1000 Hypnagogic hallucinations as a manifestation of Parkinson’s disease
Sleep May 29, 2023 Stephanie Hart, Lauren Tobias
Hypnagogic hallucinations—vivid, dream-like experiences that occur while falling asleep—can be a symptom of Parkinson's disease (PD) even in patients who do not have narcolepsy. A 66-year-old woman with tremor and dream enactment reported seeing a grim reaper and a dark figure upon falling asleep. She was diagnosed with mild obstructive sleep apnea and loss of REM atonia. Treatment with melatonin and clonazepam improved dream enactment. Over two years, she was diagnosed with PD and started on carbidopa-levodopa; higher doses of dopaminergic therapy were associated with more frequent hypnagogic hallucinations. The case illustrates that such hallucinations are not exclusive to narcolepsy and may be underrecognized in PD.