Sleep Education

American Academy of Sleep Medicine 

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Confusional Arousals - Overview and Facts

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.

continue to Symptoms and Causes »