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Confusional Arousal Disorder

Many people are surprised to hear that they or someone else they know experiences confusional arousals, also known as sleep drunkenness. Most episodes occur in the slow-wave phase of sleep and last about 15 minutes. In adults, the behavior may seem aggressive or hostile.

A survey of a community sample found that a number of psychiatric disorders and medications were associated with episodes, including bipolar disorder, alcohol abuse, depression and panic and anxiety disorders.

Causes

People who experience confusional arousal disorder often say they wake up and feel like they are in a dream. They can’t remember what happened or where they are, and they react slowly to other people. They may also have trouble concentrating at work or in school. It can be terrifying for a person to have this happen and it can damage self-esteem and their ability to function.

The causes of confusional arousal aren’t well understood. It can occur alone or as a part of another sleep disorder such as sleepwalking or sleep terrors. It’s more common in children and tends to stop by age 10 or so. However, it can recur in adulthood as well.

It is considered a non-rapid eye movement (NREM) parasomnia, and episodes of it are similar to those of sleep terrors or sleepwalking. They involve a lapse in consciousness and an increase in activity, including walking, talking, dressing, eating, and sexual activity. These episodes typically last a few minutes but can last up to 30 minutes.

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To diagnose confusional arousal, a healthcare provider must first rule out any medications or health conditions that might be causing poor sleep. They can ask a patient to keep a sleep diary or do an in-lab test called polysomnography. This test will observe breathing rate and limb movements while you sleep.

Symptoms

If you suffer from confusional arousal disorder, you may feel confused or disoriented when you wake up. You might struggle to open your eyes or move around, and you may have difficulty speaking. Episodes of confusional arousal last for only a few minutes and don’t usually include feelings of terror or fear.

Confusional arousals are non-REM sleep parasomnias that arise from the slow eye movement (SWM) stage of sleep. These episodes usually involve confusing, disoriented behavior and amnesia for the event in the morning. They are common in children, but they can persist into adulthood. In adults, these episodes can be a warning sign of a stroke.

The symptoms of confusional arousal can be similar to those of other conditions, making it hard to diagnose the condition without the help of a specialist. Your doctor will ask you about your medical history and examine you to determine if any underlying conditions are causing the episodes. They might also recommend a sleep study, which will observe your breathing and limb movements while you snooze.

If you’re having recurring confusional arousals, you can try to prevent them by improving your sleep hygiene and reducing stress. It’s best to get plenty of quality sleep, keeping a regular sleep-wake schedule and eliminating triggers like alcohol or drugs. If these measures don’t work, you can ask your doctor about taking medications like clonazepam and imipramine to control the episodes.

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Treatment

Although people with confusional arousal disorder may seem to wake up at times, they typically are not fully awake and have no memory of the event. This can cause them to be confused or irritable. It can also interfere with work performance and cause problems in relationships.

This sleep disorder is different from other types of arousal disorders like night terrors or sleepwalking. It usually takes place during non-rapid eye movement (NREM) sleep, when people are transitioning from light sleep into deeper NREM sleep. It is more common in children and usually stops by age 10 or sooner. However, some people who have confusional arousals go on to develop sleepwalking later in life.

Treatment for this condition is based on improving your overall sleep hygiene. This means getting enough sleep at night and making sure to have a consistent bedtime. You should avoid caffeine and other stimulants before going to sleep. Talk to your doctor if you are taking any medications that might affect your sleep.

The doctor will want to get a complete medical history from you and may ask you to keep a sleep diary for a few weeks. They might also want to do an in-lab sleep study that tracks your brain waves, heartbeat and limb movements while you snooze. If the doctor determines that you are experiencing confusional arousals due to another sleep disorder, treating that will likely decrease the frequency of these episodes.

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Prevention

If you suspect that confusional arousals, also known as sleep drunkenness or dream agitation, are a problem for you, there are a few things you can do. It’s important to talk to your doctor, especially if your episodes occur regularly and cause you or others distress. A doctor will be able to tell whether you are having an episode of confusional arousal or something else such as REM Behavior Disorder (RBD), in which people act out their dreams during REM sleep due to a loss of the physiological muscle paralysis that usually prevents them from acting out their dreams. RBD is usually triggered by alcohol and can be dangerous to the individual and their bed partner.

It’s also important to discuss your sleeping habits with your doctor, including a review of your sleep diary and notes from your bed partner if you have one. This information will help your doctor to understand your symptoms and decide on a treatment plan.

Improvements in your sleep hygiene — sticking to a regular sleep-wake schedule and making sure you get enough restful nights — can help to prevent confusional arousals. You can also try relaxation techniques and stress reduction strategies to calm your mind before going to bed. If these don’t work, your doctor may want to do a sleep study, also called polysomnography, to uncover any underlying problems that could be causing confusional arousals.