Confusional Arousals And Sleep Drunkenness

confusional arousals cartoon

If 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, and then just sat up in bed for a while in the dark. I can’t recall how long I sat in that position, but I vaguely remember feeling a little thirsty.

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 eventually got up to clean the floor. It was only when I was back in bed that it dawned on me that I hadn’t been my usual self.

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 behave in a confused, strange, or even aggressive way if you wake up in the night, it could be that you’ve also experienced confusional arousals.

And if it tends to happen in the morning, it could potentially be that you have ‘sleep drunkenness’. This is the popular name for what sleep experts call severe sleep inertia. Or in layman’s terms, being unusually slow to come back to life when you wake up in the morning!

In this article, I’ll be taking a look at what confusional arousals are, what’s thought to cause 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 is likely to be 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. 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 as a parasomnia. Parasomnias include unwanted events or experiences around sleep, such as sleep talking, sleep paralysis and nightmares.

In an interesting research study published in 2020, the authors describe confusional arousals in a way that I think helps understand what can happen during a typical episode:

CA are episodes during which the subject sits on the bed and looks around as if confused. CA often begin with automatic movements, vocalizations or moaning and can progress to thrashing about in bed or violent behaviors towards oneself or others. Individuals usually appear with slow mentation and have poor reactivity to environmental stimuli; attempts to awaken the person are often unsuccessful and may be met with vigorous resistance.

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 some fascinating research into confusional arousals.

The research made major news headlines, perhaps in part because they could use the captivating title of ‘sleep drunkenness’.

Importantly, the researchers 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% were associated with 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 and panic disorders).
  • 31.3% were using psychotropic medication (mainly antidepressants).
  • 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%

Interestingly, the team concluded that confusional arousals were often reported as arising from the treatment of other sleep disorders. And that both sleep and mental disorders were important factors – as seen from the figures above.

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, Mark R. Pressman, Ph.D. published an interesting review that looked at violent episodes during confusional arousals.

He wrote that 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 tries to calm you by holding or grabbing you.

He further clarifies that:

Violent behaviors associated with provocations and/or close proximity were found to be present in 100% of confusional arousal patients

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.

Causes and risk factors

Confusional arousals are thought to happen when transitioning from deep sleep to a lighter sleep stage, or when woken up suddenly.

Researchers in 2018 summarize what happens in a slightly more technical way:

Confusional arousals (CA) are characterized by the association of behavioral awakening with persistent slow-wave electroencephalographic (EEG) activity during non-rapid eye movement (NREM) sleep—suggesting that sensorimotor areas are “awake” while non-sensorimotor areas are still “asleep.” 

In addition, 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 / recovering from sleep deprivation
  • Stress and worry
  • Psychotropic medication
  • Drug abuse
  • Being made to wake up
  • Bipolar and depressive disorders
  • 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 another disorder is causing the episodes, 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, 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.

But if it’s worrying you or having an impact on your life or relationships, it’s a good idea to speak to a medical professional. 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 (yes, really!).

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 confusional arousals 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.

621 thoughts on “Confusional Arousals And Sleep Drunkenness”

  1. For pretty much my whole life I have had some of the problems described above.
    When someone wakes me up in the morning I can have a full conversation with them and completely forget it ever happened after I go back to sleep. I have awoken in different rooms of my house, once in a sleeping bag that was in storage.
    When I was in college I was very sleep-deprived and my reactions became aggressive when I was woken up. When someone wakes me up and I am “sleep drunk” it is like the nice part of my brain is turned off. A friend once asked if he could use my coffee maker after waking me and I told him no because he was clumsy and would break it. Another time I fell asleep watching someone play video games and shouted at them angrily after a few minutes because of the noise. The last time I remember I took a nap before a movie and was angry that no one had woken me up. I went on a tirade yelling around the house, only to return to my bed and slowly come back to myself and start to process how crazy I had just been. I have a really patchy memory of these occurrences and I mostly only remember them after someone mentions them, like reminding me about a bad dream.

  2. So weird and I found it to be pretty funny. I was suddenly awakened by a phone call that I didn’t want anyway. After declining the call, I looked out the window and a glance at the clock. I jumped out of bed, even the light and looks of the day appeared it could have been seven in the morning. I’m very late for work being that normally, I am up at 4a.m. at least that is what I thought. I run to my wife and asked her ” honey why didn’t you wake me up? It’s 7 o’clock. I’m late for work”. She has no idea what I am talking about. She tells me you did wake up and went back to sleep. Now I’m even more confused. That’s when I decided to call my friend and give him the third degree for not calling like any other morning. To see how far in my day I am or just to shoot the breeze on the phone. By then I was coming around something said look at the phone. And at the same time I said “why you didn’t call this morning?. I’m just waking up. He says ” you do realize it’s still Monday, right”? I felt so embarrassed and could do nothing but laugh. I called to give him a hard time for not calling me thinking I was late and overt slept. It was opposite he ran me off the phone.. laughing away at me. It was weird but worth the laugh… Thank you sleep drunkenness, You mad the rest of my evening or day….. now Good night. I have to be up at 4a.m.

    1. Evidently, I have a similar problem. Fell asleep watching tv. Wake up looking out the window and it seems I’m late for work. I call my boss to hear her say it’s the same day 7pm at night Erma. This is the third time in the past several months this has happened! First 2 we laugh it off but this one doesn’t seem so funny! She says it’s becoming a habit! I had to agree so started looking online for answers and ran across your story, Howard. Thanks sleep drunkenness. Least I hope that’s all it is.

  3. I don’t know if this is exactly my issue or not, but maybe about once a month I act really strangely in my sleep. Most of the time it will be me not knowing where I am in the middle of the night. One time I woke up and thought I was in a garbage truck and cried to my bf at the time that we need to get out. I tried feeling around for things and trying so hard to see where I am but then he turns on the lights and I slowly snap out of it. There also have been multiple nights where I don’t know where I am so I frantically get up and feel around and sometimes even sprint to my closet or even down the hall. I soon realize what I just had done and then I lay back down and fall quickly back to sleep. In the morning it’s kinda fuzzy remembering why I did what I did or even if that honestly really happened at all but I’ve delt with this since I was 12 years old and I am currently 23. I’m so glad I found something that I can kind of relate to!

  4. I have had three episodes in the last 12 months. I wake up but do not recognize my bedroom at all. I get out of bed, put my slippers on, get my walking stick and go to find where my family are. As I put my hand on the bedroom door handle I recognize it’s my door and the room becomes familiar. I’ve been worrying I’ve got something seriously wrong with my brain but I’m afraid to go to the doctors.

    1. This is me. I wake in the night and don’t know where I am, I even can’t think who is lying next to me. Once I find the door I come round, but the other night I was trying to get out through the wardrobe. Some weeks it happens most nights. I think it’s when I’m a bit stressed I don’t like things rocking the boat which of course they do cos life happens but it is quite scary at times. It’s nice to know I’m not alone

  5. I also have had the same experience of waking up, not knowing where I am, it happens now and then, for quite a long time (I’m sure it’s been over 5 years since it first started), but I’ve had a different experience of waking up at some point, maybe early in the morning, and grabbing my phone, but then, suddenly, my phone isn’t there, even though I was sure I felt like I was holding it… it’s strange. It doesn’t happen as often of course, rarely to be honest, but it does, for a few years now, happen.

  6. Once my little brother woke me up and handed my his phone asking a question I didn’t understand. I looked at the phone, and then him. I then asked, “Who are you?”. I remember him begin confused, and I then did something for him on his phone, and went back to sleep.

  7. One of the strangest ones I had happened earlier this year when I was sleeping on the sofa downstairs and woke up in the middle of the night seeing a small red light. I was so sure in that moment it was a camera recording me I just got straight up and grabbed any paper I could find to cover the light feeling so violated that someone tried to film me. Then I laid back down feeling relieved and after a minute or two it dawned on me what I just did. The light was just from the radio opposite me that was on standby. I was totally shocked at my strange behaviour. It felt like I had just been possessed because I was totally aware of what I was doing but it was like it wasn’t my mind that decided to do that. I was really concerned that I may have begun to lose my mind.. this wasn’t the first time I’ve experienced something like this. Even last night I had another unsettling episode. But I’m glad to know that this is some kind of condition and that I’m not alone.

  8. My Finance has been acting weird. He changed shifts and is now working from 6pm until 6am. He will call me at work about 8:30am asking where I am at. I tell him I am at work and he says to me you were just here! Where did you go? I have to explain to him that I never saw him in the morning because I had already left for work but, in his mind he really thinks I was there.

  9. I sleep in the buff. I have a reoccurring type of dream that I dream I roll over in bed, and I am sharing the bed with someone other than my husband. It is usually someone I know. Following this dream, I frequently wake up in my bed with pants on. I also sometimes wake up in my closet after digging through laundry, somehow finding a very specific pair of pants in the dark, and putting them on. I will normally remember why I was putting the pants on (that I was sharing a bed with a non-amorous friend), but it will usually take me a few minutes to realize it is my husband in my bed. It happens frequently enough that it is causing me distress. I have a history of occasional night terrors as well. I have had a sleep study done, but it was relatively unhelpful because I didn’t sleep through the night. I have been frightened of what else I can do during my sleep, or that I could have REM sleep disorder which is strongly associated with Parkinsons. Is there a way to differentiate between confusional arousal and REM sleep disorder?

    1. The exact same thing happens to me!! I wake up anxiously and quickly go to my closet to grab a pair of pants while (believing) whoever is with me is in the bathroom and will be back at any moment. It’s relieving to know I’m not the only one.

    2. I have this too, I will wake up and think I’m in bed with someone familiar but not my husband & I can’t work out who. I sometimes know while it’s happening that it’s happened before and so I try to stay in bed and ignore the panic until I can remember but normally I freak out and get dressed or go sleep in my toddler’s bed with her. I try not to worry but I’m 35 and my everyday memory is so bad that I think I’m losing my mind

  10. I have experienced pretty similar things recently. However, just small harmless things such as I’m awake thinking that someone is going to walk into my room while sleeping (someone harmless and someone I know) but it all seems so normal and makes sense. But when I wake up, I remember I had these thoughts, I sometimes get up and get dressed and then go back to bed with clothes on. I have a couple of times woken up with a tidier room because I think someone is coming in again (I had some clothes on the floor so moved them to the side for the person to walk in). Its all pretty strange but I’m not going to lie, I am very confused. Again I have tried finding my phone which I think I have dropped down the side of my bed, turn the light on to find it is on my bedside table. Very harmless but all seems so real at the time until the next morning.

  11. I woke up to go to the bathroom, on returning to my bedroom I reached for my phone to see what time it was, only I couldn’t find my phone so reached to switch the lamp on and couldn’t find the switch. Confused I turned the big light on only to find that my bedside table was facing in the opposite direction !!! Did I do this in my sleep?? No other explanation, and it’s fairly heavy. Is this possible?

  12. Thank you! This happens to me at least once a week for the past few years and I had been wondering what it was. I am frequently sleep-deprived and stressed although I have no sleep or psychological disorders. When I wake up any time before about 7, time and numbers have no meaning and I have no sense of the progression of time. Just last night I woke up at 2am, and, positive that 7am was in a few short minutes, I got completely ready for work. Additionally, I frequently cannot figure out where the sound of my alarm clock is coming from. When this happens I go around my room moving anything I am not used to seeing, like a cup sitting on my table, trying to make the noise stop.

    1. Today when I woke up numbers didn’t have any meaning to me too. I think stress has a toll and after reading your story, I am more convinced that the brain is trying to recover during sleep from the stress we are dealing with.

      1. This happened to me for the first time this morning about 3am – I woke up and was trying to think in numbers – I know that doesn’t sound like it makes any sense but it was so strange. It took me about 10 minutes to ‘let go’ of whatever it was my brain was trying to solve. I definitely think it’s stress related.

  13. I work as a train guard and switch a lot between early and late shifts. I’m glad I can now put a name on what I regularly experience: Confusional Arousals. During the periods when I work late shifts, I tend to wake up after just one or two hour sleep and sit up in bed, thinking I’m at work, I went to quickly put my clothes on as I think my train will call at the next station and I’ll need to go to the platform to close the train doors and give the all clear signal to the driver when it’s time to leave. I really need to focus and really make an effort to tell to myself: I’m not at work. But most of the times I can only convince myself I’m not in charge of the train myself, that I’m on a train, as a passenger, sleeping.
    On the other hand, when I work early shifts, and need to get to bed early in the evening, I tend to wake up every hour, bathed in sweat, disorientated in time, thinking I overslept. As my partner hasn’t come to bed because it’s too early, I tend to think at those moments that he’s probably not yet in bed because he maybe fell down the stair or got a heart attack or anything like that, after which I need to go downstairs to verify everything’s alright. Which leaves me kinda broken in when I actually need to get up.

  14. I had an episode of this last night. I woke up thinking that it was Monday and that I was late for work. I live in a house that everyone leaves at about the same time, so I yelled to take everyone up, needless to say, someone got up and told me it was Sunday and snapped me out of it. At that point I felt embarrassed. I’m thankful that I found this article and that there are many others with the same problem.

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