Sleep disturbances and nightmares
Sleep problems after psychedelics are common
Sleep problems are one of the most common sorts of extended difficulty after psychedelics. In our PLOS One survey of 608 people who reported post-psychedelic difficulties, 58 respondents or 9% of the total mentioned problems with sleeping as one of the post-psychedelic extended difficulties they experienced. Some people said they couldn’t sleep for days after their trip. Others said their sleep quality got a lot worse as they felt more anxious or derealized, like Aisha interviewed here. Here’s one respondent to the survey:
I currently have extreme anxiety. I am so stressed by everything at the moment. I sleep extremely badly.
Some people report their trip being ‘reactivated’ when they sleep and dream, so they wake up tripping. Here’s one account from the survey:
Around three days after I began to have intense dreams that woke me up. After waking up I felt like I was having a psychedelic experience. This made me incredibly anxious as I seemed to have no control. Sometimes I felt as though energy was pulsing through my entire body and that at at minute I would lose control of bowel and defecate in the bed although it never actually happened. This meant that after waking at 3 pm every night I would not return to proper sleep for the rest of the night. The lack of sleep impacted my sense of well being during the day.
Here's a similar experience from the survey:
I experienced what it looks like a ayahuasca overdose. I do not recall anything during the trip (I went completely black). I was told I was sweating tons and tons, static with eyes closed and very tense. I woke up unable to remember anything but fine, normal. Two nights afterwards I woke up with extreme paranoia, sweats, psychedelic sensations and the horrific sensation that I was losing my mind and going to the psychiatrist at any point… Three months later something happened again, also during my sleep. I kept waking up in loops, sweating, with paranoia. This second time It was several evenings. As it always occurred if I was sleeping I started struggling with the idea of sleeping, I was really scared. I got medication but this just made me sleep more however it would not diminish or reduce what was going on. 10 months later I have had a few but very light cases again. I believe and hope the worst is gone.
There is one case on Reddit of someone who had insomnia for weeks after a psychedelic experience:
I've had a bad trip two months ago. It was unique in that I was mentally fine but throughout have had a very strong physical sense of anxiety - tingling, tremors, palpitation. I was fine after that for a few days but then I've been having this insomnia where I'm jolted out of sleep, just as I'm about to fall asleep as immediately after, with sensations very similar to the ones I've experienced during the trip. This has been haunting me for weeks now, I can barely function during the day, with brain fog and also lingering sensations of anxiety (triggered by my attempts to fall back asleep in the early morning).
This person had a very rough time for several weeks, but from the sounds of it eventually found relief through anti-depressants.
We did a literature review for post-psychedelic sleep issues. Brekseema et al’s meta-study of adverse experiences in psychedelic trials found that insomnia was a common ‘late adverse experience’ in MDMA trials. In this study of psilocybin for demoralized long-term AIDS patients, two participants (11% of the total) reported mild insomnia following the treatment. In Holze et al’s 2022 comparison study of LSD and psilocybin on 28 healthy subjects, one participant reported insomnia and one reported nightmares after taking psilocybin. In Morton et al’s 2022 survey of 541 people with bipolar disorder who use psilocybin, insomnia was a commonly reported adverse effect (along with manic symptoms). Insomnia is also mentioned as an adverse effect in psilocybin and LSD microdosing, in Ona and Bouso’s 2020 systematic review.
We found one mention of nightmares as an extended difficulty (besides in our own study) - Bouso et al’s 2022 paper on adverse effects in the Global Ayahuasa Survey (n = 11,000), in which 19% reported ‘nightmares, disturbing thoughts, feelings or sensations’ after an ayahuasca session. Post-psychedelic nightmares are a more familiar phenomenon in the underground or retreat circuit - here’s one blog article on post-ayahuasca nightmares. And there is one case study involving a well-known British chef, Prue Leith, who had a terrifying LSD trip as a teenager in the 1960s, which led to nightmares that carried on occurring into her sixties.
Coping techniques
In terms of what helps people recover, it is often similar to other forms of post-psychedelic difficulty – acceptance, patience and reassurance, to try and calm your nervous system down and enable it to relax out of the fight-or-flight response. Nightmares can be very disturbing but they usually pass in a few weeks, so does insomnia, so it can be a question of hanging in there and gritting it out, without becoming too agitated. If possible, stay in your normal work and sleep routine. For some, sleep medication or herbal remedies may also help.
Here are some practices people generally have reported to find helpful to cope with challenging psychedelic experiences:
- Speaking to friends and family or attending a peer support group
- Speaking to a therapist, especially one who is familiar with psychedelic difficulties (CBT is often effective for anxiety and panic problems, although some also say they are helped by somatic therapy exercises that help regulate their nervous system).
- Cognitive practices like compassionate self-talk, cognitive distancing, and especially meditation and prayer
- Embodied self-care practices like exercise, yoga, walking in nature or body relaxation
- Finding useful information online and in books (e.g. the work of Stanislav Grof’s or “Breaking Open: Finding a Way Through Spiritual Emergency” by Jules Evans and Tim Read)
- Journaling
- Engage in creative activities like writing, art-making, or music
- Some people find medication helpful. Additionally, although controversial and risky, some may find that a subsequent altered state experience can help resolve their difficulties. However, this method carries obvious risks and should be approached with caution.
It is essential to explore and integrate these strategies in a way that resonates with personal preferences and needs, seeking support from professionals or trusted sources as needed.
Marcus' story
Marcus is a 50-year-old humanities professor living in a US city, with a wife and two children. During the pandemic, he rediscovered his youthful enthusiasm for psychedelics, and developed a practice in which he took a medium-to-large dose of magic mushrooms once a month. He tells me:
I had a couple of really big mystical experiences. I became a real evangelist for psychedelics. They changed me in every way - made me a better father, made me more open to new experiences. I was making new friends. I felt I was living a much better life than I had before.
This year, Marcus’ psychedelic practice tailed off as he felt he’d ‘got the message’. But a lingering low mood after a friend’s death made him decide to try another trip as a refresher. He took 1.7 grams of dried mushrooms, alone in a hammock, listening to music.
There were a couple of incidents that may have affected his trip. The day before, he saw a neighbour be carried out to an ambulance, dead. The war in Gaza was in the news. And his friend had passed away earlier that year. This may have fed into what was a rather downbeat trip experience – sad, rather than terrifying. But Marcus felt fine afterwards and had a great conversation with his daughter.
The problems began that night. He tells me:
I couldn’t sleep at all. That's weird, a little scary. But you know, you don't think much of it when it’s one night bad sleep. The next night, same thing. And that went on, I think it was initially four nights in a row, zero sleep. So then I'm freaking out, worrying how this will affect my job. And it just keeps going.
This went on for some months. Marcus described a pattern. For one night, he would get zero sleep. The next night, he would get a little sleep, but not deep REM restorative sleep, and often waking up in terror. Then the next night, no sleep. And so on. He told me:
It’s a living hell, like being tortured every other night. And it’s not like you go through the days feeling groggy. I feel hyper-alert, like my nervous system is stuck on fight-or-flight. I always go to bed with hope, and then I lie there and nothing happens. And then by three or four in the morning, I get intrusive thoughts, which are pretty scary. I have had nightmares as well, really heavy nightmares, nothing like I had with normal sleep, hellish nightmares which seem incredibly real. I remember one night I tried Trazodone [a sleeping pill], and I woke up dreaming I was in this hellish dark sludge that I had to claw myself out of. I feel like that Robert Johnson song, hellhounds on my trail, like it’s witchcraft or something.
The post-psychedelic insomnia had a huge impact on his life. He told me during the crisis:
I can’t work. I can’t drive the two hours to the university where I teach. I’ve tried teaching online but my university need someone there. We tried driving me to the train station but it’s a three-hour journey by train and I can’t do it. I’ve taken time off work but insomnia is not considered a serious enough condition for medical coverage. I have a wife and two daughters to support, I try not to catastrophize but this is serious. It’s also led to a worsening of my mood, of course, and to social anxiety and panic. My basic concentration levels have also been affected.
Marcus eventually recovered his normal sleep patterns. He says eventually the symptoms passed with time, and that what he thinks most helped him was sticking to his normal work schedule, however difficult it was to do so.
Further resources
For further information and support, the following web resources and support services are recommended:
- We run a free monthly online support group for people experiencing post-psychedelic difficulties.
- Psychedelic Clinic in Berlin: Clinic at Charité – Universitätsmedizin Berlin offering immediate support. Click here to get in touch.
- Psychedelic Support: Connect with a mental healthcare provider trained in psychedelic integration therapy and find community groups that can provide support.
- Fireside Project: The Psychedelic Support Line provides emotional support during and after psychedelic experiences.
- Institute of Psychedelic Therapy: The Institute for Psychedelic Therapy offers a register of integration therapists.