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Without proper understanding, bizarre but relatively normal hypnagogic\/hypnopompic experiences can be misinterpreted as psychotic hallucinations (occurring, by definition, in the fully awake state), potentially leading to stigma and misdiagnosis in clinical contexts and to misconception and bias in research contexts. This Perspective proposes that conceptual and practical understanding for differentiating hallucinations from hypnagogic\/hypnopompic experiences may be offered by lucid dreaming, the state in which one is aware of dreaming while sleeping. I first introduce a possible systematization of the phenomenological range of hypnagogic\/hypnopompic experiences that can occur in the transition from awake to REM dreaming (including hypnagogic perceptions, transition symptoms, sleep paralysis, false awakenings, and out-of-body experiences). I then outline how metacognitive strategies used by lucid dreamers to gain\/confirm oneiric lucidity could be tested for better differentiating hypnagogic\/hypnopompic experiences from hallucinations. The relevance of hypnagogic\/hypnopompic experiences and lucid dreaming is analyzed for schizophrenia and narcolepsy, and discussed for neurodegenerative diseases, particularly Lewy-body disorders (i.e. Parkinson's disease, Parkinson's disease dementia, and dementia with Lewy bodies), offering testable hypotheses for empirical investigation. Finally, emotionally positive lucid dreams triggered or enhanced by training\/induction strategies or by a pathological process may have intrinsic therapeutic value if properly recognized and guided. The overall intention is to raise awareness and foster further research about the possible diagnostic, prognostic, and therapeutic implications of hypnagogic\/hypnopompic experiences and lucid dreaming for brain disorders.<\/jats:p>","DOI":"10.1093\/pnasnexus\/pgad442","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T18:54:22Z","timestamp":1703012062000},"source":"Crossref","is-referenced-by-count":7,"title":["To be or not to be hallucinating: Implications of hypnagogic\/hypnopompic experiences and lucid dreaming for brain disorders"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7289-6668","authenticated-orcid":false,"given":"Guglielmo","family":"Foffani","sequence":"first","affiliation":[{"name":"HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales , Madrid 28938 , Spain"},{"name":"Hospital Nacional de Parapl\u00e9jicos , Toledo 45004 , Spain"},{"name":"CIBERNED, Instituto de Salud Carlos III , Madrid 28031 , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"2024041006365844600_pgad442-B1","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1037\/0033-2909.83.3.452","article-title":"The hypnagogic state: a critical review of the literature","volume":"83","author":"Schacter","year":"1976","journal-title":"Psychol Bull."},{"key":"2024041006365844600_pgad442-B2","doi-asserted-by":"crossref","first-page":"e13719","DOI":"10.1111\/jsr.13719","article-title":"The hypnagogic state: a brief update","volume":"32","author":"Ghibellini","year":"2023","journal-title":"J Sleep Res"},{"key":"2024041006365844600_pgad442-B3","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1126\/science.290.5490.350","article-title":"Replaying the game: hypnagogic images in normals and amnesics","volume":"290","author":"Stickgold","year":"2000","journal-title":"Science"},{"key":"2024041006365844600_pgad442-B4","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/0013-4694(63)90032-4","article-title":"Nocturnal sleep of narcoleptics","volume":"15","author":"Rechtschaffen","year":"1963","journal-title":"Electroencephalogr Clin Neurophysiol."},{"key":"2024041006365844600_pgad442-B5","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/0013-4694(89)90189-2","article-title":"Effects of sleep interruption on REM-NREM cycle in nocturnal human sleep","volume":"73","author":"Miyasita","year":"1989","journal-title":"Electroencephalogr Clin Neurophysiol."},{"key":"2024041006365844600_pgad442-B6","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1093\/sleep\/29.7.890","article-title":"The prevalence of multiple sleep-onset REM periods in a population-based sample","volume":"29","author":"Singh","year":"2006","journal-title":"Sleep"},{"key":"2024041006365844600_pgad442-B7","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/sleep\/19.9.727","article-title":"The frequency of multiple sleep onset REM periods among subjects with no excessive daytime sleepiness","volume":"19","author":"Bishop","year":"1996","journal-title":"Sleep"},{"key":"2024041006365844600_pgad442-B8","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/S2215-0366(18)30138-X","article-title":"Mind and spirit: hypnagogia and religious experience","volume":"5","author":"Powell","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2024041006365844600_pgad442-B9","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/BF00052448","article-title":"The old hag phenomenon as sleep paralysis: a biocultural interpretation","volume":"2","author":"Ness","year":"1978","journal-title":"Cult Med Psychiatry."},{"key":"2024041006365844600_pgad442-B10","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1093\/sleep\/10.3.279","article-title":"High prevalence of isolated sleep paralysis: kanashibari phenomenon in Japan","volume":"10","author":"Fukuda","year":"1987","journal-title":"Sleep"},{"key":"2024041006365844600_pgad442-B11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1001\/archpsyc.1967.01730250090013","article-title":"Sleep paralysis and hypnagogic hallucinations. 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