Animated Image of a Woman Experiencing Sleep Drunkenness

What Causes Sleep Drunkenness –
Why Do You Wake Up Confused?

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Sleep is critical to our mood and happiness. When sleep is interrupted, we sometimes need a minute to come to; however, there's a difference between waking up sleepy and waking up disoriented. Contrary to how it sounds, sleep drunkenness has nothing to do with alcohol intoxication. Instead, it relates to feelings of confusion and disorientation when an individual is woken from a deep sleep.

 

People who struggle with this often have no memory of the episodes, so you may have sleep drunkenness and be completely oblivious. People with this sleep disorder often lack awareness and control over their behavior and movements, so the issue can potentially be dangerous.

 

We discuss sleep drunkenness, the risks associated with the condition, and simple tricks to avoid confusional arousals.

Section 1

Risk Factors of Confusional Arousals and Sleep Drunkenness

Section 2

What is Sleep Drunkenness?

Section 3

Sleep Drunkenness Symptoms

Section 4

Causes of Confusional Arousals

Section 5

Reducing Your Risk of Confusional Arousals

Section 6

Diagnosis

Section 7

Treatment

Section 8

Frequently Asked Questions

Section 1

Risk Factors of Confusional Arousals and Sleep Drunkenness

Section 2

What is Sleep Drunkenness?

Section 3

Sleep Drunkenness Symptoms

Section 4

Causes of Confusional Arousals

Section 5

Reducing Your Risk of Confusional Arousals

Section 6

Diagnosis

Section 7

Treatment

Section 8

Frequently Asked Questions

Risk Factors of Confusional Arousals and Sleep Drunkenness

Similar to how sleepwalking has been associated with genetic traits, the likelihood that you'll experience episodes of sleep drunkenness is higher if you have a relative that suffers from it as well.

 

Other factors[1] may also increase your chances of waking up confused, including:

What is Sleep Drunkenness?

Sleep drunkenness is synonymous with confusional arousal. Both terms refer to parasomnia, which refers to any unusual or unwanted events that disrupt one's sleep. Common types of parasomnias include sleepwalking, teeth grinding, and even sleep-eating.

 

Sleep drunkenness causes people to be confused when they wake up. They may wake up disoriented, not know where they are, and in some cases, could even become violent or aggressive. Individuals who have this disorder[2] are most likely to display symptoms when they've been woken up from a deep state of rest, either during the night or while napping.

Animated Image of a Lady Sleepwalking at Night

Sleep Drunkenness Symptoms

Slow Speech

As you can imagine, in a state of confusional arousal, speech is bound to be slow. The person may be trying to gather their thoughts or even try to speak, but their muscles may be delayed despite their mental attempts due to their disoriented state.

Waking Up Confused

Those with this condition may wake up in the middle of a sleep cycle or in the morning feeling disoriented. The person may not know where they are or how they got there. If confusional arousal happens to someone you know, be patient and calmly explain what's going on to reassure them.

Poor Memory

When asked about what happened or was said during an episode, the person will often have no recollection. Confusion arousals can create a foggy memory and leave one uncertain or without memory of what happened.

Unusual Behavior

Illustration Of a Man Talking to His Wife About Her Sleepwalking

People in the midst of an episode of confusional arousal are not fully aware and may not be able to think clearly. Individuals may even experience hallucinations or attempt to sleepwalk. If you try to talk with them in this state, you may get nonsensical answers or blunt responses due to the lack of a conscious filter.

 

Further, occasionally individuals may act out in aggression[3], unaware of where they are or who they're with, and, out of fright, could become violent.

Causes of Confusional Arousals

Recovery from Sleep Deprivation

According to a study reported by the LA times[4], 84 percent of 19,136 subjects who experienced sleep drunkenness also had another sleep or mental health disorder, which leads scientists to believe that confusional arousal is just one symptom of an underlying problem. The episodes were overwhelmingly correlated to sleep disorders, which appeared to be present in 70% of the subjects studied.

 

One such problem is sleep deprivation. In the study, 20 percent of patients who got less than six hours of sleep experienced an episode of confusional arousal. Researchers believe that this may be because as folks are trying to recover from sleep debt, their bodies are attempting to spend more time in SWS (slow-wave sleep)[5], and any waking during that time could result in confusional arousal.

Alcohol Consumption

Those who consume alcohol are more likely to display this behavior, even though it doesn't have anything to do with being drunk. Alcohol disrupts the sleep cycle[6], increasing the number of arousals and limiting the time that someone spends in deeper phases of rest. Even one drink could increase the chances of a person waking up disoriented or confused.

 

Get More Info: How Alcohol Affects our Sleep

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is characterized by the muscles in the back of the throat relaxing or collapsing while an individual is sleeping. When these muscles relax, they can obstruct the airway, resulting in several nightly breathing interruptions, often causing a person to wake up.

 

People who have this condition are also more likely to experience confusional arousal[7]. The reason for this could be that OSA is responsible. Another theory is that waking up multiple times could increase the likelihood of an episode, leading to a higher probability of waking up disoriented, or waking up and not remembering anything.

Illustration of a Person with Breathing Disorder Sleeping on Thier Back

Psychotropic Medication Use

According to the American Academy of Neurology, psychotropic medications, especially antidepressants, are closely linked to confusional arousal. The connection is likely due to the effect that these drugs have on hormones and chemicals in the brain that could affect sleeping cycles. Research has found that 31 percent of those experiencing disoriented arousals also take psychotropic medications[8], and often they were antidepressants.

Drug Abuse

Both alcohol and drug abuse[9] can trigger confusional arousal. More research needs to be done on this topic to determine exactly how the two are related. For now, scientists do know that taking drugs can cause confusional arousal and other sleep disorders.

Animation of Addicted Man Having Nightmares

Forced Rousals

When waking up from a deep sleep, it's natural to feel groggy and disoriented. However, the difference between someone without confusional arousal and someone with it is that the affected individual won't fully wake up immediately, they may even wake up and not remember much during the episode.

 

They may wake up confused and still be in a groggy, dream-like state for some time after waking. Folks may take several minutes to become alert and aware of their surroundings.

Reducing Your Risk of Confusional Arousals

Rotating Shift Work

People like doctors, pilots, emergency medical team members, and others who work in shifts are more at risk for confusional arousals because of an erratic schedule and a tendency to take naps during the day. To reduce the risk of having an episode during work, they should plan for extra time to wake up from a nap, especially if they are scheduled to perform a vital duty soon after waking. If confusional arousal persists despite attempts to improve sleep hygiene, another line of work may be recommended.

Animated Image of Judge Doctor Nurse Police Officer and Production Worker

Night Shift Work

Those who work the night shift tend to have reverse schedules than the rest of the world. They're up in the middle of the night, and they rest during the day. Not only does this wreak havoc on their internal clocks, but it can also lead to confusional arousals.

 

To limit these instances, we recommend maintaining a consistent schedule, even on days off. Another helpful tip is to make sure that the work environment is well-lit during the night shift and then keep the bedroom dark during the day when it's time to rest.

 

Find Out More: How Shift Work Affects the Circadian Rhythm

Other Sleep Disorders

Sleep drunkenness often appears with other parasomnia disorders, including sleep apnea and sleepwalking. However, it's been found that by getting to the root cause of the disorder and fixing the underlying problem, the other conditions tend to go away as well.

illustration of a woman using earplugs for blocking husbands snoring

Minimal or Excessive Sleep

Getting too much or not enough rest are both associated with episodes of confusional arousals. To reduce the likelihood of disoriented arousal, it's recommended to get at least six hours of shuteye nightly and be careful not to exceed nine hours.

Anxiety

When you're stressed out, it affects your ability to relax, and it's not always easy to quiet your mind. Anxiety could lead to fitful sleep and increase the possibility of waking up disoriented. In addition, anxiety may increase your sleep latency (the time it takes to go to sleep), even leading to sleep deprivation. 

 

Some helpful tactics include meditating or doing something relaxing before bed. Also, resist checking emails or social media before bed, as that can also make falling asleep more challenging.

 

Want to know more? Discover how anxiety target your sleep in our complete guide.

Bipolar and Depressive Disorders

People with mental health conditions are also more likely to experience confusional arousal. Medications could either help or worsen the frequency of episodes. Those with these sleep disorders should take extra care to maintain their health, including following a consistent and regular sleep schedule.

 

Learn More: How to Sleep with Bipolar Disorder

Diagnosis

To receive an official diagnosis, you'll need to be seen by a doctor who specializes in sleep. The first step is often a sleep journal to record y ourlseep patterns. The doctor may evaluate your entries and look for potential causes that could be responsible for confusional arousal.

 

You may need to share your medical history to seek potential triggers. In some cases, a formal sleep study may be required. A study in a lab may monitor you for movement and apneas.

Before heading to a medical professional, you can do a self-test to see if you might be experiencing sleep drunkenness. Here are four questions to ask yourself:

 

  1. Have you been told that you act strangely or seem confused upon rousing?
  2. Have the people who are waking you ever noted that you seem hostile or aggressive?
  3. Have you ever done anything inappropriate upon waking?
  4. Does odd waking behavior occur regularly?

To answer these questions accurately, you may need the help of a friend, roommate, or relative that lives with you. If you're experiencing any of these situations, you're not likely to remember them, so a witness may help shed some light.

Treatment

Before taking treatment into your own hands, speak to a specialist first to get a formal plan. The first course of action is often treating any other sleep disorders. The reason is that once those are under control, confusional arousal usually dissipates on its own.

 

If you drink or take drugs, your doctor may recommend cutting back or stopping altogether. Some medications are also prescribed, including antidepressants and sleeping pills.

Frequently Asked Questions

Is nighttime drunkenness normal?

Even though confusional arousal is common, with approximately 15 percent of the population experiencing it, it is not normal. As a culture, we tend to find comfort when other people are going through the same thing as us, but that doesn't make it normal.

Nighttime drunkenness is a potentially dangerous condition and could even lead to death in rare circumstances.

Can it be linked to anxiety?

Yes, anxiety can trigger these episodes. The exact cause and likelihood are unknown, but researchers are aware that those who suffer from anxiety have a higher probability of having this disorder.

Why do I wake up confused and disoriented?

Being roused because it takes the brain and body time to go from sleeping to waking from deep sleep is bound to make someone feel confused and disoriented. However, most people recover quickly and become alert within seconds. Those with confusional arousal can remain in a semi-conscious state for several minutes.

Do confusional arousals happen to toddlers and kids?

Yes, confusional arousals occur in toddlers and kids as well. However, they'll usually outgrow the condition as they enter their teenage years and adulthood. However, when confusional arousals continue as an adult, treatment may become necessary.

[1] “Everything You Need to Know about Sleep Drunkenness”, Cleveland Clinic, May 5, 2021.
[2] “Everything You Need to Know about Sleep Drunkenness”, Cleveland Clinic, May 5, 2021.
[3] “What Is Sleep Drunkenness? Causes, Symptoms, Treatment, and Prevention”, Sleep Clinic Services
[4] “Sleep Drunkenness May Affect More than 1 in 7 People, Study Finds”, Los Angeles Times, August 24, 2014.
[5] Thomas Roth, “Slow Wave Sleep: Does It Matter?”, Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, American Academy of Sleep Medicine, April 15, 2009.
[6] Michael D. Stein and Peter D. Friedmann, “Disturbed Sleep and Its Relationship to Alcohol Use”, Substance Abuse, U.S. National Library of Medicine, March 2005.
[7] Lynn M. Trotti, “Waking up Is the Hardest Thing I Do All Day: Sleep Inertia and Sleep Drunkenness”, Sleep Medicine Reviews, U.S. National Library of Medicine, October 2017.
[8] “Sleep Drunkenness Disorder May Affect One in Seven”, American Academy of Neurology
[9] “Connections between Sleep and Substance Use Disorders”, National Institute on Drug Abuse, March 9, 2021.
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