Confusional Arousals (Sleep Drunkenness)

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

It was only when I’d lifted it to my mouth that I must have realized that it didn’t contain anything drinkable, and so put it down again.

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 smashing glass must have been what snapped me out of the confused state. But even then I couldn’t exactly understand what it was 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 really 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 pretty 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 dangerous things, then 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 be talking about a fascinating piece of research done in 2014. It shows just how common a sleep disorder it is, and who is more likely to have it.

Poll results

In 2015 I asked readers about their experience. Out of 657 people, 230 said they experience confusional arousals very regularly – between 1 and 3 times per week. However, a further 188 people only experience them occasionally during the year.

image demonstrating the results of a poll about confusional arousals

What are confusional arousals?

Until 2014 confusional arousals wasn’t categorized as a sleep disorder. So its appearance in the latest diagnostic manual of sleep problems says a lot about its perceived importance.

The 2014 version of the International Classification of Sleep Disorders (ICSD) describes confusional arousals as being when someone wakes up in a confused state.

That may sounds obvious, but the confusion can take different forms. For example, people might be confused about who they are, where they are or what’s happening.

In addition to that, they might have slurred speech and slow mental processes. So if someone else tries to communicate with them they might not get much sense.

And in some extreme cases the person might behave in a dangerous or violent way, injuring either themselves or someone else. This is more likely if someone else has done something to lead to the arousal.

Many people don’t even remember the episode; it’s therefore often left to a partner or family member to describe the odd behavior.

It most typically happens if you wake up 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 wide spectrum of sleep disorders, confusional arousals are classified under the parasomnias category. This means it’s grouped with other strange sleep occurrences like sleep talking and nightmares.

Who experiences confusional arousals?

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’. But also because they discovered that an enormous amount of people experience it. And furthermore that people in certain categories are much more likely to experience it.

What they were looking for specifically was if confusional arousals happen more often to people with mental disorders and/or those taking psychotropic medication.

The results of their research shed a lot of light on how common sleep drunkenness is, and also what it’s associated with.

Key points and findings

Here are some of the main statistics and results of the Stanford study:

  • They interviewed 19,136 adults of age 18+ in the United States.
  • 15.2% of people had experienced confusional arousals in the last year. More than 50% of those had experienced it more than once a week.
  • 84% of people who experienced it also had a sleep disorder, a mental health disorder or were taking psychotropic drugs like antidepressants.
  • Just 0.9% of the people experiencing confusional arousals had no related condition or identifiable cause, so could be said to have confusional arousal disorder.
  • 8.6% either don’t remember the episode, or only partially remember what happened.
  • 31.3% of people experiencing them were using psychotropic medication, mainly anti-depressants.
  • 14.8% of people also experienced sleep walking.
  • Of the mental health issues identified, people most likely to experience confusional arousals are those with depression, bipolar disorder, alcoholism, panic or post-traumatic stress disorder and anxiety.

Different types of confusion

In terms of the kind of confusion which people experienced, the study found the following were the most common:

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

Treatment and prevention

As important a piece of research as that study was in 2014, there still remains a bit of a mystery surrounding the exact cause of confusional arousals.

What they found were associations with other conditions, not so much pin-pointing the exact neurological cause. But it does highlight the case for dealing with the associated condition or medication choice. The hope being that this would also help reduce the occurrences of sleep drunkenness.

So for example, doctors could change someone’s medication if confusional arousals are having a negative impact on the patient’s lives. And if someone has a mental health problem or other sleep disorder, then by receiving effective treatment for that, the frequency of confusional arousals might reduce.

If someone doesn’t have an identified mental health problem or sleep disorder, then it might be worth speaking to a doctor to find out if there is something they weren’t aware of.

If it’s found that the confusional arousals exist on their own, with nothing associated, a doctor may choose to prescribe a short course of a benzodiazepine to help reduce the occurrences.

And the advice from sleep professionals is as always to follow good sleep hygiene habits. Making adjustments to your lifestyle, routine and environment can help enormously.

One final note if you’ve been worrying about your behavior is to remember that you’re not alone. And that you shouldn’t be embarrassed or think you’re abnormal for doing whatever it is you may be doing in the night.

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, then there’s no harm in speaking 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, mainly through sleep hygiene techniques. 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 luckily 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 deal with it, and therefore 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 in particular makes them more or less likely to happen?

And 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 story in the comments below.

448 CommentsLeave a comment

  • Last night freaked me out a bit because I was fully awake reading an article on my laptop. I was in bed, room was dark except for the light emanating from the screen. I glanced away and I remember thinking how dark it was and that’s when it happened. I lost the sense of where I was. I was suddenly in my old bed, same position, in my old apartment that I moved out of 3 months ago. Everything about my old room was EXACTLY how it used to be, but it just didn’t make sense because part of me knew it’s not possible to be there when I’m here in my own bed. A few minutes after I gained my bearings and assured myself I was in my new apartment, it happened again! The only times this has happened was right upon wakening in a new place (like a hotel room when traveling for business), but that makes sense to me because of I’m used to sleeping in the same spot. This has never happened while I was AWAKE! I really hope I don’t have a brain disorder.

  • One time I awoke about 4:00 am and notice my pillow cover was off my pillow and was placed on my night stand this was confusing because I don’t have any memory of me doing that

  • Lately I’ve been waking up and feeling the need to do strange things, per example, I woke up at 5 one morning and felt the need to clean my room and go for a shower and fell back to sleep when I was done,I once felt the need to rearrange my drawers in the middle of the night and again fell back asleep when the task was done, the most recent one being I woke up and felt the need to repeat a story although I had no idea what this story was about, this made me anxious and I had a tight feeling in my chest and when I tried to fall back asleep I would jolt awake. I have no idea why this is happening or what this is as there seems to be no answers online and I do not feel the need to visit a doctor yet.

  • Once my mum touched me and I immediately stood up, started screaming and held my hands up for protection.

    She thinks I’m going insane now.

  • Usually the situation for me is I forget something but I know something great or bad happened the last night but I cant remember exactly and I will think.hard just to remember what happened. Also after I ate dinner I ofter forget whats our viand.or even other things. I have depression for more than a year now. And im really worried.

  • I often jump out of bed about an hour after falling asleep, convinced that it’s time to wake up. I struggle to tell the time and it takes me a while before I realise its still the middle of the night. Yesterday, I got half way through a shower before my husband found me. I suppose he must have woken me up although it’s hard to tell whether I’m asleep or awake during these episodes. This one really shook me up… What if I went further and got in the car? It used to be funny and now it’s getting troubling. Nice to know I’m not alone and I can show this article to my doctor in case they haven’t heard of it before. Thanks!

  • I wake up, knowing i am on route to the toilet but often think i am in a different room. This is complicated as we live in a rural area so know street lighting so visual clues are nil, only light is a plug in in living room that is directly off our bedroom, its a small cottage. Odd feeling as i am not fully awake, know where i am going, often feel for a light switch that isn’t there, i think i am in a different room remember and if my wife speaks or anything else disturbs whatever state i am in i am back to reality at once.

  • I’d always thought it was normal to wake up not remembering much at first. After all, you’ve been asleep for hours. But I’ve heard that’s not the case.

    When I wake up, it takes time to understand what day it is, what I’m supposed to be doing, etc. Sometimes I don’t even remember who I am for a few minutes. My husband sometimes wakes me up to tell me things before heading to work. I can’t figure out why he thinks that’s a good time to tell me anything.

    I don’t walk or talk in my sleep. I’m a very heavy sleeper. I do have anxiety, executive dysfunction, and Autism. And it seems to happen more when I get a full night’s sleep and am allowed to wake on my own.

  • Woke up, showered, got dressed, was driving to get my morning coffee, only to realize it was 2:30am, not 6am. First time this have ever happened, scary.

  • I seem to wake up trying to find the door to go to the bathroom and I search all over the walls for the door and then I find it , but I do not turn the lights on cause I don’t want to wake my wife up. My wife has woken up and ask me what I was doing and I told her twice that I don’t know and once that I was lost. My wife told me she found me looking out the window but with my eyes closed and tears in my eyes. I remember 90% of these episodes.

  • Hi I was watching the cricket and I fell asleep in my man cave on the couch It felt Like I teleported to a house sitting in front of a window and then a bright light came over and I started to levitate in the air at that time my body was shaking my heart was racing and I was tearing up and then i was back in the shed not knowing what was going on.
    I saw a shadow as well very strange freaked me out I think I might of been lucid dreaming.

  • One time, I had fallen asleep in the living room and my sister woke me up in the middle of the room and told me to go to my room then instead of going to my own room, I went to my sister’s and she had her friends in there and I sat on the side of the bed for 5 seconds before going to my own room.

  • This has happened twice in the past few months were I wake up not knowing where I am and I get up trying to find the door, it’s so weird and eventually I realise I’m in my bedroom and then go back to bed but it’s like I’m sleep waking for the first half and then suddenly realise what I’m doing but remember everything. The first time it happened I remember I was hyperventilating and feeling very hot and panicking because I couldn’t find the door And then finally found it (the door that leads to outside) and I was standing there for ages in the cool breeze then closed the door and went back to bed and remembered doing it in the morning
    It’s really weird! and then the other time I don’t remember getting up but I remember frantically trying to find the door to escape and once I opened it I closed it straight away and went back to bed and I’m surprised I didn’t fall over trying to find it I had my laundry basket on the floor right in the middle of we’re I would have walked
    Why is this happening!

  • I needed to reasearch this because just recently (in the last two weeks), on separate occasions, both my husband and I have woken at some weird hour in the night not knowing where we were or even who we were, it happened to me first and him later. We were both creeped out by it. Neither of us are on any medications or drugs. We do like to drink beer/ wine every week so we’ve decided to cut that out for now after the events. We also just moved to a new home in state that we are both new to so maybe it’s a factor because it has been very stressful and a huge adjustment for all of us. It’s just strange in such a close proximatey of time we have each had this exact thing happen and it’s scary. Glad to read that it is unlikely dementia or early ahlzimers though..

  • I’ve had actually hallucinations and ive woken up telling my partner to not move and acting scared, and I’ve seen structured spider webs flying through the air and all sorts. It scares me how confused I get :( I also speek rubbish and don’t make sense sometimes. I’m not on medication and dont have any other sleep disorders apart from sleep paralysis.

  • Hi. I have early parkinsons disease. Í often find myself coming to after a nod off & talking rhe most stupid gibberish. Is this a part of the disease, or am I experiencing some sort of tia

    • Hi Di
      Thanks for your comment. It’s something I’d definitely mention to your doctor to get their opinion. Some people do wake up talking gibberish with confusional arousals, and don’t have Parkinson’s. But equally, they could be connected. It’s something only your doctor can really advise you properly on.

  • I have been waking up in the middle of the night in a panic because I think I have forgotten to do something that was very important and it might cause harm to me or someone else. It has happened so often in the last 2 months that while I’m trying to figure out what it is that I forgot, I decide that I need to write down my evening routine, so that if I wake up like that again, I can read the routine and realize everything is OK.

    • Catherine, I get that a good few times a week. I jolt upright and I’m convinced I’ve forgotten something really important and something that will affect my health. I sit there for a minute or so and go through things in my head and realize that everything is as it should be. I would describe it as feeling like something is missing also. I do take medication which can cause this. It’s a real horrible feeling.

  • I also think this is pretty funny at first. But what I really hate is explaining why I did such things that time I was having an episode. People not suffering from this can’t understand that I didn’t mean to do what I did and kept forcing their opinions on me. What am I supposed to do? It’s not like I’m willingly doing it, I can’t even remember any it. I always end up in an argument where the other part can’t understand that at that time you were talking to me but I wasn’t really there, wasn’t really conscious of it. Yes at times it could be funny but, some people are just too insensitive to think that “hey, she can’t remember any of it, maybe she did not mean to do such a thing.”

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