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

What are causes of confusional arousals?

Potential causes for this disorder include the following:

Confusional arousals occur at the same rate among both men and women. Rates are high among children and adults under the age of 35. It may occur in as many as 17% of children. About 3% to 4% of adults have confusional arousals.

How to diagnose confusional arousals?

Self test

  1. Has someone told you that you act in a way that is strange or confused when they wake you?
  2. Has this behavior been described as hostile or aggressive?
  3. Have these actions been inappropriate in any way?
  4. Is this a pattern of behavior that occurs on a regular basis?

If your answer to each of these questions is yes, then you might have confusional arousals. Because you may have no memory of the events, it can be hard for you to know on your own.

Diagnosis

In children, parents should keep track of the child’s sleep-wake schedule and the timing and characteristics of the events. This can be helpful in distinguishing type of event, as well as be used in constructing a treatment plan. A sleep evaluation to look for other sleep problems that may be interfering with the child’s ability to get the right number of hours or quality of sleep is necessary. In some cases, polysomnography may be recommended.

In adults, a sleep doctor will often ask you to complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. She might also ask you to rate your sleep using a simple questionnaire. This will help show how your sleep is affecting your daily life. The doctor will need to know your complete medical history. Be sure to inform her of any past or present drug and medication use. Also, tell the doctor if you or a relative have ever had a sleep disorder.

A sleep doctor will try to determine if there is something else that is causing your arousals or making the symptoms worse, such as:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

The sleep doctor may want to examine your sleep using a sleep study. Also known as polysomnography, a sleep study charts your brain waves, heartbeat and breathing as you sleep. It also looks at how your arms and legs move and records your behavior during sleep on video. This will help show if you get out of bed and do anything unusual during your sleep study.

How to treat confusional arousals?

Confusional arousals can occur when sleep is fragmented by other sleeping problems. Treating the underlying disorder will likely lessen the frequency of the arousals.

For confusional arousals in children, first make sure your child maintains a regular sleep schedule 7 days a week and achieves the age-appropriate number of hours of sleep per night. If confusional arousals persist, it may help to gently wake the child about 15 minutes prior to the typical timing of the arousal.

For some people with confusional arousals, medications may be recommended.

Your doctor will advise you of the appropriate treatment for your or your child.