Melatonin-Responsive Complex Nocturnal Visual Hallucinations

Abstract

Complex nocturnal visual hallucinations are vivid, dramatic, intricate visual hallucinations occurring during sleep onset or awakenings at night, generally lasting for a few minutes at most and disappearing with increased levels of light. They may occur in a number of neurological conditions, as well as in normal individuals. The optimal treatment for this condition remains unclear. We describe three patients with complex nocturnal visual hallucinations in whom melatonin brought about a dramatic improvement in symptoms. Our report suggests that melatonin may be a safe, effective treatment for this rare but often distressing and anxiety-provoking condition.

Melatonin-Responsive Hypnagogic Hallucinations in a Patient With Bipolar Disorder and Posttraumatic Stress Disorder

“…One additional factor involved in the evaluation of hypnagogic hallucinations is the connection between these symptoms and use of β-blockers. β-Blockers suppress the production of melatonin 16 and patients in 2 case series showed resolution of hypnagogic hallucinations on stopping β-blockers 6,12 . Our patient's nocturnal hallucinations long preceded her use of metoprolol (started at age 50) and she had no recent dosage changes, making this medication an unlikely contributory factor in her case.…”

“…Although no definitive treatment has been determined, 1 recent report described 3 patients with sleep disorders and concomitant complex nocturnal visual hallucinations who responded fully to treatment with melatonin. 6 Like our patient, each of these individuals described seeing animals or people just as they were falling asleep or waking up. Unlike them, our patient did not have a known sleep disorder nor one of the medical conditions commonly associated with hypnagogic hallucinations.…”

“…Most of these experiences are mild and infrequent. These nocturnal symptoms are much more common and intense in certain medical conditions including neurological disorders (peduncular hallucinosis, treated Parkinson disease, migraines, and epilepsy 7 ), substance use disorders (central nervous system depressant withdrawal syndromes, 8 hallucinogen intoxication 7 ), blindness (Charles Bonnet syndrome 9 ), and specific sleep disorders (rapid eye movement sleep disorder 10 and narcolepsy 6 ). Despite the disparate pathologies involved, the patients' descriptions of visual hallucinations are remarkably similar with generally intact memory and no other involved senses 7 .…”

“…Exogenous melatonin, available over the counter (OTC), is a common and well-tolerated treatment for insomnia 4,5 . Use of OTC melatonin for other clinical conditions has been studied, 5 including 1 case series showing its benefit in patients with hypnagogic hallucinations and other nocturnal visual hallucinations associated with sleep disorders 6 . Here, we present a case of a patient with bipolar disorder and posttraumatic stress disorder (PTSD) but no other known contributing medical illnesses who had a recurrence of hypnagogic hallucinations on stopping OTC melatonin, followed by rapid resolution on restarting the medication at her previous dosage.…”

Nocturnal visual hallucinations in patients with disorders of arousal: a novel behavioral and EEG pattern

“…Nonetheless, some patients with CNVH also have comorbid NREM parasomnias ( 40 ). CNVH often take the form of vivid mobile or immobile images of animals or people, sometimes distorted in shape, typically occurring following a sudden awakening and often, they are initially perceived as being real and frightening ( 1 , 21 , 41 ). CNVH have also been reported to cease with an increase in the background illumination ( 1 ).…”