Sleep drunkenness

Sleep drunkenness also known as confusional arousals or severe sleep inertia, is a sleep disorder that causes you to act in a very strange and confused way as you wake up or just after waking. Research finds 1 out of 7 may experience sleep drunkenness ¹. The researchers also say 84 percent of the people with sleep drunkenness also had a sleep disorder, mental health disorder, or were taking psychotropic drugs, such as antidepressants ¹.

Of the study participants with sleep drunkenness ¹:

• 37.4 percent had a mental health disorder, such as depression, bipolar disorder, alcoholism, panic or post-traumatic stress disorder or anxiety. The highest odds were observed people with bipolar disorders or panic disorder.
• 31 percent were on psychotropic medications, such as antidepressants.

But researchers say the amount of sleep you get may also play a role ¹. Both long and short sleep times are associated with the disorder. That’s because 20 percent of the people who’ve experienced “sleep drunkenness” admitted getting less than six hours of sleep per night, while 15 percent of them were getting at least nine hours.

Sleep drunkenness are considered a parasomnia. This class of sleep disorder involves unwanted events or experiences that occur while you are falling asleep, sleeping or waking up. Sleep drunkenness involve mental confusion or inappropriate behavior during or following arousals from sleep, typically from slow-wave sleep in the first part of the night, but also upon awakening in the morning ¹. Sleep drunkenness may appear that you don’t know where you are or what you are doing.

Your behavior may include the following:

• Slow speech
• Confused thinking
• Poor memory
• Blunt responses to questions or requests

Sleep drunkenness or severe “sleep inertia” refers to the transitional state between sleep and wake, marked by impaired performance, reduced vigilance, and a desire to return to sleep. Sleep drunkenness episode can be triggered by a forced awakening and may even cause violent behavior during sleep or amnesia of the episode.

Sleep drunkenness tend to occur as you wake from slow-wave sleep. This sleep stage is most common in the first third of the night. In some cases, these episodes may occur later in the night or during a daytime nap.

When a sleep drunkenness occurs, you may seem to be awake even though you have a foggy state of mind. Episodes often start when someone else has to physically wake you up. Sleepwalking or shouting during an episode is common. Some people with sleep drunkenness also grind their teeth. These incidents may last a few minutes up to several hours. People with sleep drunkenness tend to have no memory of these episodes.

In some rare cases, adults may act very inappropriately or even hostile and aggressive. This behavior can put a huge strain on relationships. These extreme episodes are uncommon for most people who have confusional arousals.

Episodes of sleep drunkennesss in children may seem bizarre and frightening to parents. The child can have a confused look on his or her face and “stare right through” you. Children may become more agitated when you try to comfort them.

The intensity and duration of sleep drunkenness vary based on situational factors, but its effects may last minutes to several hours. Most episodes last from five to fifteen minutes. But they may last as long as thirty to forty minutes in some youth.

Sleep drunkenness is a normal phenomenon, but one with potentially dangerous ramifications, e.g., in health care workers or military personnel who are woken abruptly in the night and required to make cognitively-taxing decisions ². In some disease states, a transitional period akin to markedly pronounced sleep inertia is present and is sometimes referred to as “sleep drunkenness”. Such pronounced sleep inertia is a core feature of idiopathic hypersomnia, a potential consequence of delayed sleep phase syndrome and a contributor to non-REM (NREM) arousal parasomnia severity ³. Difficulty awakening is also common in people with mood disorders and may be an important treatment target ⁴.

Optimal treatment of sleep drunkenness is unknown, although several medications have been used with benefit in small case series ⁵. Difficulty with awakening is also commonly endorsed by individuals with mood disorders, disproportionately to the general population. This may represent an important treatment target, but evidence-based treatment guidance is not yet available.

Sleep Stages

Sleep occurs in 2 main phases, Non-Rapid Eye Movement (NREM) sleep, which has three stages (N1, N2, and N3), and Rapid Eye Movement (REM) sleep ⁶. Each sleep phase and stage of sleep includes variations in muscle tone, brain wave patterns, and eye movements. Your body cycles through all stages approximately 4 to 6 times each night, averaging 90 minutes for each cycle ⁷. Each sleep stage serves different functions, from the light transition into sleep (N1), to the restorative deep sleep (N3) and the active dreaming of REM sleep.

Sleep Stages ⁸, ⁹:

• Stage 1 (N1 or light sleep) is the lightest stage of sleep and occurs as a person first falls asleep. This brief stage is when your drowsiness gives way to falling asleep. Your heartbeat and breathing start to slow down, but it’s still pretty easy to wake you up during this stage. Average length 1 to 7 minutes.
• Stage 2 (N2 or intermediate sleep) is where the body starts to relax more deeply. Your body temperature drops, your muscles relax, and your breathing and heart rate slow even more. Average length 10 to 25 minutes.
• Stage 3 (N3 or deep sleep) is the deepest and more restorative sleep, allowing your body to recover and grow. In stage 3 sleep, your breathing and pulse are slow and steady. Average length 20 to 40 minutes.
• Stage 4 (REM Sleep) is where most dreaming occurs, brain activity increases almost as if you were awake, and your muscles become temporarily paralyzed. Your heart rate and respiration speed up and become more erratic, and your eyes move quickly behind your eyelids. Dreams are most vivid during the REM stage. Average length 10 to 60 minutes.

Although the sleep stages are described numerically, you don’t always progress through them in this exact order. For example, in many sleep cycles, you transition from stage 3 sleep back to stage 2 sleep before beginning a period of REM sleep.

Sleep occurs in 5 stages: Wake, Non-Rapid Eye Movement (NREM) stage N1, then progress through N2 and N3, and after N3 you enter REM sleep ⁶. You then return to NREM stages, often starting again at N2. Throughout the night, the REM periods lengthen, and deep N3 sleep decreases, with most N3 sleep occurring in the first half of the night, with each stage leading to progressively deeper sleep. Approximately 75% of sleep is spent in the NREM (Non-Rapid Eye Movement) stages, with the majority spent in the N2 stage ¹⁰. A typical night’s sleep consists of 4 to 5 sleep cycles, with the progression of sleep stages in the following order: N1, N2, N3, N2, REM ¹¹. A complete sleep cycle takes roughly 90 to 120 minutes. The first REM period is short, and as the night progresses, longer periods of REM and decreased time in deep sleep (NREM) occur ⁶. With each new cycle, you spend increasing amounts of time in REM sleep, so most of your REM sleep takes place in the second half of the night.

Sleep isn’t uniform. Sleep cycles can vary from person to person and from night to night based on a wide range of factors such as your age, recent sleep patterns, and alcohol consumption. Over the course of the night, you go through several rounds of the sleep cycle, which is composed of four stages. In a typical night, a person goes through four to six sleep cycles ⁶. Not all sleep cycles are the same length, but on average they last about 90 minutes each.

The first sleep cycle is often the shortest, ranging from 70 to 100 minutes, while later cycles tend to fall between 90 and 120 minutes. In addition, the composition of each cycle — how much time is spent in each phase of sleep — changes as the night goes along.

Figure 1. Sleep Stages

Footnotes: A sleep episode begins with a short period of NREM stage N1 progressing through stage N2, followed by stage N3 and finally to REM. However, individuals do not remain in REM sleep the remainder of the night but, rather, cycle between stages of NREM and REM throughout the night. NREM sleep constitutes about 75 to 80 percent of total time spent in sleep, and REM sleep constitutes the remaining 20 to 25 percent. The average length of the first NREM-REM sleep cycle is 70 to 100 minutes. The second, and later, cycles are longer lasting—approximately 90 to 120 minutes ¹². In normal adults, REM sleep increases as the night progresses and is longest in the last one-third of the sleep episode. As the sleep episode progresses, stage 2 begins to account for the majority of NREM sleep, and stages 3 and 4 may sometimes altogether disappear.

[Source ⁸ ]

Figure 2. Typical Sleep Pattern in Young Adults 

Footnotes: Average times and sequences of sleep cycles during the night. Over the course of a period of sleep, NREM and REM sleep alternate cyclically. The function of alternations between these two types of sleep is not yet understood, but irregular cycling and/or absent sleep stages are associated with sleep disorders ¹³. For example, instead of entering sleep through NREM, as is typical, individuals with narcolepsy enter sleep directly into REM sleep ¹⁴. Rapid eye movement (REM) sleep occurs cyclically throughout the night every 90 to 120 minute. Brief periods of wakefulness (stage W) occur periodically.  Sleep time is spent as follows:

• Stage N1: 2–5%
• Stage N2: 45–55%
• Stage N3: 13–23%
• REM: 20–25%

[Source ¹⁵ ]

Figure 3. EEG activity of the four stages of sleep

Footnotes: EEG activity during wakefulness with eyes open and closed and during the different stages of sleep. Brainwave activity changes drastically over the course of the different stages of sleep. REM sleep brain activity most closely resembles brain activity while awake.

• Alpha activity is a smooth electrical activity of 8-12 Hz recorded from the brain; generally associated with a state of relaxation during wakefulness.
• Beta activity is a irregular electrical activity of 13-30 Hz recorded from the brain; generally associated with a state of alertness during wakefulness.
• Theta activity is EEG activity of 3.5-7.5 Hz that occurs intermittently during lighter stages of NREM sleep.
• Delta activity is a regular, synchronous electrical activity of less than 4 Hz recorded from the brain; occurs during the deepest stages of slow-wave sleep.
• Sleep spindle is a short burst of 12 to 14 cycle per-second waves observed during NREM sleep, decrease brain’s sensitivity to sensory input and keeps person asleep.
• K complex are single delta waves, sudden sharp wave forms, 1 per minute but can be triggered by noise.

[Source ¹⁶ ]

Your sleep-wake cycle is regulated by the circadian rhythm (your body’s natural internal 24-hour clock that manages your sleep-wake cycle and other vital functions, like hormone release and body temperature, by synchronizing with the day-night cycle), which is driven by the suprachiasmatic nucleus (SCN) of the hypothalamus that acts as a “master clock” or “circadian pacemaker”, receiving light cues from your eyes to control the circadian rhythm ¹⁷, ¹⁸, ¹⁹. The circadian rhythm also controls the nocturnal release of adrenocorticotropic hormone (ACTH), prolactin, melatonin, and norepinephrine (NE) ²⁰. External factors like light exposure, meal timing, and activity can influence the circadian rhythm, and disruptions to the circadian rhythm, such as from shift work or jet lag, can negatively affect your health.

The suprachiasmatic nucleus (SCN) of the hypothalamus receives input from nerve cells in the retina that detect light to regulate the circadian rhythm and sleep via multiple pathways that cause the nocturnal release of adrenocorticotropic hormone (ACTH), prolactin, melatonin, and norepinephrine ²¹. One of the most commonly recognized pathways by which this occurs is via the stimulation of norepinephrine release by the suprachiasmatic nucleus (SCN), which in turn stimulates the pineal gland to release melatonin ²², ¹⁹. Wakefulness is maintained by subcortical structures and pathways activating the cortical system ²². This system is termed the “ascending arousal system” and utilizes several major neurochemicals, including:

• Norepinephrine (locus ceruleus)
• Serotonin (midline raphe nuclei)
• Histamine (tuberomammillary nucleus)
• Dopamine (ventral periaqueductal gray matter)
• Acetylcholine (pedunculopontine tegmentum and laterodorsal tegmentum of the pons)
• Orexin (perifornical area)

Transitions between sleep and wake states are influenced by multiple brain structures, including ⁶:

• Hypothalamus: controls onset of sleep
• Hippocampus: memory region active during dreaming
• Amygdala: emotion center active during dreaming
• Thalamus: prevents sensory signals from reaching the cortex
• Reticular formation: regulates the transition between sleep and wakefulness
• Pons: helps initiate REM sleep. The extraocular movements (eye movements) that occur during REM sleep are due to the activity of PPRF (paramedian pontine reticular formation/conjugate gaze center).

Although it is apparent that humans need sleep, the current understanding of why sleep is an essential part of life is still yet to be determined ⁶. The current hypotheses on the function of sleep include ²³:

• Neural maturation
• Facilitation of learning or memory
• Targeted erasure of synapses to “forget” unimportant information that might clutter the synaptic network
• Cognition
• Clearance of metabolic waste products generated by neural activity in the awake brain
• Conservation of metabolic energy.

Wake or Alert Stage

The first stage is the wake stage or stage W, which further depends on whether your eyes are open or closed. During wakefulness, the EEG is characterized by waves of low amplitude and high frequency. This kind of EEG pattern is known as low-voltage fast activity or activated. During eye-open wakefulness, beta waves predominate. Alpha waves (8–13 Hz) become the predominant pattern as you become drowsy and close your eyes, particularly in occipital regions ²⁴. The Electromyography (EMG, a test that measures the electrical activity of muscles) reveals tonic muscle activity with additional phasic activity related to voluntary movements.

EEG recording: beta waves – highest frequency, lowest amplitude (alpha waves are seen during quiet/relaxed wakefulness)

Non-Rapid Eye Movement (NREM) Sleep Stages

• Stage N1 (Light Sleep): This is the transition between wakefulness and sleep, characterized by slowing heart rate and breathing.
• Stage N2 (Intermediate Sleep): Your heart rate and body temperature decrease further, and your body relaxes.
• Stage N3 (Deep Sleep): This is the deepest stage of Non-Rapid Eye Movement (NREM) sleep, when your body performs restorative work, and it is crucial for feeling rested.

Stage 1 or N1 Sleep

NREM Stage 1 (N1) or Light Sleep serves a transitional role in sleep-stage cycling. This is the lightest stage of sleep and begins when more than 50% of the alpha waves are replaced with low-amplitude mixed-frequency (LAMF) activity. Muscle tone is present in the skeletal muscle, and breathing occurs regularly. This stage lasts around 1 to 7 minutes in the initial cycle, comprising 5% of total sleep time and is easily interrupted by a disruptive noise.

Brain activity on the EEG in stage 1 transitions from wakefulness (marked by rhythmic alpha waves) to low-voltage, mixed-frequency waves. Alpha waves are associated with a wakeful relaxation state and are characterized by a frequency of 8 to 13 cycles per second ¹⁴.

EEG recording: Theta waves – low voltage.

Stage 2 or N2 Sleep

NREM Stage 2 (N2) represents deeper sleep as the heart rate and body temperature drop ⁶. The presence of sleep spindles, K-complexes, or both characterizes it ⁶. Sleep spindles are brief, powerful bursts of neuronal firing in the superior temporal gyri, anterior cingulate, insular cortices, and thalamus, inducing calcium influx into cortical pyramidal cells. This mechanism is believed to be integral to synaptic plasticity. Numerous studies suggest that sleep spindles are essential in memory consolidation, specifically procedural and declarative memory ²⁵. Individuals who learn a new task have a significantly higher density of sleep spindles than those in a control group ²⁶.

K-complexes are long delta waves that last approximately one second and are known to be the longest and most distinct of all brain waves. K-complexes are shown to function in maintaining sleep and memory consolidation ²⁷.

Stage 2 sleep lasts approximately 10 to 25 minutes in the initial cycle and lengthens with each successive cycle, eventually constituting between 45 to 55 percent of the total sleep episode. Stage 2 sleep is when bruxism (teeth grinding) occurs. An individual in stage 2 sleep requires more intense stimuli than in stage 1 to awaken. Brain activity on an EEG shows relatively low-voltage, mixed-frequency activity characterized by the presence of sleep spindles and K-complexes.

EEG recording: Sleep spindles and K complexes.

Stage 3 or N3 Sleep (Deepest Non-REM Sleep)

Sleep stage 3 or N3 sleep is also known as slow-wave sleep (SWS). This is considered the deepest stage of sleep and is characterized by signals with lower frequencies and higher amplitudes, known as delta waves ⁶. Sleep stage 3 or N3 sleep is the most difficult to awaken from; for some people, loud noises (> 100 decibels) will not lead to an awake state ⁶. As people age, they spend less time in this slow, delta-wave sleep and more time in stage N2 sleep ⁶. Although this stage has the greatest arousal threshold, if someone is awoken during this stage, they will have a transient phase of mental fogginess, known as sleep inertia ⁶. Cognitive testing shows that individuals awakened during this stage tend to have moderately impaired mental performance for 30 minutes to 1 hour ²⁸. Sleep stage 3 or N3 sleep stage is when the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system. Sleep stage 3 or N3 sleep is also the stage when sleepwalking, night terrors, and bedwetting occur ²⁹.

Sleep stage 3 or N3 sleep lasts only a few minutes and constitutes about 3 to 8 percent of sleep. The EEG shows increased high-voltage, slow-wave activity.

EEG recording: Delta waves – lowest frequency, highest amplitude.

Rapid Eye Movement (REM) Sleep Stage

Rapid eye movement sleep or REM sleep is the fourth and final stage of sleep and is when you have your most vivid and intense dreams. During REM sleep your brain activity increases to near-waking levels, your eyes dart quickly under your eyelids with fluctuating in your breathing and heart rate and most vivid dreams occur in this phase of sleep. Your muscles become limp (atonia) to prevent you from acting out your dreams. EEG recording shows beta waves – similar to brain waves during wakefulness. You experience your first period of REM sleep about 60 to 90 minutes after falling asleep ²¹.

REM sleep is defined by the presence of desynchronized (low-voltage, mixed-frequency) brain wave activity, muscle atonia, and bursts of rapid eye movements ¹⁴. “Sawtooth” wave forms, theta activity (3 to 7 counts per second), and slow alpha activity also characterize REM sleep ¹². During the initial cycle, the REM period may last only 1 to 5 minutes; however, it becomes progressively prolonged as the sleep episode progresses ¹².

Most adults need about 2 hours of REM sleep each night, which contributes to brain development, brain function, memory consolidation, and emotional health ³⁰, ³¹.

Infants and children need more REM sleep, because their brains are still rapidly developing. For example, newborn babies spend around eight hours in REM sleep each day.

How much time you actually spend in REM sleep can vary from night to night. On a night when you’re short of sleep, your total REM time can get cut short. This can trigger your brain to initiate more REM sleep the following night, which is known as a REM rebound ³². Some research also suggests that REM sleep may increase after learning new information ³³.

Because REM sleep enables better brain function, memory, and emotional regulation, a lack of REM sleep can cause a range of issues. On top of that, a lack of REM sleep circumvents healthy sleep overall, contributing to sleep deprivation. In the short term, signs of sleep deprivation can include ³⁴:

• Difficulty concentrating
• Excessive daytime sleepiness
• Forgetfulness or poor memory
• Irritability or frustration
• Greater risk of accidents

Over the long term, insufficient sleep can weaken your immune system and raise your risk of conditions like heart disease, diabetes, depression, and anxiety.

How Much Deep Sleep Do I Need?

Different people need different amounts of sleep. Most adults need 7 to 8 hours of sleep a night for good health and mental functioning. Some adults need up to 9 hours a night ³⁵. During a healthy night’s sleep for most adults, deep sleep (stage 3 or N3 sleep) makes up between 10% and 20% of total sleeping time ³⁶. People who sleep less than approximately 7 hours a night are at a greater risk for heart disease, stroke, asthma, arthritis, depression, and diabetes. Nearly 20% of all car crashes, both fatal and nonfatal, are attributed to drowsy driving. Without enough sleep, your brain may struggle to perform basic functions. You may find it hard to concentrate or remember things. You may become moody and lash out at co-workers or people you love.

If you’re not sure about how much sleep you really need, you can use an online Sleep Calculator (https://www.sleepfoundation.org/sleep-calculator). However, your doctor is in the best position to make a detailed sleep recommendation for you based on your age, your overall health and your unique situation.

Table 1. Recommended Sleep Duration

	Age Range	Recommended Daily Sleep
Infant	4–12 months	12-16 hours (including naps)
Toddler	1–2 years	11-14 hours (including naps)
Preschool	3–5 years	10-13 hours (including naps)
School-age	6-12 years	9-12 hours
Teens	13-18 years	8-10 hours
Adults	18 years and older	7 or more hours

[Source ³⁷ ]

Just as your brain needs sleep to restore itself, so does your body. When you do not have enough sleep, your risk goes up for several illnesses.

• Diabetes. Your body does not do as well controlling blood sugar when you do not get enough sleep.
• Heart disease. Lack of sleep can lead to high blood pressure and inflammation, two things that can damage your heart.
• Obesity. When you do not get enough rest from sleep, you are more prone to overeat. It is also harder to resist foods high in sugar and fat.
• Infection. Your immune system needs you to sleep so it can fight colds and keep you healthy.
• Mental health. Depression and anxiety often make it hard to sleep. They also can become worse after a string of sleepless nights.

The cancer research branch of the World Health Organization has determined that disruption of regular sleep is “probably carcinogenic to humans”, putting it in the same risk category as the infectious agents malaria and human papillomavirus (HPV), as well as the biochemical weapon mustard gas. Sexual health is affected by sleep deprivation as well, as men with the worst sleeping habits have significantly lower sperm counts, decreased circulating testosterone, and even testicular shrinkage.

Adults generally need about 1.5 to 2 hours of deep sleep per night, which equates to roughly 13-23% of their total recommended sleep time. This stage of sleep is crucial for physical recovery, immune function, and cognitive health, so ensure you are getting sufficient overall sleep and practicing healthy sleep habits to obtain enough deep sleep

Why Deep Sleep is Important?

While all stages of sleep are necessary for good health, deep sleep is important because it is when your body undergoes essential physical restoration, immune system strengthening, and hormone production, while your brain processes and stores memories, consolidates learning, and clears waste products ⁹. During deep sleep, your body works to build and repair tissue, muscles, and bones, including by producing high levels of growth hormone ³⁸. Achieving sufficient deep sleep helps you wake feeling refreshed, promotes long-term physical and mental health, and supports healthy weight and cardiovascular function ⁹. Deep sleep also promotes immune system functioning. Research suggests that it helps you build stronger immune responses and reduce unwanted chronic inflammation ³⁹.

Slow-wave sleep also helps regulate blood sugar levels. As a result, the risk of developing type 2 diabetes may be higher if you don’t get enough deep sleep ⁴⁰. And a shortage of deep sleep has also been linked to high blood pressure ⁴¹.

Deep sleep is important for cognitive function and memory. Although brain activity slows during deep sleep, this may actually facilitate learning by keeping the brain from becoming oversaturated with information. Evidence suggests that deep sleep also helps eliminate waste material from the brain, which may help protect against dementia ⁴².

Because deep sleep is an essential component of your nightly rest, a shortage of deep sleep contributes to broader impacts of sleep deprivation. In addition to causing tiredness, a shortage of deep sleep can cause general symptoms of sleep deprivation, including ⁴³:

• Reduced alertness and attention
• Trouble learning and remembering things
• Irritability
• Symptoms of depression or anxiety
• Increased likelihood of accidents and injuries

On top of these immediate effects, a chronic lack of quality sleep can increase the likelihood of multiple health problems, such as:

• Infections and reduced immune system function
• Obesity
• Type 2 diabetes
• Cardiovascular problems, including high blood pressure, stroke, and heart disease
• Kidney disease

If you want to get more deep sleep, focus on enhancing your overall sleep. If your sleep quality and quantity are good, it usually means you’re getting plenty of restorative deep sleep. You get the most deep sleep during the early part of the night.

One of the most reliable ways to improve your sleep is by practicing good sleep hygiene. Good habits include ⁴⁴:

• Establishing a consistent bedtime and wake-up time
• Ensuring you have a quiet, cool, and dark sleep environment
• Creating a relaxing bedtime routine to wind down in the evening
• Reducing caffeine intake in the afternoon and evening
• Limiting use of mobile devices, tablets, laptops, and other screens for 30 minutes or more before bedtime

There are some additional steps you can try to encourage more deep sleep:

• Take a warm bath: Some research suggests that heating your body with a warm bath before bedtime may induce more slow-wave sleep ⁴⁵. A warm bath raises body temperature, which promotes blood circulation, and the subsequent cooling may help ease the transition to sleep.
• Change your diet: What you eat and drink before bedtime impacts your sleep. One small study found that people eating a diet high in saturated fats obtained less slow-wave sleep ⁴⁶. People who ate more fiber were more likely to have increased amounts of deep sleep.
• Listen to binaural beats: Binaural beats are created by listening to two slightly different tones, one in each ear. The difference between the frequencies of those tones creates a perceived third tone, or binaural beat. Limited research suggests that listening to certain binaural beats may contribute to more stage 3 sleep ⁴⁷.

Sleep drunkenness causes

More studies are needed to pinpoint an actual cause for sleep drunkenness. Sleep drunkennesss are more likely if you have a relative with this sleep disorder. Other factors that can increase your risk for sleep drunkenness disorder include:

• Rotating shift work
• Night shift work
• Other sleep disorders (hypersomnia, insomnia, circadian rhythm sleep disorders)
• Not enough sleep
• Stress
• Worry
• Bipolar and depressive disorders

Potential causes for sleep drunkenness disorder include the following:

• Recovery from sleep deprivation
• Alcohol consumption
• Obstructive sleep apnea (OSA)
• Periodic limb movement disorder
• Psychotropic medication use
• Drug abuse
• Being forced to wake up

Sleep drunkennesss occur at the same rate among both men and women. Rates are high among children and adults under the age of 35. It may occur in as many as 17 percent of children. About three to four percent of adults have sleep drunkennesss.

Sleep drunkenness symptoms

Sleep drunkennesss causes you to act in a very strange and confused way as you wake up or just after waking. It may appear that you don’t know where you are or what you are doing. Your behavior may include the following:

• Slow speech
• Confused thinking
• Poor memory
• Blunt responses to questions or requests

When a sleep drunkenness occurs, you may seem to be awake even though you have a foggy state of mind. Episodes often start when someone else has to physically wake you up. Sleepwalking or shouting during an episode is common. Some people with sleep drunkennesss also grind their teeth. These incidents may last a few minutes up to several hours. People with sleep drunkennesss tend to have no memory of these episodes.

Sleep drunkenness diagnosis

Self test

• Has someone told you that you act in a way that is strange or confused when they wake you?
• Has this behavior been described as being hostile or aggressive?
• Have these actions been inappropriate in any way?
• Is this a pattern of behavior that occurs on a regular basis?

If your answer to each of these questions is yes, then you might have sleep drunkennesss. Because you may have no memory of the events, it can be hard for you to know on your own.

You will need to see a sleep specialist because this sleep disorder can cause severe problems. The doctor will require you to complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing your problems. You can also rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life.

The doctor will need to know your complete medical history. Be sure to inform him or her of any past or present drug and medication use.

You may need to do an in-lab sleep study. This type of sleep study charts your brain waves, heart beat and breathing as you sleep. It also records how your arms and legs move. An in-lab study will show if there are other disorders, such as sleep apnea or a movement disorder that are causing your sleep problems. Many sleep studies will also record your sleep on video to show if you do anything unusual while you sleep.

Figure 1. Epworth Sleepiness Scale Questionnaire

Sleep drunkenness treatment

Any other sleep disorders that may be the cause of the unusual behavior need to be treated first. It may help if you cut back on alcohol or stop drinking it completely. It is also important that you always get a full night of sleep.

Some reports indicate that medication has helped. Antidepressants and sleeping pills are among the types of medication that have been used. Talk to your doctor for advice about this and any other form of treatment.

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