Sometimes I hear voices.

Now that I’ve got your attention, I’ll explain. Ever since I can remember, I have had nights where, as I start to fall asleep, I start hearing a jumble of words. Oftentimes this consists of voices from people I’ve spoken with during the day; sometimes they’re talking to me, sometimes it’s just nonsensical words strung together. Sometimes it’s someone who I haven’t spoken with in years. Other times, it’s a vague and unfamiliar voice. Regardless, I hear voices saying random words with no association to one another, and usually this is how I know I’m getting sleepy. Rather than fighting it, I try to follow the word trails until I eventually doze off.

I thought this was totally normal, something that everyone experiences as their brain makes the transition from consciousness to unconsciousness. It was only after mentioning it to my mom, who was surprised and completely unfamiliar with the phenomenon, that I realized that maybe there was something wrong with me.

Fortunately, there’s nothing wrong with me. I did some research and found out about hypnagogic hallucinations: these hallucinations come on as one shifts from wakefulness to sleep, and can be auditory, tactile, or visual. Somewhere between 25-38% of people experience this type of hallucination. Such people may have mental illnesses such as anxiety, depression, or bipolar disorder, but this isn’t usually the case; over half of those reporting such hallucinations have no evidence of psychiatric or sleep disorders. In other words, it’s nothing to worry about, just a quirk of the brain. That being said, after I realized this wasn’t something everyone experiences, I started wondering more about the hallucinations.

Most people who know anything about schizophrenia will immediately think of hallucinations. Maybe they’ll think of the movie "A Beautiful Mind," or of someone talking to themselves in a psych ward. Hallucinating is a prominent symptom in the disorder, but it's not the only one. According to the National Institute of Mental Health, people with schizophrenia most commonly experience these three “positive” symptoms:

1. Hallucinations: this is essentially any sensory information being perceived which is not really occurring. Most people think of visual hallucinations, seeing people who aren’t really there, but actually for schizophrenia, auditory hallucinations are most common.
2. Delusions: these are beliefs which aren’t supported by reality, and can be positive or negative. Someone may believe they are God, or they may believe that everyone is conspiring to harm them.
3. Thought disorders: these are unusual or dysfunctional ways of thinking. A person with abnormal thoughts may create a sentence with no meaning but consistently rhyming words, or may string together a cluster of words which are totally unconnected. This is known as “word salad."

Now, I’m by no means an expert on schizophrenia, but I am fascinated by the similarities between our sleep state and this psychotic disorder. Could there be a link between the two?

For a few years now, I’ve wondered if there could be some sort of association between dreaming and having schizophrenia. Without any context that sounds incredibly unfounded, even offensive to someone living with schizophrenia. But as time has gone on, I have noticed more and more connections between the two. Because I find this subject so interesting, I decided to do some research.

Let’s break this talk down by the three positive symptoms that I mentioned earlier. As I mentioned at the beginning of this article, auditory hallucinations can be brought on by falling asleep or waking up. Many people also experience visual hallucinations when they are half awake, half asleep: this is known as “sleep paralysis." One could even make the argument that dreams themselves are hallucinations.

Dreams fit all three of these categories. Not only are you typically seeing pretty bizarre, unreal things, but often these hallucinations are completely nonsensical. One minute you might be in your house, and the next you’re at school with no transition in between. Realistically it makes no sense, and yet you believe it to be true anyway (at least until you wake up). I have even had dreams where I recognize that I’m asleep, but for the sake of someone else in my dream, I pretend not to notice or care so I don’t hurt their feelings. Couldn’t that be considered a delusion? Is that any different from a schizophrenic person knowing the voices they hear aren’t real, and yet feeling driven to believe them anyway?

I already mentioned thought disorders, what with the hypnagogic hallucinations. I can’t tell you how many times I’ve heard phrases like “forgetting blood” or “Paula sandwich” (both true) and accepted them as completely normal.

This whole theory led me to do some research on an actual link between the two, rather than believing merely on my own experiences. Previous to this research, I already knew that dopamine is a neurotransmitter which is excessively expressed in schizophrenic patients. It’s the neurotransmitter people say is responsible for love (which explains the untrue conclusion that “love is insanity”), and to put it in its most simple terms, it’s a “happy” chemical, but unlike serotonin, it’s more of the unstable form of happy. It’s responsible for creativity, pleasure from rewards, and, you guessed it, dreams. To be fair, there’s a whole plethora of neurotransmitters that play a role in sleep, but what I found during my research was that dopamine specifically promotes dreaming.

One of the most interesting articles I read was about a study, where mice were deprived of dopamine, which led to a lack of sleep and rigidity, but also administered extra doses of dopamine. Not only were the animals able to sleep again, but additionally, “They found that the excess dopamine in the brains of the mice generated patterns of brain activity that made it look as though the animals were experiencing brain activity associated with dreaming when they were actually awake.” This made researchers wonder if schizophrenia is essentially the inability to stop dreaming even when awake.

Beyond that, another article explained that the more dopamine swimming through your brain as you sleep, the more vivid, emotional, and bizarre your dreams will be. This would explain the delusional thoughts which are almost nightmarish in oddity and emotionality that schizophrenics often face. To a person who believes they are being tracked down by the government, they may feel as afraid, if not more afraid, than neurotypical people feel while experiencing a bad dream.

Reality isn’t always easy to distinguish. Just as we may never question the fact that a monster is chasing us in a dream until the moment we wake up, someone with schizophrenia may be unable to make themselves realize that no one really wants to kill them. They become so caught up in the feelings brought on by their perceptions that it’s hard to see reality. It’s like they never get to wake up from the dream.

I just brought up a lot of big ideas, and it all might still seem a little confusing. The bottom line here is that schizophrenia may not be as foreign to us as we think. Not that dreaming is synonymous with schizophrenia by any means, please don’t misinterpret me here, but maybe there’s something to be learned from the similarities.

Ultimately I hope that what you take away from this article is that people living with schizophrenia are nothing to be afraid of. By being able to understand their experiences a bit better, hopefully we can reduce the stigma that they are different from us.