Confusional Arousal: confusion during and following partial arousals from sleep, most typically from the deep (NREM) stages of sleep. is a parasomnia in which a person behaves in a confused way because they are not fully awake or asleep. It is very common in children, although some adults experience them.


      This parasomnia occurs during periods of transition from sleep, either while waking up, or just after waking. For this reason, Confusional Arousals has been labeled as one of three "classical" arousal disorders, along with sleepwalking and sleep terrors. Episodes evolve gradually after a cycle of deep sleep, usually in the first third of the night. Sometimes they arise later in the night, or after a nap.
    Confusion results from a brain that is divided between wakefulness and sleep. You are still in the process of waking up!  Behavior may include: confused thinking, slowed speech, poor memory, or incomplete responses to questions. Parents may find episodes in their children to be bizarre or frightening, if they do not know what to expect. The child may be agitated or appear dazed. Episodes last an average of 5 to 15 minutes, but can last for one half hour or more.
       A variation of confusional arousals called Severe Morning Sleep Inertia  affects teens and adults. Behavior is similar to confusional arousals except that episodes occur in the morning. Also known as sleep drunkenness, this variation tends to affect people consistently every morning, for years. Because the episodes last for longer than just a few minutes, consequences such as traffic accidents and poor job or school performance are common.


       Diagnosis begins with a careful medical history to determine whether the arousals are secondary to another health condition, or a side effect of certain medications. Providing a two week sleep log of your (or your child's) sleep habits and possibly video tapes will demonstrate the episodes to your doctor or sleep specialist. An overnight sleep study will be key to conclusively identifying this sleep disorder, which can look similar to sleepwalking and sleep terrors.
     The sleep study involves an overnight polysomnogram, which records brainwaves, muscular activity and breathing during sleep. The sleep study may also record your sleep on videotape.


Behavioral Modification is an important part of treating Confusional Arousals in both adults and children. Incorporating
Healthy Sleep Habits will eliminate unnecessary interruptions during sleep. Limiting or avoiding the use of alcohol, especially during the evening hours may also help.
        Parents can take specific measures to ensure their child's safety during an episode. Keep in mind that your child will not remember the episode.

>  Respond in a calm, reassuring manner to avoid frightening her.
>  Try not to awaken your child.
>  Watch over your child until she returns to sleep.

        Medication may be helpful for severe or persistent episodes. Antidepressents and sleeping pills may be prescribed.

Confusional Arousal Mechanics

     Sleep specialists define sleep according to stages or degrees of sleep. The brain behaves differently during each sleep stage. Confusional arousals occur during stages 3-4 of NREM sleep, the deepest sleep. NREM sleep is not associated with much dreaming, so the arousals are not nightmares or vivid dreams. Part of the brain remains asleep while areas involved with movement, thinking, and emotion become "awakened" or activated. They are not activated enough to render the person fully conscious of their words and actions, nor is the episode likely to be remembered.

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Confusional Arousals