My experience with psychosis is that it can spiral out of control incredibly quickly. It can also progress to the point that you are not able to discern that what you are hearing and seeing are in fact hallucinations. I have only experienced it once and I had no idea it wasn't real. It was the worst and scariest experience of my life.

That said, there are several members here who report the types of experiences you are having regularly and they have learned to live alongside the hallucinations and function relatively normally. The presence of hallucinations does not necessarily mean you are escalating to an unsafe state.

If it were me and I knew I was hallucinating, I would inform my doctor asap. I agree with you that the lack of sleep is probably a major contributor. You have also implemented several med changes recently and many mental health drugs can actually cause psychosis in some patients. Withdrawal from meds can cause it as well.

Your doctor may not be super concerned, but he or she should be made aware in case this escalates or if another med change is indicated. I also think it would be a good idea to inform your wife so that she can assist in the event this escalates and you lose insight.

Good luck Scooter. I know this can be unsettling.