![]() ![]() She also had a history of sleepwalking and sleeptalking/ sleepscreaming since childhood, now occurring two to five times per month, usually in the first half of the night, and often triggered by periods of stress. She had no visual complaints, and optometric examination earlier this year showed a visual acuity of 20/20 and full visual fields bilaterally, with no retinal disease or glaucoma. In 2013, she was started on bisoprolol for high blood pressure. The second case involves a 45-year-old woman with diabetes and no significant neurological impairments, in whom moderate OSA (AHI 26.6 events/h) was diagnosed by PSG in 2009, and whose snoring and daytime sleepiness were effectively controlled on continuous positive airway pressure (CPAP). She subsequently combined 5 mg immediate-release (to treat the hallucinations) and 5 mg timed-release (to improve sleep continuity) forms of melatonin with near-resolution of hallucinations this benefit is currently sustained. Within 1 week of initiating melatonin, she noticed a dramatic improvement in the frequency (“decreased by 95%”) and intensity (would now only occasionally see immobile unformed patterns on the ceiling) of her hallucinations. A few months later she was started on melatonin 10 mg a night this improved her self-reported sleep duration from 6.5 hours to about 7.25 hours and reduced her nocturnal awakenings from four to five per night to zero to once per night. She was started on treatment with an auto-adjusting continuous positive airway pressure device, with which she had trouble remaining adherent she abandoned its use, and it did not affect the frequency or nature of her hallucinations. In 2015, she underwent polysomnography (PSG) for complaints of snoring, choking/gasping during sleep, and daytime sleepiness, and was found to have mild obstructive sleep apnea (OSA), with an apnea-hypopnea index (AHI) of 5.9 events/h. She had no signifi-cant visual complaints, and in 2014 she underwent an opto-metric evaluation that showed full visual fields, bilateral best corrected visual acuity of 20/30, keratitis sicca, and bilateral nuclear sclerosis, but no retinal disease or glaucoma. ![]() She was also on venlafaxine 37.5 mg a day for her anxiety. She was not on a beta blocker when her hallucinations initially appeared, although propranolol 40 mg twice a day was added for palpitations approximately 2.5 years prior. Initially she would respond with fright to these images, screaming and bolting out of bed fully awake, occasionally injuring herself as a result later she “got used to them.” She had a history of heavy weekend alcohol use when they began, and subsequently quit drinking, but the hallucinations persisted. ![]() The frequency of these hallucinations waxed and waned throughout her life, and worsening with stress they were almost daily at the time of presentation. The hallucinations were not associated with dreams. These hallucinations appeared very real and had no auditory or tactile accompaniment, although early in the course she experienced very rare auditory hallucinations at sleep onset, such as hearing a word in her head, which occurred separately from the visual hallucinations. Some of these images appeared to move, for example, a wedding dress floating under the ceiling, whereas others remained immobile. She stated that she was fully awake when she saw these images, which persisted for seconds to minutes and vanished upon turning on the light. At times, she saw similar images, as well as a paisley pattern (akin to looking through sheer lace), while going to the bathroom at night in low lighting. These included seeing people in her room, bugs in her bed, and tarantulas on the ceiling. In her 20s, she began experiencing visual hallucinations in the middle of the night upon awakening, usually after 2 to 3 hours of sleep. She had no significant neurological impairments, and had a history of anxiety and sleepwalking as a child (that resolved spontaneously in adolescence), as well as a very abusive childhood. The first case involves a 59-year-old woman who worked as a police employee. ![]()
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