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.

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.

496 CommentsLeave a comment

  • I sometimes wake at night to make the bed or some other chore for my son or mother, neither of which live in the home. Last night I left the bathroom light on most of the night expecting my mother to get-up and go to bed…however, mom wasn’t at my house. This has occurred before but never 3 nights in a row. I just returned home from a 2-week trip away, perhaps this had something to do with it. Thank you.

  • I fell asleep on the sofa. When I woke up I asked my husband where she was. I was actually looking for my mother who died 32 years ago. I went and looked for her. I have done this a couple of times before. I even asked my husband who he was. This kind of thing terrifies me as I am a very anxious person. I also take panic attacks.

  • Hi
    I have this problem since childhood i wake up in panic and ask questions or start shouting pointing to the walls or curtains .. (i lost my father at the age of 8 and my mother chose to spend her whole life with her young three children instead of starting a new life. After my father death we used to live alone in our house and at the age of 9 i started feeling my mother’s fear of living alone with small children which she always tried to hide it ) i have sleep paralyze problem but it happens once or twice a year when i’m so scared or depressed. But 4 months back my mother had a road accident and i found her in a hospital in very critical condition. that time was very stressful and after that this happens to me more than once a week i wake up in panic and start questioning my husband about the things they don’t make sense.

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