Confusional Arousals

Why these strange episodes happen and how they're treated

Toddler sleeping on pillow
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Confusional arousals are episodes in which a sleeping person wakes up—or seems to wake up—but behaves strangely. She may seem disoriented or unresponsive; if she says anything, it probably won't make a lot of sense or even be coherent because her speech is slow or slurred. During a confusional arousal, a person's behavior may seem a lot like that of someone who's intoxicated. In fact, a nickname for confusional arousal is "sleep drunkenness."

A Particular Type of Sleep Problem

Confusional arousals are one of a number of sleep disorders called parasomnias. Other examples of these include sleepwalking and sleep terrors. Children, especially kids under 5, are more likely to experience confusional arousals than adults are. According to the American Association of Sleep Medicine (AASM), around 17 percent of children have confusional arousals. By contrast, they occur in only 3 percent to 4 percent of adults.

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 she was having an episode of confusional arousal. Adults who have confusional arousals sometimes come across as hostile or aggressive. A person who has an episode of confusional arousal won't remember it at all when she's finally fully awake. 

Confusional arousals usually occur within the first two hours of sleep and can last from five minutes to as many as 15 minutes. They tend to happen during the transition from the deepest stage of sleep, stage 3, to a lighter stage of sleep. Children go through more stage 3 sleep than adults do: This deep, slow-wave sleep is when growth hormone is released.  

Who's At Risk of Confusional Arousals?

Besides kids, certain subsets of people are more likely than others to have confusional arousals. These include folks whose jobs require rotating or night shift work; who have other sleep disorders; who don't get enough sleep; who are dealing with a great deal of stress and worry; or who have bipolar disorder or chronic depression, according to the AASM.

Confusional arousals also can happen in the wake of recovery from sleep deprivation or being forced to wake up; drug abuse or drinking too much alcohol; taking psychotropic medications; obstructive sleep apnea; and periodic limb movement disorder—sudden jerking movements of the legs during sleep that's sometimes associated with restless legs syndrome. They're also more common in adults under 35, the ASSM says. 

Diagnosis and Treatment

If you're having confusional arousals, you probably won't know unless someone witnesses them. Remember: 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 doctor will get a complete medical history from you and 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 movement while you snooze.

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. 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 doctor may prescribe medication such as an antidepressant or a sleeping pill. 

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