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

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Contrary to how it sounds, sleep drunkenness has nothing to do with falling asleep drunk, sleeping while drunk, or even drinking while you’re asleep.

Instead, it has to do with feelings of confusion and disorientation when someone is woken up from a deep state of rest. The way they act may mirror the behavior of being drunk, though the two are unrelated.

Before you dismiss this article and say that this condition is something you’ve never had, people who do have it often have absolutely no memory of the episodes associated with this disorder. Therefore, you may have sleep drunkenness and not even know it!

Because people with this condition lack awareness and control over their behavior and movements, it can be dangerous and potentially deadly. There’s an account of a man who died while he was on a ship because he woke up in a confused state and then fell overboard.

So, let’s dive in to learn more about this disorder and what you can do if you are suffering from it.

What is Sleep Drunkenness?

Sleep drunkenness is synonymous with confusional arousal. Both terms refer to parasomnia sleep disorder, in which the person who has the disorder acts out while they’re asleep. Other types of parasomnias include sleepwalking, teeth grinding, and even sleep-eating.

To put it simply, this disorder causes people to be confused when they wake up. They may be disoriented, not know where they are, and in some cases, they become violent or aggressive. Those who have this disorder 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.

Sleep Drunkenness Symptoms

Slow Speech

As you can imagine, in a confused state, speech is bound to be slow. The person is trying to gather their thoughts and make the connection between what their brain is thinking and how the muscles in their mouth and vocal chords are supposed to coordinate in order to communicate a message.

Confused Thinking

Those with this condition wake up either in the middle of a sleep cycle or in the morning feeling disoriented. They may not know where they are or how they got there.

Poor Memory

Often, when you ask the person later about the things they did or said during this episode, they’ll have no recollection. This is probably for the best, as many with this disorder would likely be embarrassed if they remembered how they had acted!

Blunt Responses

Again, people in the midst of an episode are not fully aware or thinking clearly. If you attempt to talk to them in this state, you may get nonsensical answers or blunt responses due to the lack of a conscious filter. For example, if you want to know how someone really feels about a topic (or the outfit you wore last night), try asking them during a state of confusional arousal.

happy friends are talking

Possible Causes

Recovery from Sleep Deprivation

The study cited earlier drew an interesting conclusion about the cause. Interestingly enough, 84 percent of the subjects observed had another sleep disorder or mental health issue, which leads scientists to believe that confusional arousal is just one symptom of an underlying problem.

One such problem is sleep deprivation. In the study, 20 percent of patients who got less than six hours of shuteye had an episode. It’s likely that as they’re trying to recover from sleep debt, their bodies are attempting to spend more time in SWS (slow-wave sleep), 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. It turns out that alcohol disrupts the sleep cycle, increasing the number of arousals and limiting the time that someone spends in deeper stages of rest.

Obstructive Sleep Apnea (OSA)

As a reminder, obstructive sleep apnea (OSA) is characterized by the muscles around the throat relaxing while the subject is unconscious. When those muscles relax, they can obstruct the airways, resulting in several nightly breathing interruptions.

People who have this condition are also most likely to also experience confusional arousal. It could be that OSA is responsible. Another theory is that waking up multiple times could increase the likelihood of an episode.

Periodic Limb Movement Disorder (PLMD)

PLMD is another disorder that is correlated with confusional arousal. The legs will cramp or jerk involuntarily while the person is asleep. It’s referred to as periodic because it happens at regular intervals of about 20 to 40 seconds apart.

The difference between PLMD and restless leg syndrome is that the subject who has Periodic Limb Movement Disorder remains asleep while someone with RLS (restless leg syndrome) is awake during the movements.

Psychotropic Medication Use

Psychotropic medications, especially antidepressants, are closely linked to this disorder. It’s likely due to the effect that these drugs have on hormones and chemicals in the brain that could affect sleeping cycles.

Drug Abuse

Both alcohol and drug abuse can trigger a 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 disorders.

Forced to Wake Up

If someone wakes you up from a deep sleep, it’s natural to feel groggy and disoriented. The difference between someone without this disorder and someone with it is that the affected individual won’t fully wake up and will still be in a groggy, dream-like state. It may take them several minutes to become alert and aware of their surroundings.

woman waking up

Reducing Your Risk of Confusional Arousals

Rotating Shift Work

People like doctors, pilots, emergency medical teams and others who do shift work are more at risk for confusional arousals because of an erratic schedule and 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.

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, it can 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.

Other Sleep Disorders

Sleep drunkenness goes hand in hand with other disorders, including sleep apnea and sleepwalking. However, it’s been found that by getting to the root cause of the disorder and fixing the problem, the other conditions tend to go away as well.

Lack of Sleep

Getting too much or not enough rest are both associated with episodes. To reduce the likelihood of suffering from this condition, it’s recommended to get at least six hours of shuteye each night, being careful not exceed nine hours.

Stress

When we’re stressed out about something, it affects our ability to get adequate rest. It may delay the time it takes to become unconscious, causing sleep deprivation. It could also lead to fitful rest and the possibility of waking up more easily from the deeper sleeping stages. As we know, being woken up from deep rest is more likely to trigger a confusional arousal.

Worry

Being worried is the same as being stressed. If you’re feeling either stressed or worried, it’s not always easy to quiet your mind and stop these emotions. Some helpful tactics include meditating or doing something relaxing before bed. Resist checking emails or social media before bed, as that can also make falling asleep more challenging.

Bipolar and Depressive Disorders

People with mental health conditions are also more likely to experience this condition. Medications could either help or worsen the frequency of episodes. Those with these disorders should take extra care to maintain their health in every other aspect of their life, including following a regular and consistent sleeping schedule.

unhappy girl sitting on the floor

Diagnosis

To receive an official diagnosis, you’ll need to be seen by a doctor who specializes in sleep. The first step in the evaluation is often a journal that you’ll keep for two weeks. The doctor will evaluate your entries and look for patterns or potential causes that could be responsible for the disorder.

You’ll also have to share your complete medical history with the doctor, again to determine potential causes. In some cases, a formal sleep study may be needed. A study in a lab will monitor you for movement and apneas, and there will also be a visual recording, so the doctor will be able to watch you the entire time to see if there’s anything out of the ordinary happening.

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 as provided by Sleep Education:

  1. Have you been told that you act strangely or seem confused if they wake you?
  2. Have the people who are waking you ever noted that you seem hostile or aggressive?
  3. Have you ever done anything inappropriate during this time?
  4. Does this behavior occur on a regular basis?

To answer these questions accurately, you’ll 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 can help shed some light.

Treatment

The first recommended course of action is likely to be treating any other sleep disorders. The reason is that once those are under control, confusional arousal often 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.

Before taking treatment into your own hands, speak to a specialist first to get a formal plan.

woman taking pills

Frequently Asked Questions

Is nighttime drunkenness normal?

Even though this condition is common, with approximately 15 percent of the population experiencing it, it is not normal. As a society, we tend to find comfort when other people are going through the same thing as us, but again, 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 aroused from a deep sleep is bound to make someone feel confused and disoriented. It takes the brain and body time to go from sleeping to waking. However, most people recover quickly and become alert within seconds. Those with confusional arousal can remain in a semi-conscious state for several minutes, or even hours.

Do confusional arousals happen to toddlers and kids?

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

Conclusion


Researchers are genuinely surprised by how common this condition is. However, considering our hectic schedules, widespread sleeping deficits and the constant stress and worry of modern society, it’s no wonder that issues like this are manifesting at alarming rates.

Our advice: Do your best to maintain a regular schedule and relax! Once you get a handle on any other sleeping disorders, you may find that this one disappears on its own.

Sources and References:

  1. The place of confusional arousals in sleep and mental disorders: findings in a general population sample of 13,057 subjects – ncbi.nlm.nih.gov
  2. What Is Sleep Drunkenness? – healthline.com

More Reading:

Author: Sleep Advisor

Our team covers as many areas of expertise as we do time zones, but none of us started here as a so-called expert on sleep. What we do share is a willingness to ask questions (lots of them), seek experts, and dig deep into conventional wisdom to see if maybe there might be a better path towards healthy living. We apply what we learn not only to our company culture, but also how we deliver information to our over 12.7M readers.

Sleep research is changing all the time, and we are 100% dedicated to keeping up with breakthroughs and innovations. You live better if you sleep better. Whatever has brought you here, we wish you luck on your journey towards better rest.

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