Oneirism (delusions of sleep): symptoms, causes and treatment

The oneirism or delusion of the dream is an alteration of the consciousness that usually occurs due to the abuse of psychoactive substances or organic brain disorders such as epilepsy and parasomnias. Its main feature is the appearance of hallucinations similar to those that occur when we dream, but in this case they occur while awake.

In this article we will describe the characteristics, symptoms and main causes of oneirism. For this it is necessary that we dwell on other concepts and disorders associated with the delusions of sleep, such as "productive disorder of consciousness", that of "parasomnia" or the term itself "hallucination".

• Related article: "Hallucinations: Definition, Causes, and Symptoms"

What is oneirism or dream delusion?

Oneirism, also known as dream delusion, is a psychological state characterized by the presence of hallucinations similar to those that occur during dreams but they occur during wakefulness. The two nomenclatures refer to this fact, since the Greek word "oneiros" can be translated as "dream" or "reverie".

This phenomenon is associated with the abusive consumption of certain substances, such as toxic products or alcohol and other drugs, as well as pathophysiological changes in the brain. However, on other occasions, oneirism does not have a pathological component, but can also be the result of normal biological factors, such as sleep deprivation.

The delusion of the dream is part of the group of alterations that we know as "productive disorders of consciousness", which also includes delirium (very frequent in hospitalized elderly and in alcoholics with withdrawal syndrome), depersonalization, derealization or phantom limb syndrome.

The common aspect that unites this group of disorders is that hallucinations appear in all of them due to alterations that affect consciousness. We speak of hallucination when a person perceives something through any sensory channel (auditory, visual, etc.) without there being a stimulus that justifies it, especially if you believe that such perception is real.

• Related article: "The 6 levels of loss of consciousness and associated disorders"

Main symptoms and manifestations

In the case of oneirism, and as it tends to happen when organic alterations of the brain are present or when substances with psychoactive effects are consumed, hallucinations are mainly visual in nature. However, sometimes tactile hallucinations and, to a lesser extent, auditory, olfactory and gustatory hallucinations are also identified.

Hallucinations do not always occur in a single sensory modality, but can be multimodal; for example, hearing a threatening voice and feeling someone's breath in your ear would be a multimodal hallucination. Some authors use the concept "delusional dream" only when the hallucinations are of this type, while "oneirism" would be a broader term.

Like most productive disorders of consciousness, oneirism is frequently associated with loss of contact with reality, either completely or partially. Sometimes the person can lose consciousness of himself or perceive the environment in which he is in a hallucinatory way.

The most common is that the delusions of the dream have a transitory nature, closely related to factors specific biological disorders, and that do not have a significant impact on the psychological state of the person who suffers from them in the long term term. Another characteristic of oneirism is that it usually starts suddenly, in a matter of hours or a maximum of days.

• You may be interested in: "The 7 main sleep disorders"

Causes of delusions of sleep

oneirism arises as a consequence of different organic factors that affect the brain. The most common is intoxication due to the abuse of certain substances, but any transient or chronic disease has the potential to cause these symptoms, especially those that affect processes related to wakefulness and the dream.

1. Psychoactive substance abuse

The most common cause of dream delusions is excessive alcohol consumption, antidepressant and sedative-hypnotic drugs (especially barbiturates) and drugs with hallucinogenic effects, among which are hallucinogenic mushrooms or psilocybin, mescaline, found in peyote, and lysergic acid or LSD.

Poisoning by certain types of poison and other substances that are toxic to the human body is also associated with the appearance of dreamlike episodes.

2. Parasomnias

Parasomnias are a group of sleep disorders characterized by the appearance of abnormal behaviours, perceptions or emotions in the transition periods between sleep and sleep vigil. Oneirism is especially common in REM sleep disorders, during which dreams are very vivid and muscle tone rises.

• You may be interested in: "The 5 phases of sleep: from slow waves to REM"

3. organic alterations

Epilepsy, in which there are episodes of abnormal brain activity that often cause Seizures, is one of the chronic organic alterations most related to delusions of dream. Other relevant organic processes include febrile states, infections, gastrointestinal bleeding and degenerative brain diseases.

4. Non-pathological factors

People without relevant organic disorders and who are not under the influence of a substance that we have mentioned may also have low-intensity dream delusions. Among the non-pathological factors that predispose to oneirism, it is worth noting severe fatigue, sleep deprivation, indigestion and marked anxiety states.