Hearing voices as you fall asleep can be normal—until it isn’t.

Hearing voices as you drift off to sleep can be unsettling—but it's often a normal part of the "hypnagogic" state. Understanding when these experiences are harmless and when they signal something more serious can help you decide whether to simply improve your sleep habits or seek medical care.

What are hypnagogic hallucinations?

Research (Cheyne et al., 1999) shows that as you transition from wakefulness into sleep—known as the hypnagogic state—your brain can produce brief sensory experiences that feel very real. These may include:

• Hearing someone call your name, whispering or distant voices
• Feeling a presence in the room
• Seeing flashes of light or simple images

Most of these events last only seconds, don't recur every night, and don't cause distress once you're fully asleep.

Common benign causes

1. Sleep deprivation
   • Skipping sleep or working late raises stress hormones and makes hypnagogic hallucinations more likely.
2. Irregular sleep schedule
   • Jet lag, shift work or inconsistent bedtimes disrupt normal sleep cycles.
3. High caffeine or stimulant use
   • Coffee, energy drinks or certain medications can increase brain activity at bedtime.
4. Stress and anxiety
   • Worrying about work, finances or relationships primes your mind for intrusive thoughts as you relax.
5. Listening to audio or watching TV in bed
   • Lingering sounds or images may "bleed" into your falling-asleep state.

In these cases, simple lifestyle changes usually reduce or eliminate the voices.

When it isn't normal

If hearing voices when falling asleep is accompanied by other signs or becomes frequent, consider a deeper evaluation. Possible red flags include:

• Voices continuing into full wakefulness
• Persistent insomnia or daytime sleepiness
• Visual disturbances or complete dream–reality confusion
• Mood changes (depression, apathy or irritability)
• Cognitive issues (trouble concentrating, memory lapses)
• Physical signs such as tremors, coordination problems or asterixis (flapping hand movements)

These symptoms may point to an underlying medical or psychiatric condition.

Potential medical causes

1. Narcolepsy

Narcolepsy is a neurologic disorder characterized by:

• Excessive daytime sleepiness
• Sudden muscle weakness (cataplexy)
• Hypnagogic and hypnopompic hallucinations (before sleep and upon waking)

2. Psychiatric conditions

Certain mental health disorders can cause auditory hallucinations:

• Schizophrenia spectrum disorders
• Brief psychotic episodes
• Severe mood disorders with psychotic features

3. Substance-related causes

• Alcohol withdrawal
• Recreational drugs (hallucinogens, stimulants)
• Certain medications or their sudden withdrawal

4. Neurologic disorders

• Epilepsy (especially temporal lobe seizures)
• Parkinson's disease or Lewy body dementia
• Brain lesions or tumors (rare)

5. Metabolic and toxic encephalopathies

One often-overlooked cause is hepatic encephalopathy in advanced liver disease. According to the 2014 practice guideline by the American Association for the Study of Liver Diseases (Montagnese et al., 2014), patients with chronic liver disease may develop confusion, personality changes and hallucinations when toxins (like ammonia) build up in the bloodstream.
A noninvasive lab index (Wai et al., 2003) can help predict significant fibrosis or cirrhosis, which raises your risk for hepatic encephalopathy.

Steps you can take at home

If you suspect your voices are the harmless hypnagogic type, try these sleep-friendly habits:

• Stick to a consistent sleep–wake schedule, even on weekends
• Create a calming bedtime routine—read, stretch or meditate
• Avoid screens (phones, tablets, TV) for at least 30–60 minutes before bed
• Limit caffeine and stimulants after mid-afternoon
• Keep your bedroom cool, dark and quiet
• Reserve your bed for sleep and intimacy—no work or TV

If stress or anxiety is a trigger, consider relaxation techniques such as deep breathing, progressive muscle relaxation or guided imagery.

Why you shouldn't ignore warning signs

While occasional, brief auditory hallucinations can be benign, persistent or worsening symptoms deserve attention. Untreated medical and psychiatric conditions may progress, leading to:

• Poor daytime function and safety risks (e.g., driving or operating machinery)
• Declining mental health or quality of life
• Potential progression of an underlying disease

When to see your doctor

Make an appointment if you experience:

• Frequent or disturbing voices that last more than a few seconds
• Hallucinations during full wakefulness
• Additional neurologic signs (tremors, weakness, coordination loss)
• Jaundice, abdominal swelling or fatigue (possible liver disease)
• Changes in mood, thinking or behavior that worry you

Your physician may recommend:

• A detailed history of sleep habits and mental health
• Blood tests (liver function, metabolic panels)
• Screening for sleep disorders (overnight sleep study)
• Neurologic or psychiatric evaluation

Before your appointment, you can use Ubie's free AI symptom checker to assess your sleep-related symptoms and receive personalized guidance on whether your hallucinations may be connected to a sleep disorder.

Don't wait—speak to a doctor

If you ever feel unsafe with your symptoms—or worry they could be life-threatening—seek prompt medical attention. Early recognition and treatment of underlying causes can improve your sleep, mood and overall well-being.
Whether your voices are a quirk of sleep or a sign of something more serious, a healthcare professional can help you find answers and relief.