| Important points | Summary |
|---|---|
| What is confusional awakening? | Confusional awakening is a sleep disorder characterized by inappropriate behavior and temporary disorientation upon awakening, with incoherent speech and illogical gestures. |
| What causes confusional awakening? | The main causes are sleep deprivation, stress, mood disorders, circadian rhythm disturbances, alcohol/medication consumption and coexisting sleep disorders. |
| What are the symptoms of confusional awakening? | Symptoms include temporal and spatial disorientation, inappropriate behaviors, psychomotor slowing, amnesia of the episode and sometimes transient hallucinations/delusions. |
| Difference between confusional awakening and other sleep disorders | Confusional awakening differs from somnambulism, night terrors, REM sleep behavior disorder and sleep paralysis in its symptoms and the stage of sleep involved. |
| Risk factors and vulnerable populations | Children, the elderly, neurological disorders and sleep deprivation increase the risk of confusional awakening. |
| Diagnosis and assessment of confusional awakening | The diagnosis is based on anamnesis, sleep diary, clinical examination, polysomnography and actigraphy. |
| Treatment and management of confusional awakening | Treatment includes sleep hygiene, cognitive-behavioral therapy and medical devices such as the Back2Sleep intranasal orthosis. |
What is confusional awakening?
Confusional awakening, also known as "sleep inertia" or "sleep drunkenness", is a sleep disorder belonging to the parasomnias.
It is characterized by inappropriate behavior and temporary disorientation during the transition from sleep to awakening.
What happens during an episode?
The sleeper seems to be waking up, but his behavior indicates otherwise.
He is:
💊 disoriented in time and space,
💊 psychomotor retardation (slowness of thought, speech and comprehension difficulties).
He may make incoherent statements and behave inappropriately or illogically.
What are the causes of confusional awakening?
Sleep deprivation
Chronic sleep deprivation is one of the main causes of confusional awakening.
When you don't get enough sleep, your body is forced to wake up during the deep slow-wave sleep phases, increasing the risk of confusional episodes upon awakening.
Poor-quality sleep disrupts sleep architecture and encourages sudden awakenings from deep sleep.
Stress and mood disorders
Important risk factors for confusional awakening are:
💊 chronic stress,
💊 anxiety,
💊 depression,
💊 other mood disorders.
Around 37% of people suffering from confusional awakenings also have a mental disorder.
Circadian rhythm disorders
Disturbances of the natural circadian rhythm such as :
💊 shift work,
💊 jet lag,
💊 irregular sleep schedules.
They can lead to confusional awakenings.
These factors desynchronize the biological clock and disrupt sleep cycles, increasing the risk of waking from deep sleep.
Alcohol and medication consumption
Consumption of alcohol and certain medications, in particular:
💊 sleeping pills,
💊 antidepressants,
💊 anxiolytics.
It can fragment sleep and cause sudden awakenings.
Coexisting sleep disorders
It is often observed in people suffering from other sleep disorders such as :
💊 sleep apnea,
💊 restless legs syndrome,
💊 insomnia.
What are the symptoms of confusional awakening?
Temporal and spatial disorientation
The person is completely disoriented in time and space.
He/She doesn't know where he/she is or what time it is.
This disorientation can last from a few minutes to an hour or so.
Inappropriate and illogical behavior
The person may exhibit inappropriate, illogical or incoherent behaviors during the episode.
For example, it can:
💊 make meaningless statements,
💊 be aggressive,
💊 make strange gestures without being aware of it.
Psychomotor retardation
It is often accompanied by a marked psychomotor slowdown.
The person has difficulties:
💊 to talk,
💊 to move,
💊 to understand the instructions given.
His movements and speech are slow and slurred.
Episode amnesia
In most cases, the person has no memory of the episode once it's over.
Amnesia about the event is almost complete.
Hallucinations and transient delusions
During the episode, some people may experience visual or auditory hallucinations and temporary delusions.
These symptoms disappear at the end of the episode.
Difference between confusional awakening and other sleep disorders
Sleepwalking
The somnambulism like confusional awakening, is one of the parasomnias of deep slow-wave sleep.
However, unlike confusional awakening, where the subject is disoriented and confused, sleepwalking occurs during episodes of deep sleep.
Its engine behavior is complex and automatic, but it remains asleep.
Night terrors
The night terrors also occur during deep slow-wave sleep.
They are characterized by episodes of intense terror with:
💊 extreme fear,
💊 screams,
💊 motor agitation,
💊 faster vital functions.
REM sleep behavior disorder
This rare disorder occurs during REM sleep (rapid eye movement).
The sleeper literally acts out his dreams violently due to a loss of normal muscle atony.
Although confused on awakening, the symptoms differ from the confusional awakening that occurs from deep slow wave sleep.
Sleep paralysis
The sleep paralysis is a parasomnia that occurs during transitions between wakefulness and REM sleep.
The subject is temporarily paralyzed, but conscious, which can lead to a feeling of oppression and hypnagogic hallucinations.
Unlike confusional awakening, the subject is fully awake mentally.
Risk factors and vulnerable populations
Children
It's very common in young children, affecting around 15% of them.
This is due to the immaturity of their nervous system and sleep architecture, with longer and more frequent cycles of deep slow-wave sleep.
Seniors
As people age, they become more vulnerable to sleep disorders and parasomnias such as confusional awakening.
💊 Brain changes,
💊 comorbidities,
💊 medicines,
💊 sleep fragmentation increase the risk.
Neurological disorders
Certain neurological pathologies predispose to confusional awakenings by disrupting sleep architecture and quality, such as:
💊 Brain damage.
Sleep deprivation
Chronic sleep deprivation, whether by choice or due to medical conditions, greatly increases the risk of confusional awakenings by forcing awakenings from deep slow-wave sleep.
Diagnosis and evaluation of confusional awakening
Anamnesis and sleep diary
Healthcare professionals begin by asking patients and their families about:
💊 Symptoms,
💊 Frequency of episodes,
💊 Potential triggers, etc.
A detailed sleep diary is often requested.
Clinical examination
A complete physical examination is performed to detect any underlying pathologies that may be causing sleep disorders.
Cognitive and neurological tests may also be carried out.
Polysomnography
This reference examination records physiological sleep parameters (brain waves, eye movements, breathing, etc.) to identify abnormal awakenings and the sleep stages involved.
It confirms the diagnosis.
Actigraphy
This small device, worn on the wrist like a watch, evaluates sleep-wake cycles over a long period.
Although less accurate than polysomnography, actigraphy provides useful information on sleep hygiene.
Treatment and management of confusional awakening
Sleep hygiene
Adopting good sleep habits helps prevent and manage confusional awakenings.
This includes:
💊 a regular sleep schedule,
💊 a quiet, comfortable environnement,
💊 avoiding stimulants such as caffeine before bedtime,
💊 soothing pre-sleep routines.
Cognitive-behavioral therapy
Cognitive behavioral therapy (CBT) can be beneficial, particularly when confusional awakening is linked to stress, anxiety or depression.
CBT helps to identify and modify thought patterns and behaviors that are detrimental to sleep.
Techniques such as relaxation and cognitive restructuring are taught.
Medical devices
The Back2Sleep is a medical device that can help treat confusional awakenings.
By keeping the airways open during sleep, it promotes more restful sleep and reduces respiratory disturbances that can cause sudden awakenings.
You may also like
View all
- Choosing a selection results in a full page refresh.
- Opens in a new window.