How do you wake up from a nightmare if you're not asleep?
Trevor Reznik (Bale) is wasting away. He hasn't slept in a year, which has led to a shocking deterioration of his physical and mental health. His only solace comes from his call-girl girlfriend (Leigh) when his world becomes a living nightmare as cryptic notes turn up in his apartment and he has visions of a co-worker nobody else can see. Determined to find answers, he embarks on a journey of self-awareness, but the more he learns, the less he wants to know.