@Moose72 I'm having a hard time saying this so please tell me if I don't make sense. I don't think not sleeping makes your meds not work. More it's that if you have symptoms that for some reason your meds aren't working as well as usual and so other symptoms can pop up and for me at least there is a pattern with several days of lack of sleep leading to other symptoms which may or may not be psychotic. I guess your AP may be working as well as usual and is overwhelmed or that your AP isn't working as well causing the lack of sleep which causes hallucinations. (It's like the song about the old lady who swallowed the fly . For me the rule is 3-4 nights without a reasonable amount of sleep and I'm to contact my pdoc. If I do that fast enough a few days of a higher dose of AP helps. If I don't I feel worse.