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Confusional Arousals

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What is it?

Confusional arousals is a parasomnia. A parasomnia involves undesirable events or experiences during the sleep period. A confusional arousal takes place as you wake up or just after waking.

You act in a way that is very strange and confused. It appears that you don’t know where you are or what you are doing. Your behavior may include the following:

  • Slow speech
  • Confused thinking
  • Poor memory
  • Blunt responses to questions or requests

You may seem to be awake even though you have a foggy state of mind. Episodes often start when someone else has to physically wake you up. It is common for you to sleepwalk or shout during an episode. You also may grind your teeth. A confusional arousal may last only a few minutes or a few hours. You tend to have no memory of these episodes.

Confusional arousals tend to occur as you wake from slow-wave sleep. This sleep stage is most common in the first third of the night. In some cases it may occur later in the night or during a daytime nap.

In some rare cases adults may display behavior that is very inappropriate. Their actions can be hostile and aggressive. This behavior can put a huge strain on their relationships with others. These extreme episodes are uncommon for most people who have confusional arousals.

One variation of confusional arousals is called severe morning sleep inertia. It can affect teens and adults. Sometimes it is called “sleep drunkenness.” The signs of it are the same as those of typical confusional arousals that occur early at night. The difference is that severe morning sleep inertia occurs in the morning when you are waking up.

This version of the disorder tends to occur every morning for many years without going away. It can cause you to miss time and perform poorly at school or at work. It also can be a source of conflicts with people at home. In rare cases injuries may occur. Another danger is that it can make you less alert while you are driving in the morning.

Episodes of confusional arousals in children may seem bizarre and frightening to parents. The child can have a confused look on his or her face and “stare right through” you.

Children may become more agitated when you try to comfort them. Most episodes last from five to fifteen minutes. But they may last as long as thirty to forty minutes in some youth.

Overall, these events are fairly harmless in children. Arousals are less common after the age of five years. Children who have confusional arousals often will sleepwalk when they are teens.

Who gets it?

It occurs at the same rate among both men and women. Rates are high among children and adults under the age of 35. It may occur in as many as 17 percent of children. About three to four percent of adults have confusional arousals.

You are more likely to have this disorder if a relative also has it. These are other factors that can increase your risk of having confusional arousals:

  • Rotating shift work
  • Night shift work
  • Other sleep disorders (hypersomnia, insomnia, circadian rhythm sleep disorders)
  • Not enough sleep
  • Stress
  • Worry
  • Bipolar and depressive disorders

Potential causes for this disorder include the following:

  • Recovery from sleep deprivation
  • Alcohol consumption
  • Obstructive sleep apnea (OSA)
  • Periodic limb movement disorder (PLMD)
  • Psychotropic medication use
  • Drug abuse
  • Being forced to wake up

How do I know if I have it?

  1. Has someone told you that you act in a way that is strange or confused when they wake you?

  2. Has this behavior been described as being hostile or aggressive?

  3. Have these actions been inappropriate in any way?

  4. Is this a pattern of behavior that occurs on a regular basis?

If your answer to each of these questions is yes, then you might have confusional arousals. Because you may have no memory of the events, it can be hard for you to know on your own.

It is also important to know if there is something else that is causing your sleep problems. They may be a result of one of the following:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

Do I need to see a sleep specialist?

Yes. This is a disorder that can cause severe problems. You need someone with the proper training and experience to help treat it.

What will the doctor need to know?

You should complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. You can also rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life.

The doctor will need to know your complete medical history. Be sure to inform him or her of any past or present drug and medication use.

Will I need to take any tests?

You may need to do an overnight sleep study. This is called a polysomnogram. The polysomnogram charts your brain waves, heart beat and breathing as you sleep. It also records how your arms and legs move. This shows if there are other disorders that are causing your sleep problems. Two examples of these disorders are sleep apnea and periodic limb movement disorder.

The best sleep study will also record your sleep on video. This will help show if you do anything unusual during the study.

How is it treated?

Any other sleep disorders that may be the cause of the unusual behavior need to be treated first. It may help if you cut back on alcohol or stop drinking it completely. It is also important that you always get a full night of sleep.

Some reports indicate that medication has helped. Antidepressants and sleeping pills are among the types of medication that have been used. Talk to your doctor for advice about this and any other form of treatment.

Reviewed by David A. Kristo, MD
Updated on August 16, 2006

More Information
Preventing Parasomnias

Comparing Parasomnias

Comparing Child Parasomnias

Tips for Parents
Confusional arousals can be very disturbing to parents. Most of the time a child has no memory of the event. These tips will help you respond well when your child has this parasomnia:

  • Remain calm so that you do not frighten your child with a panic-stricken response.
  • Do not try to wake your child.
  • Watch your child to make sure that he or she remains safe.
  • Wait near your child until he or she returns to normal sleep.

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