Home » Sleep Disorders » Confusional Arousals
December 2020 |  Reviewed by:  Andrea Matsumura, MD and Anne M. Morse, DO

What are confusional arousals?

Confusional arousals is a sleep disorder that causes you to act in a very strange and confused way as you wake up or just after waking. It may appear 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

When a confusional arousal occurs, you may seem to be awake even though you have a foggy state of mind. Episodes often start when someone else must physically wake you up.

Sleepwalking or shouting during an episode is common. Some people with confusional arousals also grind their teeth. These incidents may last a few minutes up to several hours. People with confusional arousals tend to have no memory of these episodes.

Confusional arousals is considered a parasomnia. This type of sleep disorder involves unwanted events or experiences that occur while you are falling asleep, sleeping, or waking up.

Episodes tend to occur as you wake from slow-wave or stage N3 sleep. This sleep stage is most common in the first third of the night. In some cases, these episodes may occur later in the night or during a daytime nap.

In some rare cases, adults may act very inappropriately or even hostile and aggressive. These extreme episodes are uncommon for most people who have confusional arousals.

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 15 minutes.

Overall, confusional arousals 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. Parents or bed partners witnessing these events may feel distressed by these behaviors and may try to wake or console the individual during the event. This can actually have the opposite effect causing worsening of the behaviors or a more prolonged event.

What are risk factors for confusional arousals?

You are more likely to experience confusional arousals if you have a relative with this sleep disorder. Other factors that can increase your risk for arousals include:

  • Rotating shift work
  • Night shift work
  • Other sleep disorders (hypersomnia, insomnia, circadian rhythm sleep disorders)
  • Not enough sleep
  • Stress
  • Worry
  • Bipolar and depressive disorders