Confusional Arousal Disorder

Confusional arousal disorder is a sleep parasomnia that can cause you to act strangely and confuse others. It is sometimes called “sleep drunkenness.” People who have confusional arousals may seem aggressive or hostile when they wake up.

The episodes happen during a transition from deep sleep to light sleep. They can be triggered by sleep deprivation, stress and certain medications such as sedatives and antipsychotics.

Symptoms

People with confusional arousal disorder will wake up in their sleep with their eyes open and appear disoriented. They may mumble or talk to themselves but they don’t experience intense fear or terror. The episodes last for a few minutes and typically occur as you are transitioning out of deep non-rapid eye movement (NREM) sleep. It is rare for people with confusional arousal to get out of bed during these episodes. This condition is not the same as sleep walking or night terrors because it doesn’t involve any physical movements.

In children, episodes of confusional arousal usually occur in the first two hours after falling asleep and occur during the transition from REM to NREM sleep. These episodes are less common as the child gets older. In adults, a lack of sleep and certain medical conditions can trigger confusional arousals. People with depression or anxiety disorders are at a higher risk for experiencing confusional arousals, as well as those who have a family history of sleepwalking or night terrors.

It is important to not try to awaken or console a person during an episode of confusional arousal. This can actually aggravate the behavior. Rather, it is better to try to prevent an episode by practicing good sleep hygiene (regular sleeping and waking schedules, comfortable bedroom, etc.), reducing stress and taking iron supplements.

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Causes

Confusional arousal disorder (also known as Elpenor syndrome) is one of a group of sleep disorders called NREM parasomnias. It’s in the same family as sleepwalking and sleep terrors, both of which involve a partial arousal from non-rapid eye movement (NREM) sleep. People with confusional arousal disorder seem to wake up from deep NREM sleep, or slow wave sleep (SWS), but they don’t fully awaken and they behave in a confused or agitated state. This can result in the person doing things like sitting up in bed, mumbling or muttering, jumping out of bed and running around wildly or climbing through windows. They may also hurt themselves or harm others. They will probably not remember the episodes in the morning.

Confusional arousals appear to be more common in children, but can occur in adults too. It’s thought that they tend to resolve with age, but some people still experience them into adulthood. They can be triggered by many different things, such as fever, pain, menstruation, stress, anxiety, alcohol use, some medications (especially sedatives) and shift work.

It’s difficult to know what causes confusional arousals in specific, but there seems to be an association with psychiatric conditions and some physical illnesses. It’s also possible that they can be caused by obstructive sleep apnea, periodic limb movements of sleep and other sleep disorders.

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Diagnosis

During an episode of confusional arousal disorder, a person will wake up or appear to awaken but behave as though they are confused and disoriented. This sleep disorder, also known as “sleep drunkenness,” may last for less than 15 minutes and occur during non-rapid eye movement (NREM) sleep in the first third of the night or during a nap. People with this disorder speak slowly and incoherently, lack reaction to others, and may have poor memory.

Confusional arousal disorder occurs more often in children but can continue into adolescence and adulthood. Like sleepwalking and sleep terrors, it is a type of NREM parasomnia. A sleep doctor can determine if someone is suffering from this disorder by taking a medical history and asking questions about symptoms. They may have a patient keep a sleep diary or do an in-lab sleep study to look at brain waves, heart rate, and arm and leg movements during snooze time.

Lifestyle changes can help to reduce the frequency of episodes. Avoiding alcohol, getting adequate amounts of sleep, avoiding certain medications, and treating any underlying sleep disorders can all help reduce confusional arousals. It is also important to take safety measures to ensure that a person with confusional arousal disorder does not harm themselves or anyone else during an episode. Medical experts recommend that individuals don’t try to rouse or restrain them during an episode as this can increase aggression or dangerous behavior.

Treatment

Confusional arousals usually occur during the N3 stage of non-rapid eye movement (non-REM) sleep. This is a transitional phase between deep sleep and light sleep. During this time, your brain activity is not as intense. Your dreams are also less vivid.

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A person afflicted with confusional arousal disorder might appear confused or act strange when they wake up from sleep. These episodes last from a few minutes to several hours. They usually begin with a noise or someone disturbing the person’s sleep. The person may have slow speech, confused thinking and poor memory. They also may respond to questions or requests bluntly or in a nonsensical manner. In some cases, people in a state of confusional arousal may leave their homes and engage in other dangerous behaviors.

If the behavior is recurring, it is best to seek medical advice from a doctor who can examine your symptoms and conduct a sleep study. It is important to rule out other sleep disorders that can cause confusional arousals. For example, sleep apnea or shift-work sleep disorder could trigger them.

Getting more overall sleep, avoiding alcohol and certain medications (including sedatives) and improving good sleeping habits may help reduce the number of confusional arousals. Some research suggests that cognitive behavioral therapy for insomnia can be helpful in reducing confusional arousals as well.

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