Understanding Confusional Arousals or Sleep Drunkenness

Confusional arousals are episodes in which a sleeping person wakes up—or seems to wake up—but behaves strangely as though they are disoriented or confused.

These episoides are more common with children. In adults, episodes of confusional arousal can be caused by a number of habits and conditions, like drinking too much alcohol or taking certain medications. Fortunately, most causes can be treated or prevented.

This article covers the causes and symptoms of confusional arousals along with how they are diagnosed and treated.

What Causes Confusional Arousals?

Confusional arousals tend to happen during the transition from the deepest stage of sleep, stage 3, to a lighter stage of sleep mixed with wakefulness.

Research suggests that confusional arousal happens when different regions of the brain fail to fully communicate with each other. As a result, some parts of the sleeper's brain stay asleep while others suddenly awake.

Possible causes of interrupted sleep leading to confusional arousal include:

• Recovering from sleep deprivation or a period of sleep disruptions
• Drug abuse
• Drinking too much alcohol
• Taking psychiatric medications
• Narcolepsy
• Obstructive sleep apnea
• Periodic limb movement disorder, a condition associated with restless leg syndrome in which the legs make sudden jerking movements during sleep
  

Risk Factors

Certain subsets of adults are more likely than others to have confusional arousals and sleep drunkenness. These include people with:

• A family history of confusional arousal
• Jobs require rotating or night shift work
• Other sleep disorders like sleep apnea or periodic limb movements of sleep
• Sleep deprivation
• Alcohol use near bedtime
• Excessive stress and worry
• Bipolar disorder or chronic depression

Symptoms

If you're a parent and have ever witnessed your child seem to wake up and "stare right through you" or not respond when you say her name, in all likelihood they were having an episode of confusional arousal. Adults who have confusional arousals sometimes come across as hostile or aggressive. 

The episodes are fairly brief, usually lasting less than 10 minutes, and may include simple movements and confused speech. Confusional arousals are characterized by amnesia and are not typically remembered the next day.

Diagnosis

If you're having confusional arousals or sleep drunkenness, you probably won't know unless someone witnesses them. People don't remember these episodes, so your only clue will be if you've been told you seem confused or behave aggressively or act hostile when you wake up and that this behavior happens regularly. 

In that case, you may want to see a sleep specialist. To confirm that you're having confusional arousals, the healthcare provider will get a complete medical history from you. They may have you keep a sleep diary for a couple of weeks and/or do an in-lab sleep study to observe things like your breathing rate and limb movements while you snooze.

Treatment

If it appears you're having confusional arousals because you have some type of sleep disorder, treating that will likely put an end to them.

For adults, it also might be beneficial to cut back or quit drinking alcohol. And of course, it's important to always get a full night of sleep, so adjusting your bedtime and creating a sleep environment that will help you get all the shut-eye you need also may help.

If all else fails, your healthcare provider may prescribe medication such as an antidepressant or a sleeping pill. These medications may disrupt sleep depth, reducing the likelihood of waking from a prolonged period of slow-wave sleep. In addition, there are devices such as the Lully Sleep Guardian that can prompt awakenings in children.

A Word From Verywell

If bothered by persistent or recurrent confusional arousals, consider consultation with a board-certified sleep physician. It may be possible to identify techniques or treatments to reduce their frequency.