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.
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.
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.
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.
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.