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Confusional Arousals – Symptoms, Causes, Treatment

Healthy Sleep | Sleep

Confusional arousals are most common among children and adults up to 35 years old. This sleep disorder can coexist with related sleep disorders like sleep walking or sleep terrors; these conditions all share a few symptoms between them.

Some people rise in the morning and take no time to become completely alert to their surroundings, get up, and get on with their day.

And then there’s the rest of us—blinking our eyes open after a full night’s sleep, dragging our asses out of bed, going, “Where am I? What is happening? What year is it?” This level of disorientation is perfectly normal (and funny); you’re just giving your brain a moment to “fully wake up” and engage all the senses.

However, there’s a group of people whose “disorientation” goes beyond this—they will wake up and be totally unresponsive, sometimes even acting aggressively or inappropriately. It’s almost like they are a completely different person who doesn’t know who or where they are.

Can’t sleep and don’t know why? Check out our Complete Guide to Sleep Disorders with symptoms, causes, and treatments on over twenty types of sleep disorders.

Quick Facts – Confusional Arousals 

Frequency: 17% in children, 3-4% in adults*

Risk Factors: Other sleeping disorders (e.g. insomnia, obstructive sleep apnea, circadian rhythm sleep disorder), excessive daytime sleepiness, smoking, irregular work schedules, family history

Nature: Physical

Treatment: Medication, sleep study to find any underlying disorders, sleep hygiene improvement, stress reduction

Symptoms – Confusional Arousals 

Unlike sleep walking, confusional arousals don’t involve the patient getting up and out of bed. Rather, patients just sit up and appear to awaken, albeit with their consciousness impaired. Here are common behaviors observed among people experiencing confusional arousals.

  1. Little to no recollection of how they awoke
  2. Waking up confused and disoriented
  3. Exhibiting strange and unusual behavior even though they appear awake
  4. In extreme cases, can lead to sleep-related violence (either towards themselves or their bed partner) and inappropriate or sexual behavior
  5. With children, they may wake and sit up in bed, start crying, and become difficult to comfort and console for 10-30 minutes.
  6. Confusional arousals may last longer the more you try to interact with the patient during an episode.

Causes – Confusional Arousals

As in most sleeping disorders, many factors can trigger confusional arousals. A sleep specialist would have to study each case at depth to be able to pinpoint a likely cause and confirm a diagnosis, or determine that the symptoms indicate an underlying physical or psychological disorder.

That said, research shows that the following can increase the likelihood of confusional arousals.

  1. Sleep deprivation
  2. Mental health conditions, like bipolar disorder
  3. Other sleep disorders such as obstructive sleep apnea and periodic limb movements of sleep (PLMS)
  4. Irregular sleep-wake schedules
  5. Health problems like migraine and fever
  6. Drug and alcohol use and/or abuse

Treatment – Confusional Arousals 

No single treatment specifically addresses confusional arousals. If sleep hygiene improvement and lifestyle changes don’t work, seek professional help! Specialists will conduct a sleep study and uncover any underlying conditions behind your confusional arousals.

Here are some common treatment methods for confusional arousals.

  1. Sleep hygiene improvement – This is critical as sleep deprivation and irregular sleep-wake schedules are popular triggers for confusional arousals.
  2. Medications – Clonazepam (used for treating seizures), imipramine (used for treating anxiety, depression, and panic attacks), and sedatives might help ease confusional arousal symptoms. Sleeping pills may also help prevent confusional arousals in the middle of the night and help you get deeper sleep.
  3. Stress reduction and relaxation techniques – This can include setting “rules,” like ignoring work emails past a certain hour, or doing deep breathing and other relaxing activities before bed.

How You Will Overcome Confusional Arousals

If your child is experiencing confusional arousals, don’t worry! Most kids naturally outgrow it by age of 5 or 6.

When an episode comes up, let it run its course. Let your child cry or mumble and don’t attempt to fully awaken them. Kids will usually just stop crying and go back to sleep. Help manage your child’s symptoms by setting regular sleeping and waking times.

That last one applies to adults too! Improving sleep hygiene (regular sleep-wake schedule, ensuring the bedroom is comfortable, etc.) and reducing stress can effectively prevent confusional arousals.

Now, if symptoms persist or even worsen (e.g. violent or sexual behavior during episodes), consult a doctor or a sleep specialist to get the best treatment option for you. Before you know it, you or your loved one will be able to wake up in confidence and a smile, and not feel like a lost little lamb every time.

Did you know?

This article is part of our Complete Guide to Sleep Disorders – A resource that will help you get your quality sleep back. Click here to learn more about sleep disorders, their causes, symptoms and how to overcome them.

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