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Sleep Disorders

Confused Arrousal?

11/05/2007

Question:

When I awoke this morning I yelled the first name of someone who is completely unknown to me. I was not completely awake when it happened. The name was audible and very clear, even to my ears. I began to feel very confused. Just before this occurred, I remember looking over at the opposite side of the bed to notice that my wife was not beside me. The TV was on in the background, and a doorbell buzzer had just sounded. I remember still lying down, then propping myself up with my right elbow, and in a very clear voice, yelled "Ashley?!" I remember wanting to know where my wife was, but for some reason the name "Ashley" came out instead. My wife was shocked and became very upset, quickly concluding that I must be involved with a woman by the name of Ashley. Needless to say my waking up became a stressful process that morning as my wife became very upset. I felt quite helpless in the face of this situation, especially since she began accusing me of dreaming about another woman. I could not figure out why I had called out the name Ashley, except that in what seemed liek a few short seconds upon waking I do remember clearly wondering where my spouse was, and feeling confused. I was most cetainly not fully awake. I tried to explain to my wife that I was half awake and wondering where she(my spouse) was. I recall feeling that she had left the house for work. Feelign that she had left without saying goodbye- something I have grown used to. For some reason, I recall a panic coming over me, and I just blurted out the name, "Ashley " instead. But I don`t know anyone by the name of "Ashley". Nor have I ever been involved with, worked with, or had a friend who`s name was Ashley. I remember feeling in my body the desire to call my wife`s name but I was unable to articulate it. My wife`s nmae is very uncommon, has four sylables, and begins with a vowel instead of a consonant. I have searched several sites on sleep disorders which has yielded that I am a Sleep Talker(Somniloquist). I have talked in my sleep since I was a child and have very vivid dreams, taking on a character role at times. However, I am as sure as I have ever been after waking up that I was not dreaming, logical to me moreso because I remember wondering where my spouse was as soon as I notice that she was no longer beside me. My conclusion is that what I have experienced is as close to a definition of a Confused Arrousal as anything else I have been able to find online. It also occured to me that since my brain was half asleep and half awake when I yelled the name "Ashley", my wife`s name has four syllables; in Ashely there are only two. Perhaps my brain was incapable at the time to pronounce a more complex name? I recall a time when we were arguing, and clouded by frustration I mumbled something which sounded like, Ashe. I had orignally included the first name of my wife in this article as I felt it was relevant to compare against the name I uttered but did not feel that was fair to her to do so in a public forum.

When I consider the profanity which sometimes ensues during spousal arguments, it seems logical that I my brain is unable to articulate during moments of stress. Unfortunately, my spouse is not always soscientific in her examination of things. We have had some challenges in the past, but having worked through those this only weakens the situation. I feel quite desparate for some rationale of my involuntary verbal emission. Any advice is impatiently welcomed! Thank you. A very frazzled husband

Answer:

I am glad you have taken the time to research the topic, and I hope the information online has not caused you unnecessary confusion. Your report of the event is quite descriptive and helpful and I understand your distress regarding the whole issue.

Undesirable events that occur during sleep or during transition between wakefulness and sleep are called “Parasomnias”. You seem to have experienced one, or a combination. There are many different parasomnias. A famous one is sleep talking. Less common ones include hypnopompic hallucinations and confusional arousals.

Sleep talking is common in the general population and may occur during dream (REM) sleep or during non-dream (non-REM) sleep. It may be associated with other parasomnias.

Sleep related hallucinations are a prominent, vivid, dream-like mentation that occur at sleep onset (called Hypnagogic), or while waking up (called Hypnopompic). These phenomena are also common (10-20% of the population) and may be associated with sleep paralysis. In sleep paralysis a person may be awake but unable to move other than their eyes and their breathing muscles. This paralysis episode may last up to a few minutes.

Confusional arousals are less common (3-4% of the population) and usually occur when a person is woken up from sleep during the early part of the night. However, similar events have been described during spontaneous waking in the morning (like in your case). During these episodes a person may react inappropriately to his or her environment. Sleep talking is common during confusional arousals. Most episodes last a few minutes. However, some episodes last as long as 30-40 minutes.

Parasomnias may be caused by underlying sleep disorders or neurological disorders. For example, Sleep Apnea, which causes breathing disturbance during sleep, can precipitate and worsen parasomnias. Nocturnal Partial Seizures are seizures that occur only during sleep and may mimic certain parasomnias. Drugs, substances, and medical conditions may precipitate or may exacerbate many of these disorders of sleep. In some cases, no underlying condition is found to explain the parasomnia.

As you see, parasomnias can be a complex problem with several potential underlying causes. The management requires further history, an examination and possibly sleep investigations. This type of evaluation often starts with your primary care physician, but may require the help of a specialist in sleep disorders.

Although disturbing--and in your case, unfortunate--many people with parasomnias learn how to adapt to their disorder with home modifications, and don’t need any particular treatment. Home modifications include safeguarding room exits, padding the area around the bed, and installing alarms. When parasomnias become a social nuisance, medication use may be necessary.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website . This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck, and sleep well.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University