Can Using a Fan Make You Hallucinate?

Reader’s Question

OK, I’m not hearing voices exactly. I am being treated for depression (Zoloft 100 mg) and Seroquel 25 mg at night to help me sleep. I’ve been on Zoloft for 15 years and the Seroquel for about three years.

For many years, however, and even before I started the above meds, when I’m lying in bed ready to go to sleep I hear music and voices singing. And it’s only when I have my bed fan on. I am going through menopause and get hot flashes at night. The fan seems to “bring through” the music and singing. I can’t make out what the singers are singing, but it sounds classical and/or operatic. And it’s usually only when I have the fan on. Sometimes I can tell what the song is. Sometimes it’s sopranos/altos (women) and sometimes it’s men (tenors and baritones). Occasionally it sounds like Gregorian chants.

Am I completely nutso? This has been going on for years and is not frightening, but no one else I know can relate to it. Any advice would be welcome!

Psychologist’s Reply

You’re correct — what you are experiencing is not a true hallucination. And, by the way, you’re not nutso! I suspect several components have combined to create your music. In clinical terms, you are describing a “hypnogogic hallucination” or auditory misperception that surfaces before you fall asleep. If they occurred during awakening the following morning, they would be called “hypnopompic hallucinations”. These are vivid, dream-like hallucinations associated with the sleep cycle. You’ve got to love these terms! Unlike psychiatric hallucinations, they are not related to a significant psychiatric illness and as you describe, are typically not frightening — just a bit irritating. Clinical hallucinations have been associated with elevated levels of the neurotransmitter Dopamine, the chemical also associated with Schizophrenia and other forms of psychosis. The higher the levels of Dopamine in the brain, the more severe and frequent the hallucinations. Antipsychotic medications decrease hallucinations by decreasing the brain’s level of Dopamine. OK, that’s Medication Treatment Theory 101.

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Depression and Obsessive-Compulsive Disorder (OCD) are linked to low levels of the neurotransmitter Serotonin as well as other chemicals. It’s not uncommon for depressed individuals to develop obsessive thoughts such as repetitive phrases, constant fears, counting, disease preoccupation, etc. Low levels of Serotonin can also produce “earworms” — songs or parts of songs that become stuck in your thinking and won’t go away. Common earworms are ad jingles or children’s songs.

Zoloft is a Selective Serotonin Reuptake Inhibitor antidepressant that works by making more Serotonin available. Oddly, it also has the same effect (only weaker) on Dopamine. Taking Zoloft for your depression makes it possible that you might be experiencing these auditory misperceptions due to a combination of your medications and depression.

How in the world is the fan involved? Again, another low-threat but natural process… The brain is required to make an attempt to understand everything in the environment — including noises, sights, smells, etc. When presented with a stimulus or triggered, the brain makes a “best guess”. When we see someone approaching at a distance, our brain guesses who it might be, then adjusts its interpretation as they approach. This attempt to offer a best guess produces problems when we use a hairdryer, are in the shower, or are in near-sleep (hypnogogic and hypnopompic). In most cases, random noises are interpreted as hearing our name called, the phone ringing, a knock on the door, hearing a car door slam shut, or hearing someone walking outside our property.

My theory: the fan is producing a white noise that your brain must interpret. It’s somewhat overactive in its interpretation due to mild elevations in Dopamine, created by your Zoloft. Prior to medication treatment you were experiencing “earworms” related to your Serotonin levels. These factors combine, and the result is a nonthreatening “earworm” that routinely appears as you move into pre-sleep (the hypnogogic period) with the fan running. Parts of your brain are falling asleep and other parts are still paying attention to your bedroom environment — listening to the fan — and suggesting it might be music.

What can you do to fix it? Your psychiatrist should be consulted, at which time you can consider:

  • Switch to an antidepressant that blocks Dopamine reuptake,
  • Increase your Seroquel at night,
  • Softly play your own soothing music as you go to sleep so the brain won’t need to interpret the fan noise, or
  • Continue with the current situation and recognize that it’s nonthreatening and not related to a psychiatric illness.

You could also practice sleeping with your room cooler rather than using the fan. That’s my theory.

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