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.

434 CommentsLeave a comment

  • 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.
      Rgards
      Ethan

  • 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.

  • 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.”

  • I had a pretty serious one last week. My bus ride to work is about an hour. I fell asleep on the bus on the way to work, a very deep sleep. For no apparent reason, I got off at the wrong bus stop in downtown Atlanta. I was disoriented, in a brain fog and felt detached from reality. I wandered in the opposite direction in which I should have gone and into a dangerous neighborhood. It was 6AM and still dark. When I told my daughter about it she asked why I didn’t call her. I was so disoriented, it wasn’t even something I thought about. I never thought about using my phone to navigate or to stop until I could gather my thoughts. I just kept walking. Very scary and very dangerous. I’m lucky nothing happened to me. By the time it was over I had walked about two miles. I finally made it to work and was exhausted the rest of the day. I’ve had the episodes at home before but never in a situation like this. I’m doing everything to not fall asleep on the bus again. BTW I do have sleep apnea.

  • I think I’ve had this too! Last night I woke up thinking I had a earring stuck in my ear so I jumped out of bed and put the light on, looked in the mirror then realised there was no earring there and I got confused as to why i was thinking that, then went back to sleep! The other night I woke up and I was putting my pillows on the floor and thinking I was talking to someone on the phone at the same time( I had been on the phone for a while earlier) it happens quite a bit! One time I woke up and I was peaking through my door trying to see who was outside of it and then I realised what I was doing and felt confused! I woke up to imagining something was in my bed and I was trying to find it then realised there was nothing there… I don’t understand it I have no mental problems, my sleep pattern is ok, I get anxiety but not serious or a lot? A few months a go I woke up seeing a black figure in my room that’s just faded away then I went back to sleep(not scared) other times I’ve seen someone standing in my room and I thought it was my mum so I was asking what she was doing, put the light on, no one there so I don’t think too much of it and go back to sleep, I just don’t understand how I can get up and walk around while in that state? It’s so strange!

  • I started folding laumdry while sleeping last night. There is a small blanket on the bed for our dog. She was covered up but I kept pulling and folding it. My wife woke me up so stopped
    Seconds later back to sleep and continued. Again she woke me and I rolled over so my hands would be away from the blanket
    Again back to sleep and tried folding the comforter. I could see and feel me doing it but still asleep
    This all occurred between 5 and 6am. I gave up and got out of bed. Has never happened to me before.

  • RECENTLY, I HAVE HAD TO EPISODES OF CONFUSION. I WORK NIGHT SHIFT AND I TAKE A 30 MINUTE NAP ON MY BREAK. AT THE END OF THE NIGHT I HAVE TO CHART DOWN WHAT WAS GOING ON WITH MY PATIENTS. I READ MY NOTES AND THERE WAS A LINE THAT SAID ” PT WAS STARTED ON 4 OF CPAP AND WAS A BEAUTIFUL MAN NAMED ALICE. OK, I DO SLEEP TESTS AND STARTING A PT ON 4 OF CPAP IS NORMAL BUT THERE WAS NOT A BEAUTIFUL MAN NOR ANYONE NAMED ALICE. I WAS SO CONFUSED BECUASE I DONT REMEMBER WRITING IT.THEN, A FEW NIGHTS LATER AT HOME, I WOKE UP WITHOUT A SHIRT ON. I DONT REMEMBER TAKING IT OFF.

  • I wake up often blurring all kinds of crap! Im on holiday and ive just woke my niece up cos i was trying to take the steps off her bunk bed …. shes not happy!! I whent bk to sleep and ive just woke up again thinking abwt her shouting at me!!

  • I don’t know if it’s a sleep thing or what but I woke up wrote something down and the utensils I used to write weren’t by my bed I do not remember doing it the only thing I have that I know I did it is these weird words I wrote on this napkin that is not in my writing and I can not read it this all does not make any sense to me and really I’m freaked out cause 1 why and 2 is this going to happen again or get worse please let me know if anyone has heard of this or if it is a thing

  • I woke up this morning at 1 AM. I am not sure why but I couldn’t see or think straight. I automatically assumed I was in a Naruto Fight or something and it was an emergency and I needed help. At the moment I didn’t realize I was texting this to someone I was too worried about it to notice the only thing that snapped me out of it was this persons response of “I’m lost…what the fuck is going on? ” and “huh? What do you mean? “. thats when I realized where I was and what was really going on. Being sick and having a headache was bad enough, but to have this bad of a problem in the midst of it as it already occurs pretty rarely. I hope I’m not having a mental problem.

  • For me I forget who I am where I am and with who. what surprises me is that I started having those episodes when I was 25 years. I feel like I have gone mad but after sometime, I come back to my senses.am encouraged that am not the only one. Thanks and hope it will end soon.

  • I keep waking up thinking that I am still in work & that I’ve fallen asleep on the job. I sit up in bed, and keep telling myself to look awake. I genuinely believe I am in work and am so embarrassed that I’ve fallen asleep. I sometimes imagine my co-workers there, but not always. Eventually I get so tired that I lie back down again and fall asleep. But usually I will wake up in a panic a while later, thinking that the same thing has happened again. Eventually I’ll just fall asleep or I’ll have to look at my clock and see that it’s 2am and convince myself that I wouldn’t be in work at that time.
    It also happens sometimes after a night out. I’ll wake up still thinking that I am in the pub/nightclub & I’ve fallen asleep at the table. It is so frustrating, especially when I’m wasting a hour trying to force myself to stay awake, when there is no reason too.
    My sisters have also dealt with this experience, but not as frequently as I have. Any thoughts?

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