Confusional Arousals
First created | 10/01/2000
Last edited |
05/11/2012
Summary by Maurice M.
Ohayon, MD, DSc, PhD
Reference to cite:
Ohayon MM, Priest RG, Zulley J, Smirne S.
The place of confusional arousals in sleep and
mental disorders: General population findings (13057 subjects). Journal of
Nervous and Mental Diseases 2000; 188:340-348.
Sleep drunkenness, or confusional
arousal, is a sleep disorder characterized by periods of mental confusion
occurring upon wakening at night or in the morning
The individual presents an alteration of cerebral reactivity to external stimuli
which occurs in the transitional period from NREM sleep to wakefulness
(Broughton, 1968).
The affected subject appears awake but behavior may be very inappropriate, with
memory deficits, disorientation in time and space and slow mentation and speech.
Confusional arousal is also referred to as
Sleep drunkenness,
Schlaftrunkenheit
(German), Ivresse du sommeil
(French) or excessive sleep inertia.
This sleep disorder is a
parasomnia, classified by the International Classification of Sleep
Disorders (ICSD, 1990, 1997) in the section describing disorders of arousals.
Laboratory studies with humans have shown it exists a period of sleep inertia
that occurs upon the awakening (Achermann et al., 1995; Balkin & Badia, 1988;
Jewett et al., 1999).
This period is characterized by a reduced vigilance
and impaired cognitive response which return to normal within 30 minutes to more
than one hour.
The severity of sleep inertia or the time course of its dissipation is not
related to the sleep stage when the awakening occurs (Jewett et al., 1999).
In animals, sudden awakenings by an external stimuli
from non-REM sleep, provoke a reduction of the pre-pulse inhibition of the
startle reflex which is not observed in spontaneous arousals.
This mechanism would play a protective role for the
survival of the animal that needs to response quickly to potential threats when
it is suddenly aroused (Horner et al., 1997).
History of the disorder
The description of confusional arousals is not new.
One can find in The Odyssey, the story of Elpenor, a companion of Ulysses, who
got drunk before going to sleep.
He was suddenly awakened from his sleep by a noise.
In a confusional state, he forgot all about coming down by the main staircase,
and he tumbled right off the roof and broke his neck (Homer, The Odyssey, Book
10).
One of the most well known case reports, and also the first complete description
of murder occurring when the individual is suddenly awakened, appeared in the 17
century (Bonkalo, 1974).
This is the case of a knight who, upon awakening, killed his comrade in arms.
The potential for danger when an individual is abruptly awakened, however, was
already known by primitive tribes, but for other reasons: their belief was that
a sleeper should not be awakened because the soul does not have time to return
to the body (Fraser, 1960).
Obviously, these cases are extreme situations; most of the individuals with such
a disorder will never experience such serious consequences.
Research
We selected a
representative sample from the United
Kingdom, Germany and Italy (N=13,057)
and conducted telephone interviews.
Results
Confusional arousals were reported by 2.9% of
the sample:
-
1% (95% confidence interval: 0.8% to 1.2%) of the sample also presented with
memory deficits (53.9%), disorientation in time and/or space (71%) or slow
mentation and speech (54.4%)
-
and 1.9% (1.7% to 2.1%) reported confusional arousals without associated
features.
Younger subjects (< 35 years) and shift or night workers were at higher risk of
reporting confusional arousals.
How frequent are confusional arousals?
from Ohayon MM et al. The place of
confusional arousals in sleep and mental disorders: General population findings
(13057 subjects). J Nerv Ment Dis 2000; 188:340-348.
These arousals were strongly associated with the presence of a mental disorder
with odd ratios ranging from 2.4 to 13.5.
Bipolar and anxiety disorders were the most
frequently associated mental disorders.
Furthermore, subjects with Obstructive Sleep Apnea Syndrome (OSAS), hypnagogic
or hypnopompic hallucinations, violent or injurious behaviors, insomnia and
hypersomnia are more likely to suffer from confusional arousals.
Confusional arousals appears to occur quite frequently in the general
population, affecting mostly younger subjects regardless of their gender.
Physicians should be aware of the frequent associations between confusional
arousals, mental disorders, and OSAS.
Furthermore,
the high occurrence of confusional arousals in shift
or night workers may increase the likelihood
of inappropriate response by employees sleeping at work.
References
Content of this
page is extracted from:
Ohayon MM, Priest RG, Zulley J, Smirne S. The place of confusional arousals in sleep and
mental disorders: General population findings (13057 subjects). Journal of
Nervous and Mental Diseases 2000; 188:340-348.
|
Legal Notice: you may
not distribute or transmit, modify, reuse, report, or use the content of
this Site for public or commercial or scientific or educational purposes
.png)
Hallucinations
HOME
Online Journal