confusional arousals cartoonIf you’ve ever experienced confusional arousals, you may have done something as equally strange as what I’m about to describe.

Two weeks ago, I woke up in the middle of the night feeling a little thirsty.

But instead of doing the logical thing and reaching for the glass of water on my bedside table, I picked up my phone.

It was only when lifted it to my mouth that I must have realized that it didn’t contain anything drinkable, and put it back on the table.

I then vaguely remember rummaging around for the real glass of water and knocking it off the table onto the stone floor.

I think the sound of the shattering glass must have snapped me out of the confused state. But even then I couldn’t quite understand what I was trying to do.

Over the next few minutes I slowly came back to reality, and of course got up to clean the floor. It was only when I was back in bed that it dawned on me what a strange experience it had been.

It seems I’d experienced an episode of what’s known as confusional arousals. I’m sure it wasn’t the first time either, but like many people, I probably don’t usually remember it.

Do you wake up confused and do unusual things?

If you sometimes wake up confused and perhaps do unusual or even dangerous things, it could be that you’ve also experienced confusional arousals.

And if the official medical label is a little strange, you can always opt for the more popular name of ‘sleep drunkenness’.

In this article, I’ll be taking a look at what confusional arousals are, what causes them and what can be done about them.

I’ll also discuss some fascinating research which shows how common a sleep disorder it is, and who is more likely to have it.

Poll results

Back in 2015, I ran a poll to find out how often readers experience confusional arousals.

Note that it’s a poll of people reading this article because it’s relevant to them. So the figure of 2.8% who have never had them would be much higher in the general population.

Interestingly though, out of 657 readers, 230 said they have confusional arousals very regularly – between 1 and 3 times per week. However, 188 people only have a few per year.

chart showing the results of a poll into the frequency people experience confusional arousals

What are confusional arousals?

The International Classification of Sleep Disorders diagnostic manual describes confusional arousals as being when someone wakes up in a confused state.

That might sound obvious, but the confusion can take different forms. For example, you might be confused about who you are, where you are, or what’s happening around you.

If someone talks to you, you might have slow or slurred speech. And you might give short, blunt answers to questions, or make no sense at all.

It typically happens on waking from the slow wave stage of sleep in the first third of the night. But it can also occur when waking from any stage of sleep.

In the spectrum of sleep disorders, confusional arousals are classified under the parasomnias category. Parasomnias include other disruptive sleep occurrences like sleep talking, sleep paralysis and nightmares.

Who experiences confusional arousals?

It’s believed that an equal number of men and women experience confusional arousals. And it’s more common in children and adults under the age of 35.

In 2014, researchers at the Stanford University School of Medicine published a fascinating piece of research into the disorder.

The research made major news headlines, perhaps in part due to the captivating title of ‘sleep drunkenness’.

Importantly, they discovered that it’s surprisingly common and that some groups of people are much more likely to have it.

Key points and findings

Here are the main findings of the Stanford study:

  • They interviewed 19,136 adults in the United States.
  • 15.2% had experienced confusional arousals in the last year. Over 50% of those had experienced it more than once a week.

Of the 15.2% who had confusional arousals, they found:

  • 84% had either a sleep disorder, a mental health disorder, or were taking psychotropic drugs.
  • 70.8% had another sleep disorder.
  • 14.8% sleepwalk.
  • 37.4% had a mental disorder (mostly bipolar disorder, panic disorder and depression).
  • 31.3% were using psychotropic medication (mainly anti-depressants).
  • Just 0.9% had no related condition or identifiable cause and could be said to have a confusional arousal disorder.
  • 8.6% have either partial or no memory of episodes.

Different types of confusion

The study found the following were the most common types of behavior or confusion:

  • Temporospatial disorientation (confusion about where or when they are): 57%
  • Hallucinations: 36%
  • Difficulty speaking or thinking clearly: 34%
  • Confused behaviors: 20%
  • Sleepwalking: 15%
  • No memory of episodes: 9%

Aggressive behavior provoked by another person

Do you or someone you know sometimes act in an aggressive way during an episode? This is understandably worrying and can be stressful for partners. So why does it happen and what can you do about it?

In 2007, the American Academy of Sleep Medicine reported an interesting review of violent episodes during arousal disorders.

They found violent episodes aren’t common. But when they do happen, it’s usually in two situations:

  • If someone wakes you up.
  • When you behave in a complex way in bed in your sleep, and someone else tried to calm you by holding or grabbing you.

So perhaps it’s best to avoid physical contact with someone having an episode unless they are putting themselves or others in danger. And to try to avoid waking someone up who is prone to confusional arousals.

Risk factors

Taking into account the above studies and current thinking, The American Academy of Sleep Medicine lists several possible risk factors and causes:

  • Shift work
  • Sleep disorders – sleep apnea, periodic limb movement disorder, insomnia, hypersomnia, circadian rhythm sleep disorder
  • Lack of sleep and sleep deprivation
  • Stress and worry
  • Psychotropic medication
  • Drug abuse
  • Being woken up suddenly
  • Bipolar and depressive disorder
  • Alcohol

confusional arousals risk factors infographic

Treatment and prevention

There isn’t a specific cure for confusional arousals as such, and no one-size-fits-all treatment.

If your child is experiencing it, it’s important to raise it with their doctor. They might want to do tests to rule out physical causes like epilepsy.

As an adult, if another sleep disorder is causing it, that’s what needs to be treated. This is something to speak to your doctor about, especially if you have signs of a serious sleep disorder like sleep apnea.

The same applies to mental health conditions that can be treated and managed. And if you’re taking medication like anti-depressants, it’s a good idea to mention the episodes to your doctor.

It’s also important to try to focus on your sleep and make sure you’re getting enough – don’t allow yourself to become sleep deprived over time.

Reducing the amount of alcohol you drink or cutting it out altogether might help.

And the advice from sleep professionals is as always to practice good sleep hygiene. In particular, find ways to reduce stress, develop a consistent and relaxing bedtime routine so you go to bed in a calm frame of mind.

You’re not alone

One final note if you’ve been worrying about your behavior is to remember that you’re not alone. Don’t be embarrassed or think you’re abnormal because of what you do when you’re not fully aware.

Many people experience sleep disorders or go through periods where bizarre things happen to them at night, to the point of thinking they’re going crazy.

But if it’s worrying you or having an impact on your life or relationships, it’s a good idea to speak to a doctor. At the very least they should be able to set your mind at ease.

The funny side

Personally, I choose to deal with it by trying not to take it too seriously. I try to laugh at myself when I do strange things like attempt to leave my bedroom via the wardrobe.

I know I have other sleep problems and am constantly working on those. So I hope that one day I’ll get on top of my sleep problems once and for all. Perhaps the sleep drunkenness will then resolve too.

But until then, other than worrying about replacing a broken glass, I’m able to see the funny side. I remind myself that little events like this can make life all the more colorful.

Understandably, if your confusional arousal episodes are causing problems because of aggressive behavior, sleep disruption or complaints from a partner, you might not see the funny side.

But if it’s just the occasional event of mistaking your phone for a lamp, or not knowing who you are for a moment, then perhaps a smile or laugh is the best way to stop yourself get stressed by it.

Your thoughts

If you’ve experienced confusional arousals I’d be very interested to hear from you. What exactly happens during your episodes? Have you found anything makes them more or less frequent?

It’s often the case that readers find reassurance in knowing that they aren’t the only ones who experience a particular sleep disorder. So please feel free to share you your story in the comments below.

545 thoughts on “Confusional Arousals (Sleep Drunkenness)”

  1. Thanks for the information. I am 49 I have had sleep paralysis since I was 16 and both my daughter’s starting having it around that age as well (from spiders, to aliens, to a person in our rooms). In addition I have always had a few episodes a month of waking up and not knowing where I was even though I was in my own bed. But About 2 years ago I started experiencing something different than sleep paralysis and different than not knowing where I was. I wake up now and I don’t know who I am. I lay terrified. I look around the room trying to get clues. Names and feelings come back to me. They don’t make sense. I think I am a child (my child). Then I remember no, I an adult, no I am a mom. But I think I am my mom. Who am I? I’m married? To who? In this I’m trying to figure out where I am as well. It is a scarier feeling than I have ever experienced with sleep paralysis. I get scared one day it won’t come back to me who I am. It comes back so slowly. I drink very seldom, I have no mental illness and I do not take medications (I rarely even take aspirin). Afterwards I just can’t understand how I could not know who I am or where I am. It seems like it should be there but I just can’t access it.

  2. This sounds like what I have. It happens about every 4 to 5 months. I get up out of bed and usually, early hours of the morning between 1 and 3 am. I do very strange things. The first one I remember is putting cokes and cupcakes throughout the house. I made my husbands coffee using the dog’s dry food instead of coffee grinds. I woke up once at the kitchen table with a hand full of black pepper and eating it. Once I woke up and was at my toaster and I was fixing to stick a fork in it. Just recent I woke up in the bathroom with toothpaste on my face also had the Drano bottle opened in my hand. I worry that I may do something to harm myself.

  3. I have had this ‘sleep drunkenness’ happen a few times in the past few months. It tends to happen on nights before work even if the next day isn’t that important. It has happened 4 times now and the same experience each time. It’s hard to describe the feeling but I usually wake up with my heart racing and I’m convinced that time is going by twice as fast around me (and also like I’m moving backward). I feel like I’m just getting farther and farther from reality and that I’m out of place. My conclusion is always the same, I need to get to work now then because I’m going to be very late (even though its 3 or 4am). Then once I start putting my shoes on, I kind of snap back into reality and I calm down. But each time its the same thing and it takes like 20 minutes to snap back into reality. It’s very weird.

    I don’t have any medical problems but I have been under a lot of stress with a mild depression so I’m assuming that has something to do with it. Would love to hear some input.

    1. This happens to me, too! For some reason, when I look at the clock, (usually between 12-1), my brain thinks it’s the afternoon and I have to hurry and get ready.

  4. I have this quite often. Maybe about once a week. I have no associated conditions as far as I know. I just find that I wake up in the morning and don’t have a clue what day it is. It doesn’t last for too long. Only a few minutes but it’s very strange to lie there and rack your brains about whether I have to get the children up for school!!

  5. I had an episode this morning when my daughter called and woke me up I told her that they should put a handle on the inside of the refrigerator door. I told her that I was painting with glow in the dark paint. I told her that I ate a banana. I was saying all kinds of strange things that made no sense, but I would be aware I was saying them and try to wake up and could not really get awake.

  6. I have this happen to me when I’m running a slight fever.
    My latest episode happened last night when I woke and thought I was in a dark Shed with cobwebs around me. I panicked for a few seconds sitting up and looking around having no idea where I was, I was so scared! then suddenly I could see that I was in my bedroom and I instantly became calm.

  7. Hi. I think something is wrong with me. I woke up and couldn’t remember my husband face. I tried so hard to think of anything to remind me or strike a thought; so that I can remember, how his face look. When he walked in the room, that’s when my memory came back. I am so confused. Please help me

  8. A few years back I was working shiftwork and I would wake up in the middle the night and make a mess of the kitchen and cook. Then when the alarm went off me to go to work I wouldn’t wake up fully. It’s kind of scary and my Son Took me to the emergency room one time and they did a CAT scan and said I was fine but that I needed to sleep with my head elevated. Now the last two days I’ve been doing that again and as a matter fact in the middle of the day, I’m a realtor, and I was taking pictures of a house to list it and the next thing I remember is driving down another part of town. That was scary because I didn’t remember even leaving the house or driving to the location I was at. I thought it was low blood sugar but my blood sugar wasn’t that low. So I ended up having to go back to the house to make sure I even locked it up. I could’ve killed somebody driving like that and I don’t know what to do about it. Today I’m feeling kind of funny to but I’m not going to drive to be safe. Please help me, I don’t like Feeling like this.

  9. I have had this experience only very rarely but I have just had it again tonight . I often leave a DVD playing quite softly , perhaps some light comedy, and I fall asleep to that when I’m on my own. I am always afraid of intruders during the night time. The room is dark apart from the television and I fall asleep. Then suddenly I hear the door chime sounding , very loud, only I think it’s the phone by my bed ( the door chime is on the other side of the room ) I look at the phone.I can’t sort it out.I get up prepared to repel boarders, it is gone midnight after all. I go downstairs. All the major doors are locked on the inside, and additional bolts are in place, there’s no one in the main room or indeed anywhere in the house. I put on the outside light and notice the main gate is shut and no one is in the garden. I don’t notice any alarm notification on the main control panel, usually a blue flashing light ( this would show someone has entered ). Can this be an halucination? Could it be confused waking? such as you describe or have I misinterpreted some noise. ( I have had it previously,&thought it was the phone but no calls were recorded ) It is so real. I should point out I do get rare attacks of sleep apnea and not infrequently wake confused about appointments for the day.

  10. Hi, the first time I started having these episodes is when I started traveling. The very first episode I ever had was me getting up in the middle of the night at a hotel and thinking “why am I in this hotel”, “this isn’t my hotel room” but it was my hotel room…. I got up walked outside of my hotel room and finally snapped out of it and realized it was my hotel room. The second episode I had was the very next day… i came home from a vacation and got up in the middle of the night and got on my phone and called my sister and told her I didn’t know where I was!!! I was in my bedroom!!!!

  11. I’ve noted these things for at least 6 months, I’ve had so many sleep issues they’ve maybe been around longer. Upon starting to wake and not being able to move much, on these days, I don’t know where I am. But I am always me. I cannot figure out what age I am, what house I am living in, what stage of life I am in, what room, if it’s one of the houses I grew up in or the one my family and I live in now. My eyes won’t open and I try and feel blankets and guess by the atmosphere. I do not move until my senses are aware and my eyes are able to open. I’m not a fan at all.

  12. I woke up at 3 am to call my boyfriend who works night shift . But when I woke up , I felt like I had to do something and I have forgotten it. Like, I couldn’t recollect what I had to do. I felt like I had to evaluate answer sheets and was going through my phone to find a reminder about it (to know if I actually had any) . It continued for almost 5-8 minutes. I was in a confused state during that time. But when I became more conscious, I was like “What the hell was I looking for?” and was scared aboyt what was actually happening to me. I had suffered from anxiety disorder before. So I thought this might be something related to that. That’s why I searched online to know why that actually happened with me. Now I know….

  13. I was talking on the ‘phone late at night, and I was dozing off, because I was so tired. I jumped awake and didn’t recognise the room I was in. This lasted or a few seconds. I often wake from a half sleep state, feeling confused and disoriented for a few seconds. It is as though my brain can’t catch up with me. This makes me panic like mad, even though it lasts only seconds.I am on a cocktail of medications, including bisoprolol. I think that beta-blockers could be the cause. I am on 10mgs, which is quite high.

    This usually happens when I am just dozing off; then I open my eyes, and whatever I am looking at feels unfamiliar. It is really freaky.

    This evening, for instance, I dozed off whilst knitting. I was only just drifting off, when I suddenly woke up, knitting still in my hands. It was as though my eyes recognised them as my hands but, for a few seconds, my brain didn’t. I kept blinking my eyes and sat bolt upright in a state of utter terror.

    I’m not describing this very well, but does anyone else have similar experiences? Perhaps you could describe them better than I can. I’d love to hear about experiences similar to mine.

  14. Hi I’m 22 years old. I started having this problem for about two years or less. Idk if it’s bc I have two jobs and I work about 50 hours each week which I don’t think is that bad honestly. But I do need to take a daily nap to function. I try my best not to Bc I hate sleeping w.e I have of my day left. But I can’t stay awake so I sleep for 2-3 hours after work. Sometimes my family tries to wake me up and I don’t wake up no matter how many times they call me. They say I woke up and went back to sleep but I don’t remember. I’ve also answered phone calls from my bf when I’m asleep and I don’t remember talking on the phone till I actually see the phone all there. They say I also say stuff that makes no sence sometimes. Does this happen to other people? Can this eventually go away? I hate having to deal with this

    1. I do this too! Makes me feel crazy! I went to an ENT and had a home sleep study to try to find the reason for my “fatigue” the ENT just looked inside my nose and said I had a sinus infection and ordered a home sleep study only after I begged and bothered him! It came back that I snore. Nothing else – only the wires kept coming off at night and I breathe through my mouth at night so I think that whole home study was a bunch of balogna… But anyway! Try to see if you have sleep apnea!! That could be why you are so tired! You aren’t getting enough REM sleep.

      1. Sleep apnea wreaked havoc on me! Sometimes I found it impossible to stay awake during the day and had to take a nap first thing after work. I almost ran off the road on my way home from work. I had hallucinations at night and panic attacks. My doc suggested a sleep study and it came back positive. After a couple of weeks I felt like a new person! But I still have the sleep drunkenness. I wake up many mornings thinking I’m in my childhood home, and my parents are there. They both passed away over 20 years ago and there’s only my wife and me in our home since my children have flown the coop. I was scared I had dementia or early Alzheimer’s. This make me feel better.

    2. Everyone does this to an extent. You just sound very tired. I wouldnt even say its a sleep disorder. I would ask that people not call you during sleeping hours as its apparent you arent getting quality sleep if its being disturbed :) If your on call I recommend a bepper and shutting your phone off when you sleep. People need to respect your sleep times.

  15. A week ago I woke very early, decided to stay up even though I wanted to go back to sleep as I was very tired. Had a cup of coffee and went to the store and to do another errand. Came home and went back to bed, fell sound asleep and woke up, looked at my phone to check my bank balance and couldn’t understand what one of the accounts was. Couldn’t remember if I’d gone to the store that morning or not. Went to the ER where they thought I may have had a TIA, but No physical symptoms at all, knew by then it was a savings account, recalled going to the store, but not all the details of it. CAT scan was fine. Scared me so much and I’m still uneasy. My blood pressure is fine, no other symptoms of anything wrong. Please tell me what you think. Thank you ever so much.

    1. A few years ago, after a seizure, I noticed my first waking up at night and sometimes packing papers, books, I’m aware that I’m awake but trying to be quiet not to wake my husband. I’m always afraid of him but he is the best husband in the world….why I’m so afraid I don’t know. The other night I was reaching in my handbag and he ask what I was doing, I told him I was looking for a piece of paper, finally, in the dark, I said you know what I’m doing. I’ve even made the bed up with him in it. The thing that scares me so is walking up thinking family members are there to realize my dad, twin sister have died and my children married and moved away….. I took a nap and woke up, my husband went to church and I wake up wondering where my family is. It saddens me but I always know what I’m doing.

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