucinations: pathological phenomena?. Br J Psychiatry 169:4 (1996), 459–467.
Laloyaux, J., Bless, J.J., Hugdahl, K., Kråkvik, B., Vedul-Kjelsås, E., Kalhovde, A.M., et al. Multimodal hallucinations are associated with poor mental health and negatively impact auditory hallucinations in the general population: results from an epidemiological study. Schizophr Res 210 (2019), 319–322.
Larøi, F., Marczewski, P., Van der Linden, M., Further evidence of the multi-dimensionality of hallucinatory predisposition: factor structure of a modified version of the Launay-Slade Hallucinations Scale in a normal sample. Eur Psychiatry 19:1 (2004), 15–20.
Ohayon, M.M., Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Res 97:2 (2000), 153–164.
Waters, F., Blom, J.D., Dang-Vu, T.T., Cheyne, A.J., Alderson-Day, B., Woodruff, P., et al. What is the link between hallucinations, dreams, and hypnagogic–hypnopompic experiences?. Schizophr Bull 42:5 (2016), 1098–1109.
Verdoux, H., van Os, J., Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophr Res 54 (2002), 59–65.
Kråkvik, B., Larøi, F., Kalhovde, A.M., Hugdahl, K., Kompus, K., Salvesen, O., et al. Prevalence of auditory verbal hallucinations in a general population: a group comparison study. Scand J Psychol 56:5 (2015), 508–515.
Zigmond, A.S., Snaith, R.P., The hospital anxiety and depression scale. Acta Psychiatr Scand 67:6 (1983), 361–370.
Jones, S.R., Fernyhough, C., Larøi, F., A phenomenological survey of auditory verbal hallucinations in the hypnagogic and hypnopompic states. Phenomenol Cogn Sci 9:2 (2010), 213–224.
McCarthy-Jones, S., Smailes, D., Corvin, A., Gill, M., Morris, D.W., Dinan, T.G., et al. Occurrence and co-occurrence of hallucinations by modality in schizophrenia-spectrum disorders. Psychiatry Res 252 (2017), 154–160.
Larøi, F., Bless, J.J., Laloyaux, J., Kråkvik, B., Vedul-Kjelsås, E., Kalhovde, A.M., et al. An epidemiological study on the prevalence of hallucinations in a general-population sample: effects of age and sensory modality. Psychiatry Res 272 (2019), 707–714.
Bless, J.J., Larøi, F., Laloyaux, J., Kompus, K., Kråkvik, B., Vedul-Kjelsås, E., et al. Do adverse life events at first onset of auditory verbal hallucinations influence subsequent voice characteristics? Results from an epidemiological study. Psychiatry Res 261 (2018), 232–236.
ICSD-3 (International Classification of Sleep ICSD-3 Disorders), 2014, American Association of Sleep Medicine, Dartmouth, Illinois.
Cheyne, J.A., Rueffer, S.D., Newby-Clark, I.R., Hypnagogic and hypnopompic hallucinations during sleep paralysis: neurological and cultural construction of the night-Mare. Conscious Cogn 8:3 (1999), 319–337.
Sherwood, S.J., Relationship between the hypnagogic/hypnopompic states and reports of anomalous experiences. J Parapsychol 66:2 (2002), 127–150.
Aledavood, T., Torous, J., Triana Hoyos, A.M., Naslund, J.A., Onnela, J.-P., Keshavan, M., Smartphone-based tracking of sleep in depression, anxiety, and psychotic disorders. Curr Psychiatry Rep, 21(7), 2019, 49.