@raspberrytorte - Could some of it be dissociation? At least the feeling "off" and like you're going through a dream state and disconnected from reality? For me, I even feel disconnected from myself, my name, my identity. I don't have multiple personalities or anything like that, but definitely I deal with dissociation a lot. I one time did have the alternate reality feeling but that happened when I made a mistake and double took my meds. Thankfully, that hasn't happened to me again. Lack of sleep is definitely probably making things worse for you. Have you tried taking your full dosage of Seroquel (in the past you have said you take half of what you are prescribed)? You might not like it but maybe it would help you through this patch?