Charles Bonnet images do not exist in the real world

I would strongly advise against believing the images have some purpose in the world or in your life.  They use the same visual brain systems that one used before sight loss so they may appear to be outside of the self.  Caregivers will never be able to see them because the images are coming solely from your brain’s visual systems. 

There is no way to act on the images.  If trying to touch them gives you comfort however, give it a try.  Some people will use flashlights, spray bottles, or throw things at them.  The image cannot hear you even if they appear to be responding to something you’ve said.  Some people will yell at them or politely ask them to leave.  Doing these things may reinforce that they are not real.  Do not do anything that can hurt those around you.

Hallucinatory Experience in Sighted Persons.

Anyone can experience a hallucination at the moment of falling asleep or waking up.  These are hypnagogic and hypnopompic hallucinations respectively. These happen to sighted people as well. Persons participating in a sensory deprivation experiment or situation may experience visual hallucinations. Several medications may cause visual manifestations. Loneliness and isolation are sufficient to cause hallucinations

Amygdala Hijack

One cause of the anxiety attending CBS, is that it comes on in a flash, often startling the person. Part of your brain called the amygdala will actually perceive the image before it comes into conscious awareness. The amygdala’s job is to ensure that the person's physiological state is ready for fight or flight. Your body would respond to this, by raising your heart rate, dumping adrenaline into the bloodstream, and causing your palms to become sweaty. A person in this position would react with some fear to any type of image including those that are not fear inducing at other times.

The phenomenon helps to explain why a person may be unable to use reason to assure themselves that the images are not real. I have heard people say that “in the moment” it is difficult to deny the reality of an image.  Given the opportunity to consider the likelihood of 30 people appearing in the bathroom, the person may reason that they are not real.

Dreams and Charles Bonnet

As said before, the CBS images are created from visual memories. Something you’ve seen, even if not consciously remembered, can become elements of a dream.  Locations, objects, and people in dreams come from visual memories.  Experiencing a dream, one believes that what one sees is real.  Dreams also include sounds.

 CBS is not a dream.  Your brain is in a different state when dreaming.  Visual memories are used to produce the CBS images.  There is no sound related to CBS images.  As in a dream, what one sees experiencing a CBS image is not real, not matter how real it seems.

Time of day

The medical literature suggests that CBS will be more frequent in the evening.  Although this may raise a comparison with sundowner’s syndrome experienced by persons with dementia.  Rather, it is just the dimming of light in the evening that may bring on a CBS image.  When it is getting dark, anyone may misinterpret what they are seeing. While there are those who see more images in evening hours, a CBS image can appear at any time of day.  Upon waking is a frequent time that CBS images are seen.