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Sleep Disorders

Waking up in middle of the night confused

04/15/2011

Question:

So this all started about a month ago,(first thought it was due to fever from strep throat and medicine, but ive been off it for 11 days now) but ive been having very vivid dreams and it seems like i wake up during these dreams and i feel very confused and disoriented. I got up last night walked into the living room told my husband i know im awake but i feel a sleep still, walked back to bed and few mins later was back a sleep. to me it feels like im stuck in sleep and awaking phase. Other nights i wake up and i have to turn the tv on for about a hour till im fully awake before i can go back to sleep. In the morning i seem fine, i get up and ready for the day.

Answer:

During the period of an illness, our sleep is usually fragmented and sleep architecture is altered. It is not unusual for someone who is ill with strep throat for example to sleep more than their usual time and to sleep in an interrupted fashion. Taking sedating medication, such as Benadryl, although necessary to make the illness tolerable, will worsen sleep structure even more. Vivid dreams, sleep walking, and waking up in a confused state (called confusional arousals) are common manifestations of the sleep disturbance that occurs during an acute illness.

So, it is understandable that you will need some recovery time after an acute illness until your sleep goes back to normal. However, by the time you wrote your question, it seems that enough time has passed since your throat infection that the problem should have resolved. This makes me think that there may be a primary sleep problem that is not caused directly by the throat infection. You may be suffering from confusional arousals.

Confusional arousals are not very common (3-4% of the population) and usually occur mostly in younger individuals, especially children. They typically occur when a person is woken up from a deep sleep during the early part of the night. However, similar events have been described during spontaneous waking in the morning. 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.

These episodes may be caused by underlying sleep disorders or neurological disorders. For example, Sleep Apnea, which causes breathing disturbance during sleep, can precipitate and worsen confusional arousals. Nocturnal Partial Seizures are seizures that occur only during sleep and may mimic these events. Drugs, substances, and medical conditions may precipitate or may exacerbate many of these underlying sleep disorders. It is also possible that you are currently experiencing excessive deep sleep (also known as slow wave sleep or deep sleep rebound) following a lack of deep sleep resulting from you illness. During a post-recovery period, the brain may be trying to make up for lost deep sleep, leading to an increase in this type of sleep during which confusional arousals are more likely to happen.

The management of your problem requires further history, an examination and possibly some sleep investigations. This type of evaluation often starts with your primary care physician, but may require the help of specialist in Sleep Medicine.

Many people with confusional arousals don’t need any particular treatment. It’s possible this problem may resolve with time. If not, then home modifications such as safeguarding room exits, padding the area around the bed, and installing alarms may be enough to reassure the sufferer. When such arousals become a social nuisance, medication use may be necessary. If you decide to discuss this issue with a sleep specialist, please note that the American Academy of Sleep Medicine website contains a list of Sleep Centers across the country so you can locate one near you. I wish you safe and restful sleep.

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Response by:

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