Post-psychedelic sleep issues

From night terrors to waking up tripping to a severe case of post-psychedelic insomnia

Update: since I wrote this piece Marcus has recovered from the post-psychedelic insomnia, and he kindly shares what helped him recover, below.

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.

He developed a little psychedelic community in the city where he lives. It was mainly friendly and supportive, although there was one fracas with someone who ran a local psychedelic meet-up, a shaman with their own private psychedelic practice. In one meeting, Marcus asked if the shaman ought to separate their private psychedelic practice from this public community meet-up. The shaman didn’t like that and kicked Marcus out of the group.

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. It was on October 18, the afternoon after he attended one of our Psychedelic Safety Seminars. 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. Plus, he did watch our 90-minute seminar on difficult trips, which I wouldn’t necessarily recommend before tripping.

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 has been going on ever since then – almost two months. Marcus describes a pattern. For one night, he will get zero sleep. The next night, he will 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.

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.

This is having a massive impact on his life.

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 has tried many things to reset his life. He has tried sleeping pills - they have very little effect. He tried hypnotherapy – it helped one night, but not the next. He has tried exercise. He has tried every supplement recommended to him (chamomille tea has been somewhat helpful). He has tried CBT-i, the recommended therapeutic treatment for insomnia – the therapist told him to keep a sleep diary, but he just noticed more and more days with the entry ‘no sleep’. He has tried sessions with an integration coach, and free therapy sessions from the support centre at ICEERS. ‘These sessions have been amazing. But there’s still the acute issue I’m facing of not being able to sleep.’ Some of these attempts to get better have been free, others have cost money.  

This week, he saw a psychiatrist who diagnosed him as suffering from Post-Traumatic Stress Disorder. This could make sense – certainly I’ve interviewed people who suffered insomnia for weeks after a terrifying psychedelic experience, like Aisha. Marcus’ original trip didn’t sound terrifying – he says it was sad rather than blind terror. He says: 

In my case, I have no specific memories of the trauma I experienced on the trip, but it's clear to me now that some fearful vision from the experience has become deeply lodged in my amygdala, which is now stuck in a flight or fight response. Constant hypervigilance means that I can never properly relax and rest.

One question he has pondered, although he doesn’t really want to give it too much credence, is whether the ‘shaman’ could have somehow have cursed him, intentionally or unintentionally. It seems ridiculous, but he does feel like he’s in a hellish space, like he’s being spiritually attacked. He’s wondered if he should seek some sort of spiritual healing or spiritual protection – but where the hell does one go to get that?

Marcus’ difficult situation points to a couple of things. Firstly, sleep issues after psychedelics. 58 respondents to our PLOS One survey - 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 who we interviewed last month. Here’s one respondent to the survey:

I currently have extreme anxiety. Nothing feels how it should around me. I feel that I have lost all my energy and that I am not totally in the room. I feel that I have totally ruined my life and that I will never be the same again. Specific symptoms are extreme anxiety and everything that goes along with that including depersonalisation, derealisation, depression, panic attacks etc.. This is truly awful and I beg for it to stop soon. People do not seem the same, I have a worse sense of time, I struggle with simple things such as tidying my room. 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 (I’ve experienced this myself in the days after an ayahuasca retreat). 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.

I’ve also found 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.

There are similarities here with Marcus’ case, but differences as well. Marcus had no history of poor mental health. He’d had good experiences with psychedelics, he has good coping skills. And yet this experience happened to him out of the blue, and has had a severe impact on his life.

This points to one of the serious issues with psychedelics, which may hamper their ability to become mainstream medical treatments – their unpredictability. Psychedelics affect the mind, subconscious, nervous system and psycho-immune system in such profound but unpredictable ways. They may clear up long resistant mental or physical health problems. But they may also cause them, and there is a lack of research on these extended difficulties and what helps people cope with them.

I did a quick literature review for post-psychedelic sleep issues. Brekseema et al’s excellent 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.

I 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.

Prue Leith experienced nightmares that persisted for several decades following a terrifying LSD experience when she wa a teenager in the 1960s.

However I found no mention of severe insomnia lasting weeks after a psychedelic experience - although I have now interviewed two people in the last month who experienced this, Aisha and now Marcus. I also found no mention in the research of the experience of psychedelic re-activation, or ‘waking up tripping in the days or weeks after a psychedelic experience’ - although I hear about this alot (I was interviewed for Lana Pribic’s Modern Psychedelics podcast yesterday, and she mentioned experiencing it, as have I).

So there is still a big gap between what the research field knows about adverse psychedelic effects, and what people actually experience. To say nothing of the almost total lack of research on what helps people who experience these adverse effects.

If you are one of those unlucky people who find themselves grappling with a post-psychedelic crisis, like Marcus or Aisha, you’re then left to navigate your way through a bewildering array of treatment options – EMDR? Somatic experiencing? Therapy? Shamanic exorcism? All while you’re trying to navigate a completely different reality while still paying the bills.

Marcus has shared his story ‘to begin publicizing the fact that in certain rare cases such as my own, persistent and utterly debilitating PTSD-like symptoms can develop from even a small dose of psilocybin’. He wonders if others have gone through similar post-psychedelic difficulties, and if there are affordable solutions. He does not think another psychedelic experience is a good idea in his present fragile state.

Please only offer advice based either on direct personal experience, years of facilitation or therapy practice, or scientific evidence, either in the comments if you’re a paid subscriber, or you can message me.

Post-Psychedelic Insomnia Recovery: an update from Marcus 23/3/25

Just after I spoke with Jules, around two months into my struggle, I was put on 15mg of mirtazapine, which allowed me to finally get a few hours of restorative sleep on consecutive nights. I still take that - and occasionally supplement with 3000mg of glycine (I have also found CBD/CBN helpful at times). Even still, it took me several months to fully reconstitute my normal sleeping pattern, so the medication was no magic bullet.

What helped me most over the long run was the recognition that the root cause of my insomnia was nothing more than sleep-focused anxiety (or, more precisely, fear of wakefulness). As described in the article, I initially thought that I had some entirely unique malady connected to the psilocybin experience, that my sleep mechanism was broken, and that I would never sleep normally again. All of the information I found online only reinforced this, as it seemed to focus on what seemed to me like merely "bad sleep," not NO sleep at all. It didn't help that when I visited specialists, the sleep questionnaires focused on things like not being able to stay awake during the day, which was never a problem for me. No matter how little sleep I got, I was never sleepy during the day, just perpetually wired and tired. I would desperately try to nap, to no avail.

My perspective began to shift after coming across a series of interviews with former insomniacs on YouTube (The Sleep Coach School) that ultimately convinced me my insomnia was not some special, intractable case. They essentially teach Acceptance and Commitment Therapy for insomnia. (I never paid for their coaching services - just watched their content.) I learned that at the outset of their struggles almost everyone had this same belief that their sleep issues were entirely unique and unprecedented. They also nearly all experienced daytime alertness, or "hypervigilance." While the specific triggers varied – sometimes obvious, other times unknown - nearly everyone's insomnia began in much the same way: first a sleepless night, then panic over the sleeplessness, then a series of increasingly desperate efforts to force sleep. Since sleep is essentially effortless, these efforts inevitably backfire by teaching our brain that wakefulness is a threat. This leads to a vicious cycle of sleeplessness–sleep efforts–more sleeplessness.

It was reassuring to learn that my experience followed a common pattern for insomnia. The only difference in my case was that the stressful catalyst was psilocybin. Whatever initially causes the first sleepless night, after that the real trauma kicks in. The brain sees wakefulness as a terrifying threat and does all it can to keep us alert at night, which has the countereffect of keeping us vigilant and awake.

This understanding led me to an important insight about recovery: If it's our sleep efforts that keep us awake by telling our brains to fear wakefulness, then minimizing those efforts will improve sleep. The single most helpful thing I did was implement a "timeless sleep window." When it's time for bed, I stop looking at the clock and just wait for the alarm to sound in the morning - no more monitoring of how much sleep I'm getting. I still struggle more on nights when I have to get up early to commute to work, which further confirms that anxiety is the real culprit. But whatever happens, I resist the temptation to check the clock. I try to remain as restful as I can, then get up when the alarm goes off. To my surprise, I've found little correlation between my subjective sense of how much sleep I've gotten on any given night and my experience of tiredness the following day. The more I learned to "accept wakefulness" and stay calm even when rest doesn't come, the more consistently restful my sleep has become.

This is obviously no quick fix, since it takes time to retrain your brain. It took me several months to rebuild my sleep and reduce my daytime hypervigilance, which still comes and goes along with residual anxiety and depression. But the good thing is that recovery has been mostly "effortless." I did initially follow the CBTI suggestion to go to bed 5.5 hours before I intended to rise – and that helped consolidate my sleep a bit. But by far the most important factor has been dropping any concern with how much sleep I am "really" getting – and pretty quickly I was able to extend the window to 8 or 9 hours, usually 10pm to 7am. Not that I always sleep that entire time – sometimes things are choppy - but I nearly always feel adequately rested during the day to do whatever needs to be done. I try to just accept what comes, and go about my day.

After the paywall, an update on the story about the AWE psychedelic therapy training programme which I shared last Friday.