New research highlights the prevalence and risks of “sleep drunkenness,” a disorder that may affect roughly one in seven people.
Sleep drunkenness, also called confusional arousals, causes confusion or inappropriate behavior immediately after waking. Episodes can range from simple disorientation—such as answering a phone instead of silencing an alarm—to more alarming actions, including unintentionally aggressive behavior or complete amnesia for the event. These episodes often follow a forced awakening and can occur either during the first part of the night or in the morning.
Researchers published the findings in the August 26, 2014 print issue of the journal Neurology. The large-scale study surveyed 19,136 adults across the United States about their sleep habits, mental health history, and medication use to determine how common these confusional arousals are and what factors are linked to them.
The study found that 15 percent of participants reported experiencing at least one episode of sleep drunkenness in the previous year. Among those affected, more than half reported episodes occurring more than once per week, indicating that for many the problem is recurrent rather than isolated.
In most cases, sleep drunkenness did not occur in isolation. The researchers observed that 84 percent of people who experienced confusional arousals also had at least one related condition: a diagnosed sleep disorder, a mental health diagnosis, or ongoing treatment with psychotropic medications such as antidepressants. Fewer than 1 percent of affected individuals had no identifiable related condition.
Mental health conditions were prominent among associated risk factors. Of those reporting sleep drunkenness, 37.4 percent also had a diagnosed mental disorder. The analysis showed higher likelihoods of confusional arousals among people with depression, bipolar disorder, alcoholism, panic disorder, post-traumatic stress disorder (PTSD), and various anxiety disorders.
Medication use was another important association: roughly 31 percent of individuals with sleep drunkenness were taking psychotropic medications, including antidepressants. The study also linked sleep duration extremes to higher rates of confusional arousals. About 20 percent of people sleeping less than six hours per night experienced episodes, and 15 percent of those sleeping nine hours or more reported similar occurrences. Sleep-disordered breathing, including sleep apnea, was also more common among those with sleep drunkenness.
“These episodes of waking up confused have received considerably less attention than sleepwalking even though the consequences can be just as serious,” said Maurice M. Ohayon, MD, DSc, PhD, of Stanford University School of Medicine, one of the study authors. He emphasized the need for greater awareness and further research to clarify when these episodes occur and how they might be effectively treated.
Given the high prevalence in a representative sample of the general population, the authors suggest clinicians and people with sleep or mental health conditions should be alert to the possibility of confusional arousals. Identifying underlying contributors—whether psychiatric diagnoses, medication effects, or other sleep disorders—can inform management strategies and reduce the potential harms associated with sudden confused awakenings.
The study was supported by the Arrillaga Foundation.
Contact: Rachel Seroka – AAN
Source: AAN press release
Image Source: The image used in this article is credited to Pedro Simões (Creative Commons Attribution 2.0 Generic). It is included here for illustration only.
Original Research: Abstract for “Are confusional arousals pathological?” by Maurice M. Ohayon, Mark W. Mahowald, and Damien Leger in Neurology. Published online August 25, 2014; doi:10.1212/WNL.0000000000000727.