What Are Confusional Arousals?

Waking Up Confused May Suggest an Underlying Sleep Disorder

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Parasomnias are a group of disorders that include behaviors that occur around sleep. A common parasomnia affecting children is confusional arousals. What are confusional arousals and what can be done about them?

Defining Confusional Arousals

A confusional arousal is just what it sounds like: It describes an episode in which a person wakes up or arouses from sleep and remains in a confused state. These episodes are usually quite mild and often affect children.

Confusional arousals are characterized by the affected person briefly seeming to wake up, sit up, and even look around. They typically remain in bed and return to sleep soon thereafter. The episode lasts from seconds to minutes, and they may not be responsive to stimuli.

Technically, confusional arousals fall into the category of parasomnias. These disorders include many abnormal behaviors that occur during or around sleep. They typically arise from non-rapid eye movement (REM) sleep. This deeper, slow-wave sleep is more prevalent in children, which might explain why they more often experience parasomnias.

Other common parasomnias include sleepwalking and sleep terrors. Parasomnias rarely affect adults, who may more likely experience REM behavior disorder, another condition that is characterized by dream-enactment behavior.

Do Confusional Arousals Need Treatment?

Confusional arousals themselves are pretty harmless.

Unfortunately, they may suggest that there is another sleep disorder present that is causing these partial arousals from sleep. For example, conditions such as nocturnal asthma, sleep apnea, or restless legs syndrome may cause a person to shift into light stages of sleep. These problems may also result in a confusional arousal.

Therefore, though the arousal itself does not need to be treated, any underlying sleep disorder should be appropriately diagnosed and treated.


Durmer, JS and Chervin, RD. "Pediatric sleep medicine." Continuum. Neurol 2007;13(3):153-200.

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