Seeing things after you wake up? Your sleep stage may be to blame

Waking up and briefly “seeing things” can be unsettling. In most cases, these vivid images or figures—known as hypnopompic hallucinations—are harmless and tied to the way your brain transitions out of sleep. This guide explains why it happens, when it might signal something more serious, and what to do next.

What are hypnopompic and hypnagogic hallucinations?

• Hypnagogic hallucinations occur as you fall asleep.
• Hypnopompic hallucinations occur as you wake up.
• Both are vivid sensory experiences (visual, auditory or tactile) without an external trigger.
• They often last seconds to a minute and end once you’re fully awake.

A systematic review by Sharpless and Barber (2011) found that roughly 7–8% of people report lifetime episodes of sleep paralysis or related hallucinations. Many never seek medical advice because the visions are brief and harmless.

Why do these sleep-related visions happen?

During REM (rapid eye movement) sleep, your brain is active and creates dreams. Normally:

1. You enter REM after about 90 minutes of sleep.
2. Your muscles become temporarily paralyzed to prevent you acting out dreams.
3. As you wake, muscle tone returns and dreaming ends.

If parts of your brain “wake up” faster than others, dream imagery can spill over into wakefulness. Common triggers include:

• Sleep deprivation: Skipping or shortening sleep makes REM more intense.
• Irregular sleep schedule: Shift work or jet lag can disrupt REM timing.
• Stress and anxiety: Heightened arousal may blur the sleep–wake boundary.
• Sleep disorders: Narcolepsy often features more frequent sleep–wake intrusions.

Typical features of these hallucinations

• Occur just before full wakefulness
• May include shapes, people, animals or abstract patterns
• Often accompanied by a sense of presence or pressure on the chest
• Short-lived and resolve once you’re fully awake

When to consider other medical causes

Most hypnopompic hallucinations are benign. However, persistent or worsening hallucinations—especially alongside other symptoms—warrant evaluation. Two non-sleep-related causes include:

1. Hyponatremia (low sodium levels)

   • Kim et al. (2008) showed that low sodium can lead to confusion and visual disturbances.
   • Symptoms: headache, nausea, muscle cramps, seizures, altered mental status.
   • If you’re on medications like diuretics or have heart/kidney issues, check sodium levels.

2. Hepatic encephalopathy (liver-related brain changes)

   • The EASL clinical practice guidelines (2014) highlight that cirrhosis can impair brain function.
   • Symptoms: confusion, sleep–wake reversal, asterixis (“flapping” hands), personality changes.
   • People with known liver disease should monitor for early signs of encephalopathy.

Other potential causes of waking hallucinations include delirium from infections, medication side effects, withdrawal syndromes and certain neurological conditions. Always consider the broader clinical context.

Red flags: when to seek immediate help

Contact a healthcare provider if you experience any of the following alongside visual or auditory hallucinations:

• Prolonged confusion or inability to fully wake
• Seizure activity (tremors, shaking, loss of consciousness)
• Severe headache, high fever or stiff neck
• Chest pain or difficulty breathing
• Signs of liver failure (jaundice, abdominal swelling, disorientation)

These could signal life-threatening conditions requiring urgent treatment.

Practical steps to reduce sleep-related visions

• Maintain a consistent sleep–wake schedule, even on weekends.
• Aim for 7–9 hours of sleep per night.
• Create a relaxing bedtime routine: dim lights, limit screens, avoid caffeine late in the day.
• Manage stress with mindfulness, gentle stretching or journaling before bed.
• If you nap, keep it short (20–30 minutes) and not too late in the afternoon.

If you’re concerned or symptoms persist, you might consider doing a free, online symptom check for these experiences.

When to talk to your doctor

• If hallucinations become frequent or distressing
• If you develop additional neurological or psychiatric symptoms
• To rule out underlying medical issues (electrolyte imbalance, liver disease, neurological disorders)

Be open about your sleep habits, medication use and any other symptoms you’ve noticed. Early discussion can prevent complications and help tailor any necessary treatment.

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Seeing things when waking up is common and usually benign—your brain is simply shifting gears between sleep and wakefulness. However, persistent or severe episodes can point to other health issues like hyponatremia or hepatic encephalopathy. If you’re ever in doubt, please speak to a doctor about anything that could be life-threatening or serious.