If you hallucinate when waking up, this is the detail to track.

If you experience hallucinations when waking up, keeping a clear record of what’s happening can help you and your doctor understand the cause and choose the right treatment. Below is a guide to the most important details to track, possible explanations—including a liver-related cause called hepatic encephalopathy—and next steps you can take.

Why hallucinations when waking up happen

Hallucinations at the edges of sleep fall into two main categories:

• Hypnagogic hallucinations: occur as you’re falling asleep
• Hypnopompic hallucinations: occur as you’re waking up

These vivid, dream-like perceptions can involve sounds, images or even sensations in your body. In most people they are harmless, but in some cases they point to an underlying condition.

Key details to track

Use a dedicated notebook or an app to record each episode. Include:

1. Date and time

   • Exact time you fell asleep
   • Exact time you woke up and noticed the hallucination

2. Type of hallucination

   • Visual (people, shapes, colors)
   • Auditory (voices, music, noises)
   • Tactile (feeling something on your skin)
   • Olfactory or gustatory (smells or tastes)

3. Duration

   • How long it lasted (seconds, minutes)

4. Emotional impact

   • Scared, calm, confused, amused

5. Triggering factors

   • Sleep deprivation (hours slept)
   • Stress levels or major life events
   • Medications or supplements taken before bed
   • Alcohol or recreational drug use

6. Sleep environment

   • Room temperature, light, noise
   • Any disturbance (e.g., partner’s snoring, alarm sounds)

7. Physical symptoms alongside hallucinations

   • Muscle paralysis (sleep paralysis)
   • Rapid heartbeat, sweating, shortness of breath
   • Confusion or disorientation on fully waking

8. Medical history

   • Known sleep disorders (e.g., narcolepsy, sleep apnea)
   • Chronic conditions (especially liver disease)
   • Recent illnesses (fever, infections)

Special note on liver health: hepatic encephalopathy

In people with advanced liver disease, toxins (especially ammonia) can build up in the bloodstream and affect brain function. This is called hepatic encephalopathy (HE).
Key points from clinical guidelines (Ferenci et al., 2002; Vilstrup et al., 2014):

• HE can cause sleep disturbances, confusion and visual or auditory hallucinations.
• Severity is graded from minimal changes only seen on testing, up to coma.
• Serum sodium levels and other lab values (integrated in the MELD-Na score; Biggins et al., 2006) help predict short-term survival in advanced liver disease.

If you have known cirrhosis or chronic hepatitis, pay special attention to:

• New or worsening confusion
• Changes in sleep patterns (daytime sleepiness, nighttime restlessness)
• Other signs: jaundice (yellow skin/eyes), fluid buildup in legs or abdomen, easy bruising

Possible causes beyond sleep-edge hallucinations

Tracking your details will also help rule in or out other causes:

• Narcolepsy: often begins in youth, includes daytime sleep attacks and cataplexy.
• Sleep apnea: breathing pauses can fragment sleep and trigger vivid dreams.
• Medication side effects: antidepressants, anticholinergics, steroids, some antihistamines.
• Substance use or withdrawal: alcohol, benzodiazepines, stimulants.
• Neurological conditions: Parkinson’s disease, Lewy body dementia or migraine variants.
• Psychiatric conditions: severe anxiety, PTSD, brief psychotic episodes.

How to track effectively

• Create a simple table or use bullet points for each night.
• Note patterns—do hallucinations occur only on weekends, after certain meals or when you’re stressed?
• Rate sleep quality each night (1–10 scale) to see if poor rest is linked.
• Share your log with trusted family or a sleep partner who can add observations.

Next steps and when to seek help

1. Review your log after 1–2 weeks. Look for trends in timing, triggers or severity.
2. Try basic sleep hygiene improvements:
   • Keep a consistent bedtime and wake-up time.
   • Limit screens 1 hour before bed.
   • Avoid heavy meals, caffeine or alcohol late at night.
3. If hallucinations are frequent, distressing or accompanied by confusion, dizziness or weakness, get medical advice.
4. Consider doing a free, online symptom check for your specific experience to generate tailored questions for your doctor.
5. Be ready to discuss your sleep log, medical history, medications and lifestyle factors.

When to call 911 or go to the emergency room

• Sudden loss of consciousness
• Chest pain, difficulty breathing or fast irregular heartbeat
• Severe confusion that doesn’t clear after a few minutes
• Signs of stroke (face drooping, arm weakness, speech difficulties)

Talking to your doctor

Bring your sleep log and any symptom check printouts. Tell your doctor:

• Exactly when and how the hallucinations happen
• Any other physical or mental changes you’ve noticed
• A list of all medications, supplements and substances you’re taking

Your physician may recommend:

• Blood tests (liver function, ammonia levels, electrolytes)
• Sleep study (polysomnography)
• Neurological or psychiatric evaluation
• Adjustment of medications or a sleep aid trial

Keep tracking until you have a clear picture, then “speak to a doctor” about any serious or life-threatening symptoms. With a detailed record and the right professional guidance, you can get to the root of your hallucinations when waking up and find relief.