What Are the Causes of Confusional Arousals or Sleep Drunkenness?

Waking Up Confused May Suggest an Underlying Sleep Disorder

Confusional arousals or sleep drunkenness may be caused by other sleep disorders like sleep apnea affecting slow-wave sleep
Confusional arousals or sleep drunkenness may be caused by other sleep disorders like sleep apnea affecting slow-wave sleep. Getty Images

If you have ever witnessed someone wake up, mumble incoherently in a confused state, and quickly fall back asleep, you may be familiar with confusional arousals. Parasomnias are a group of disorders that include these behaviors that occur around sleep. A common parasomnia, more often affecting children, are these confusional arousals. This condition is sometimes referred to as sleep drunkenness. It may be related to sleep terrors.

 What are the causes of confusional arousals and what treatments may be helpful?

Defining Causes of Confusional Arousals and Sleep Drunkenness

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 younger 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.

If they are questioned, someone experiencing a confusional arousal may say something that doesn't make any sense. They may even slur their words. There movements may be semi-purposeful, but lack clear direction. It can be hard to shake the sleep and they may quickly fall back to sleep, almost as if they are drunk.

Due to these observations, the term "sleep drunkenness" is sometimes applied to the phenomenon.

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 or stage 3 sleep.

This deeper, slow-wave sleep is more prevalent in children, which might explain why they more often experience parasomnias. It predominates in the first third of the night. As we get older, the amount of slow-wave sleep we obtain naturally declines.

Other common parasomnias include sleepwalking and sleep terrors arise from slow-wave sleep. 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 asthma at night, sleep apnea, or restless legs syndrome may cause a person to shift into light stages of sleep. These problems may result in confusional arousals and sleep terrors.

Therefore, though the arousal itself does not need to be treated, any underlying sleep disorder should be appropriately diagnosed and treated. By addressing the trigger, the secondary events may be completely eliminated. It may also be helpful to schedule awakenings to reduce these events, and devices exist that may be helpful.


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

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