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.

512 CommentsLeave a comment

  • Hi
    This started happening to my husband about 2-3 years ago. He is 25 years old. It only happens about once or twice a year so we haven’t been to the doctor about it. It honestly scares me every time it happens and it actually just happened to him tonight. It only happens when he is woken up suddenly after being asleep for less than an hour.

    This time I heard him get up and go to the bathroom. I thought everything was fine until I heard a banging noise. I walked in to ask what was going on and he was under the sink in the cabinet. I couldn’t see what he was doing but our sink pipe was disconnected and nasty water was everywhere. He said “I’m trying to make the noise stop”. Since he’s had these before I knew what was going on so I tried to get him back in bed but he wouldn’t go. He kept cursing and yelling at me saying it wasn’t his fault. He also kept locking himself in different rooms to get away from me and kept saying “my team/the team will be mad at me”.

    He’s never hurt me physically, although the words can definitely make me upset and this time they did. I usually end up crying wondering why this happens to him and once he comes to he gets upset and sad. This time he was scared to go back to sleep because he didn’t want to hurt me.

    What should we do? I’ll take any advice honestly because even though it doesn’t happen often it’s happened enough that I can’t take it anymore.

  • For me it’s always the same, I wake up next to my boyfriend and can’t recognize him (probably not knowing where I am as well :) So I trip out that I have a stranger in my bed and then I try to live or put some clothes on. And then I slowly start to recognize him and fall asleep again OR I wake up and stay up for a little while until I come down.

  • I just woke up from a nap this eve. thinking it was the next day. I jolted awake, wondering what time it was. My phone said 7:00. I thought it was in the am. (Really wasn’t).

    I don’t have to go to work till 9:30am tomorrow so I decided to go back to sleep and set my alarm for 8:30am. It took me a few minutes to figure out why the alarm kept saying that it would ring in 13 and a half hours!

    Duh! Lol I laughed and made dinner.

  • I wake up and will not understand what I am looking at and then after a couple of seconds, I will realize it is the bureau, or the tree out the window, etc. I have been taking bisoprolol (beta blocker) and apixaban (blood thinner) so I suspect that this is a side effect of one of them, although it took a year to happen – I have looked at forums and it seems other people on one of these drugs, around my age and after a year of taking the medication had similar experiences. It has also happened a couple of times just after dusk and once in the day, but perhaps that has more to do with losing contrast sensitivity.

  • my boyfriend was in the navy and wakes up either not knowing where he is or thinks he is still on the ship. He works 2nd shift and already has a problem sleeping. he was not sure why 5 years after getting out of the service he is now all of a sudden having this issue. some people have told him it is PTSD but it is not affecting his life except for being tired. have any other military people commented about this? could be another study in itself

  • I’ve been traveling a lot for work, and frequently don’t sleep well the first few nights in a hotel, but it’s the confusion I feel when I wake up in the middle of the night when I am back home that is the weirdest. Often I dont remember where I am and think that I am on travel, then I became alarmed that someone is sleeping next to me, and I’m convinced that it is a coworker who crawled into the same bed as me after I fell asleep. I’ll often get up and leave the room in search of another place to sleep and make it to the next room or even downstairs before I realize that I am at home, and the person sleeping next to me is my husband. Other times I wake up convinced that there is a guest in the house, and I need to do something to make sure that something inappropriate doesn’t happen (like wearing revealing pajamas and running into them in the hallway or worried that I left underwear in the common bathroom). My guess is that the disorientation is a result of all my traveling, and the sense of impropriety is a result of having grown up I’m the Bible belt.

  • I wake up looking for the kids that I am supposably babysitting or the dog I was dog sitting and I am frantic looking everywhere. I wake up my husband and ask him where are the kids or the dogs ? He is puzzled and I keep asking him worried. What is going on?

  • I have been under a lot of stress and I am having spells of waking up and not knowing where I am . There is fear involved; I don’t know who’s house I am at or where a light is to turn off. I did have this happen to me while visiting family who were remodeling.

  • Ever since I was little I remember my sister waking up by herself and being totally delusional. She would talk slowly, always asking me something that makes no sense. Then she starts doing nonlogical things and just falls asleep. About ten minutes ago I woke her up and she acted the same but it was the first time she didn’t wake up by herself. She never remembers these episodes. Is this serious?

    • Hi Ena
      As long as she’s not harming herself or others in her sleep, and her daily life is not being affected, then it’s probably nothing to worry about. Try not to wake her up though if she has incidents when woken by someone. If she, or the family, is concerned, a chat with her personal doctor about it might help.
      Regards
      Ethan

  • This explains things so much. I’ll wake up super panicked all the time. For example, I took a nap, and at 8pm I woke up, looked at the clock, saw that it was 8pm, and even though it was dark outside and my school starts at 8:30 am, I ran downstairs and started getting angry at my dad, asking him why he didn’t wake me up to take me to school. He was super confused asking me what I was talking about, and then all of a sudden I snapped out of it.
    Another weird case was when I woke up at 2:30am, and I grabbed my phone, looked at the time, and for some reason I freaked out and thought I was late to school, again. Even though the phone said “2:30am,” my brain read it as “8am.” So I ran down the dark hallway of my house and woke up my friend, telling him we were late to school. He was super confused and then told me it was 2:30. That’s when I snapped out of it.
    After about a year of not experiencing this, it happened again last night. I always lock my bedroom door before sleeping, but last night, I woke up at midnight, and ran to my door. I shook the door handle and freaked out, thinking I was locked in forever. I started shaking the handle and yelling for help. After a few minutes, I snapped out of it and realized I could unlock the door handle from my side (obviously).
    I’ve experienced it more times than this but it’s super bizarre when it happens and always makes me feel anxious while it’s occurring lol.

  • One night I remember the lights being on, and I was standing up, so I sleepily started to get ready for the morning. I got clothes out of my closet and dresser and changed into them. Next I went to the bathroom to wash my face. When I walked across the hall to the bathroom it was pitch dark but I was too sleepy to realize. Once I got into the bathroom I finally looked back in time and realized that the hall I just walked through was pitched dark. I then went into my room and checked the clock to see that it was 3 am in the morning. I never remember getting up to turn on the light, I do remember doing everything else but my mind was not awake enough to stop, and this has happened twice in the past 2 weeks. I have barely ever sleepwalked in my life and I am just curious why the same thing has happened twice very recently. Thank you.

  • I just recently started the habit of waking up at 9:30 pm after having just one hour of I think a very deep sleep and not knowing if its 9:30 Am or PM.. I start my tea, get ready for work and then takes me a few minutes to figure out its PM and I go back to bed to wake up again every 2-3 hours. This is a new phenomenon for me. Does that fall into the same category as the above confusional arrousals

  • My husband hits and kicks me at night. He threatens me and makes wild accusations. He is out of it until 7 a.m. when he morphs into a nice guy.

    Because his first wife left him, I am teaching him that if I sleep in another room it is not to leave him like she did. It is so we both sleep well.

    • Kiki
      Thanks for your comment. That sounds like a difficult and delicate situation. Has he spoken to his doctor about it? If he is violently moving about in his sleep, it’s something that needs to be checked properly.
      Regards
      Ethan

  • 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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