Your body and brain need sleep to function properly. Symptoms of psychosis may be possible when you go without sleep for a long time.

If you’ve gone so long without sleep that you’re having a difficult time telling the difference between what’s real and what’s not, you may be experiencing sleep deprivation psychosis.

Getting fewer hours of sleep every now and then may not significantly impact your health. But missing sleep for more than a day could lead you to experience various physical and mental symptoms.

The longer you go without sleep, the more severe your symptoms may become.

Sleep deprivation psychosis refers to experiencing an altered perception of reality caused by a prolonged lack of sleep.

Psychosis, in general, refers to an episode in which your brain perceives reality differently than other people in the same situation. You may see, hear, smell, taste, or believe something that others don’t.

Psychosis is a formal diagnosis, and it can be a result of many factors. In this case, not sleeping for a long time can be the cause.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), at least one of the following symptoms must be present to define an episode as psychosis:

  • Delusions. Delusions are firm beliefs you hold even when there’s evidence to the contrary. For example, being convinced you’re a Hollywood star and people around you are paparazzi.
  • Hallucinations. Hallucinations refer to perceiving things that others don’t. For example, seeing colorful lights around you.
  • Disorganized speech. Disorganized speech refers to speaking in such a way that other people may not be able to follow your ideas. You may use words that don’t exist or form sentences in unusual ways.
  • Severely disorganized behavior. Severely disorganized behavior can have several characteristics. It may include behavior that’s unusual or unexpected for a given situation, or it could refer to sudden agitation.

Symptoms of sleep deprivation psychosis can change with time. More intense symptoms, like hallucinations, develop after the first 24 hours without sleeping.

A 2018 research review examined 21 articles on the correlation between time spent without any sleep and symptoms of psychosis.

Based on results gathered from 760 participants, the researchers noticed that people typically start experiencing the first symptoms within 24 to 48 hours of not sleeping. These symptoms typically include:

  • distorted perception
  • anxiety and irritability
  • not feeling like yourself and other signs of depersonalization and dissociation
  • loss of time and your sense of orientation

The review also suggested that symptoms of psychosis rapidly progress as more sleep loss is experienced.

Most participants experienced more complex symptoms after 48 hours without sleep, including:

  • hallucinations
  • simple delusions
  • disorientation
  • disorganized thinking
  • apathy
  • depression
  • euphoria
  • anger and hostility

After 72 hours of not sleeping, people started experiencing persistent:

  • complex hallucinations
  • elaborated delusions
  • bouts of aggression
  • more mood changes

In general, the first and most common symptoms of sleep deprivation include disturbances in how you perceive reality. More specifically, lack of sleep can lead you to experience:

Visual disturbances

  • objects or spaces appearing larger or smaller than they really are
  • things appearing to be moving when they’re not
  • objects changing colors or losing their sharp edges
  • objects appearing to be something different than what they really are
  • seeing things or people that are not there

Sensory experiences

  • feeling like something or someone is touching you when they’re not
  • feeling like your body or parts of your body are changing in size
  • having a sensation of movement while you’re not moving

Auditory disturbances

  • hearing sounds or voices that aren‘t there
  • not being able to identify where sounds are coming from
  • hearing sounds or voices differently than they sound in reality

Scientists are not sure why lack of sleep can lead you to experience symptoms of psychosis.

Your brain is surprisingly active while you sleep. It uses this time to perform functions essential to your well-being.

While you’re sleeping, your brain processes daily thoughts, stores new information, and gets rid of toxins.

Your brain cells — neurons — are creating and maintaining pathways while you sleep. This function is critical for:

  • forming memories
  • retaining information
  • making decisions
  • concentrating

It’s possible that lack of sleep deprives your brain of the opportunity to perform these vital functions.

Without reorganizing and communicating, neurons may have a hard time making connections. This could lead you to experience challenges when trying to concentrate and think clearly.

Gradually, performing regular functions may become increasingly difficult for your brain, and you may begin to experience symptoms of psychosis.

In most cases, sleep deprivation psychosis isn‘t permanent.

Although symptoms may be severe and sometimes unsettling, they typically lessen and stop after you’ve slept for some time.

The treatment for sleep psychosis and other symptoms of sleep deprivation is sleep.

You may want to start by addressing the underlying causes of your inability to sleep. Sleep therapy may help in this case.

The longer you’ve gone without sleep, the more time you’ll need to recover.

For every hour of sleep that you’ve lost, you could need a half-hour of sleep to recuperate. This means that if you’ve gone 24 hours without sleep, you’ll need at least 12 hours of rest to return to feeling like your usual self.

In the mentioned review, most participants felt completely recovered after returning to their regular sleep schedule. However, it took days and up to weeks for some of them to feel up to speed.

Getting enough sleep is crucial for your brain to function properly.

The Centers for Disease Control and Prevention (CDC) recommends at least 7 hours of sleep per day for adults. Going for prolonged periods without sleep can lead to symptoms that can range in severity from poor concentration to sleep deprivation psychosis.

Symptoms of sleep deprivation psychosis tend to worsen the longer you go without sleep. They can include:

  • changes in how you see and hear things
  • perceiving reality differently
  • feeling detached from your body

Sleep deprivation psychosis is typically not permanent and can be resolved by getting sleep. The longer you’ve gone without sleep, the more rest you’ll need to recover. It may take anywhere from a few days to a few weeks to feel fully recovered.