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Sleep Drunkenness: Causes, Symptoms And Treatment

Sleep drunkenness is fairly common among people all over the world. Nevertheless, as a wide majority of the people suffering from sleep drunkenness do not usually remember the specific episodes where they underwent sleep drunkenness, this disorder goes somewhat under-reported, and consequently, underestimated.

Understanding Sleep Drunkenness

Commonly referred to as confusional arousal, a typical episode of sleep drunkenness is when you wake up feeling very confused. People who have sleep drunkenness usually wake up groggily, often without a clue as to the place, time and even the date or day that they woke up in .[1]

It is usually seen that the comparatively younger population is most affected by this disorder, with a majority of cases being reported in adults that are below 35 years of age[2] , regardless of their gender. It is also commonly seen in those people who work the night shifts.

With people working through the night or irregular shifts in high-performance jobs such as at the hospital, sleep drunkenness can seriously undermine their decision-taking abilities when woken for any emergency.

Causes Of Sleep Drunkenness

While sleep drunkenness can affect almost anyone, there are nonetheless certain people who are at a higher risk as compared to the others. People at high risk for such confusional arousals are primarily those already suffering from mental disorders or other conditions, such as.[1]

Bipolar disorders

Also referred to as manic depression, this happens when there are extreme highs and lows of mood and energy reported by the same person. The person suffering from a bipolar disorder might be highly energized and elated in the manic phase which might last for many days or even months at a time. This manic phase is then suddenly replaced by the depressive phase in which the same person suffers from low energy levels and has black moods. Just as the manic phase, the phase of depression can also last for many days or months at a time.[3]

Anxiety disorders

It is a general term covering a wide range of disorders such as panic disorder, social anxiety disorder, general anxiety disorders and many other kinds of specific phobias.

Obstructive Sleep Apnea Syndrome (OSAS)

While sleep apnea is when breathing becomes shallow while sleeping, often the person not even breathing for some time, obstructive sleep apnea [4] is when something is obstructing the upper airways and the person wakes up with a snort or a jerk of the body.

Hypnagogic & hypnopompic hallucinations [5]

The term hypnagogic is used to describe dreamlike hallucinations as one is gradually falling asleep. On the other hand, a hypnopompic hallucination is experienced when one is in the process of waking up.

Violent behaviour

Such behaviours are described by psychologists as intentional and aggressive behaviours specifically directed against a particular person.

Injurious behaviour or problem behaviour

This includes destruction of property, physical or verbal aggression, tantrums, and other self-injurious behaviours (SIBs).[6]


This term is used to define excessive sleepiness which can impair normal functioning and adversely affect performance. There is a great urge for sleeping and difficulty in staying awake during the day. A major health concern, excessive daytime sleepiness (EDS)[7] is a major cause of road accidents.


A disorder which causes difficulty falling asleep as well as staying asleep, causing distress and impairment of judgement during the daytime.[8]

Consumption of alcohol

Alcohol consumption prior to sleeping has also been known to cause sleep drunkenness.

Restless leg syndrome [9] : Those suffering from restless leg syndrome are also known to have frequent episodes of sleep drunkenness.

Medication: Certain medications can also lead to confusional arousal.

Circadian rhythm sleep-wake disorders

Commonly to be understood as situations where the biological clock is all haywire. There are many ways in which the circadian rhythm disorder[10] manifests itself - the person might fall asleep much later than others and wake up later in the morning as well; or the person might go to sleep much before the rest and wake up in the middle of the night; or the person might not follow any specific time schedule at all, falling asleep any time during the day or night.

People who are jetlagged also come under this category. Jetlag is a common reason why people face sleep drunkenness or confusional arousal. This is especially understandable in the sense that suddenly waking up in a strange hotel room would probably disorient the best amongst us anyway.

There is generally seen a close association between sleep drunkenness, OSAS and mental disorders .[11]

Symptoms Of Sleep Drunkenness

Episodes of confusion when waking up from sleep are generally termed as arousal disorders, and can be broadly classified into the three main categories of - confusional arousal or sleep drunkenness, sleep terrors and sleepwalking. [12] In each one of such cases, the patient appears to be awake as well as asleep at the same time.

There is noticeable wakefulness accompanied by distress, along with either none or little awareness of the immediate surroundings. As the sufferer is technically neither fully awake nor completely asleep, there is usually no recall of the episode later.

Common symptoms associated with sleep drunkenness are the following. [13]

 Confusion on being woken, referred to as confusional arousal

 Lacking clarity as to the time of day

 Slow and deliberate speech

 Difficulty in concentrating

 Blunted responses

 Reflexes that seem to be startled or not normal

 Grogginess during day time

 Physical aggression

 General amnesia

 Hallucinations

 Sleepwalking

 Abnormal behaviour

 Aggressive or violent behaviour

A typical episode of confusional arousal can last anything from 5 minutes to 15 minutes. There have also been certain cases of an episode lasting as long as 40 minutes.

Sleep drunkenness usually bypasses the stage commonly referred to as sleep inertia. Somewhere between sleeping and waking, sleep inertia is a stage in which, while the person is awake and aware of his surroundings, his physical movements are still somewhat impaired.

Treatment Of Sleep Drunkenness

While treatment for sleep drunkenness is usually just getting more quality sleep, it is not that easily achieved. A common hurdle in the way of treatment is the fact that a person suffering from sleep drunkenness might not even be aware that he has it.

Also, in a majority of cases of sleep drunkenness, there are underlying mental or even physical disorders that might be causing confusional arousal. For example, often the people suffering from sleep apnea are unaware that they have the condition. It is only when the sufferer has awareness of an untreated disorder that he can seek medical intervention.

Treatment for sleep drunkenness involves the following :[14]

 Avoidance of alcoholic beverages, especially prior to bedtime.

 Trying to get more hours of sleep, typically something between seven to nine hours of sleep is advised.

 Not sleeping or napping during the day, as napping in the day can make it harder for you to fall asleep at night since your body is not as tired as it should have been.

 In case of antidepressants being prescribed by the doctor, taking them exactly as per the doctor's prescription.

 Taking sleeping pills, only under medical supervision. Sleeping pills are only given as the last resort.

Instead of any medications, treatment for sleep drunkenness usually requires lifestyle changes to be made.

Sleep drunkenness must not be underestimated. Usually dismissed as mild confusion on waking up, many a time, people who have witnessed such behaviour in their partners do not force them to seek medical assistance. Since the person experiencing sleep drunkenness is usually quite unaware of the situation and hardly recalls such episodes, it is up to the people around him who should coerce him to get treatment.

Almost all of us must have witnessed sporadically placed similar episodes in our own lives - when on being woken up by the alarm clock we have mistaken it for our cell phone, putting it to our ear instead; or when we wake up quite sure that it is a weekend even when it is Monday - it is only when such episodes occur about once a week with regularity that there is indeed cause for worry.

View Article References
  1. [1] Trotti L. M. (2016). Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness.Sleep medicine reviews,35, 76-84.
  2. [2] Thorpy M. J. (2012). Classification of sleep disorders.Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics,9(4), 687-701.
  3. [3] Hilty, D. M., Leamon, M. H., Lim, R. F., Kelly, R. H., & Hales, R. E. (2006). A review of bipolar disorder in adults.Psychiatry (Edgmont (Pa. : Township)),3(9), 43-55.
  4. [4] Spicuzza, L., Caruso, D., & Di Maria, G. (2015). Obstructive sleep apnoea syndrome and its management.Therapeutic advances in chronic disease,6(5), 273-285.
  5. [5] Waters, F., Blom, J. D., Dang-Vu, T. T., Cheyne, A. J., Alderson-Day, B., Woodruff, P., & Collerton, D. (2016). What Is the Link Between Hallucinations, Dreams, and Hypnagogic-Hypnopompic Experiences?.Schizophrenia bulletin,42(5), 1098-1109.
  6. [6] Waters, P., & Healy, O. (2012). Investigating the Relationship between Self-Injurious Behavior, Social Deficits, and Cooccurring Behaviors in Children and Adolescents with Autism Spectrum Disorder.Autism research and treatment,2012, 156481.
  7. [7] Minshawi, N. F., Hurwitz, S., Fodstad, J. C., Biebl, S., Morriss, D. H., & McDougle, C. J. (2014). The association between self-injurious behaviors and autism spectrum disorders.Psychology research and behavior management,7, 125-136.
  8. [8] Bollu, P. C., Manjamalai, S., Thakkar, M., & Sahota, P. (2018). Hypersomnia.Missouri medicine,115(1), 85-91.
  9. [9] Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., Zhang, G., Lin, Z., Xiong, N., … Wang, T. (2017). Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management.Frontiers in aging neuroscience,9, 171.
  10. [10] Zhu, L., & Zee, P. C. (2012). Circadian rhythm sleep disorders.Neurologic clinics,30(4), 1167-1191.
  11. [11] Gupta, M. A., & Simpson, F. C. (2015). Obstructive sleep apnea and psychiatric disorders: a systematic review.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine,11(2), 165-175.
  12. [12] Roth T. (2007). Insomnia: definition, prevalence, etiology, and consequences.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine,3(5 Suppl), S7-10.
  13. [13] Trotti L. M. (2016). Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness.Sleep medicine reviews,35, 76-84.
  14. [14] Trotti L. M. (2016). Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness.Sleep medicine reviews,35, 76-84.
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Story first published: Tuesday, March 19, 2019, 12:30 [IST]