Waking up feeling groggy (aka sleep inertia) is part and parcel of life, no matter how much ads for mattresses and sleep supplements wish to dupe us into thinking it's the opposite! For the record, the human body isn't designed to wake up with all systems ready to go.
But what if you find your sleep inertia is much more exaggerated than the typical "can't wake up" vibes in the morning? For example, you feel so disoriented when your alarm rings that you think it's an incoming phone call and try to answer instead of silencing it. Maybe you even exhibit worrying behaviors such as losing your sense of balance when you get out of bed or slurring your speech when you ask your family member to pass the jam at the breakfast table.
If that sounds like you, it could be a case of sleep drunkenness, also medically known as confusional arousal.
According to the American Academy of Sleep Medicine, sleep drunkenness usually rears its head during childhood. As many as 17% of children experience this sleep disorder, while 3-4% of adults have it. Over the years, sleep drunkenness has gained greater awareness due to its debilitating impacts on daily life. Ahead, we show you how to "sober up" in the wake of sleep drunkenness and manage this sleep disorder.
Disclaimer: This post is not intended as medical advice. If you suspect you have sleep drunkenness or are diagnosed with it, please consult a licensed healthcare professional for treatment.
Before we talk about sleep drunkenness, let's first understand how sleep inertia occurs relative to sleep homeostasis.
You can think of the sleep homeostat as a seesaw that wants to be perfectly balanced. During wakefulness, adenosine (a drowsiness-inducing compound) builds up in your brain. This burgeoning sleep pressure tilts the sleep homeostat to one side and pushes you off into sleep when your bedtime rolls around.
As you slumber, your brain gradually purges adenosine to rebalance the sleep homeostat. Because adenosine takes a while to dissipate, traces of it still linger in your system when your alarm clock rings. Consequently, you wake up feeling groggy and have the urge to lounge in bed.
Sleep drunkenness disorder, or confusional arousal, is a form of non-rapid eye movement (NREM) sleep parasomnia. Other arousal parasomnias include sleep terrors and sleepwalking.
From a medical perspective, sleep drunkenness is a more severe form of sleep inertia with pernicious consequences for the individual. Three factors can intensify sleep inertia to the degree of sleep drunkenness:
While sleep inertia triggers feelings of sleepiness, disorientation, and impaired cognition, sleep drunkenness takes it several steps further with symptoms such as:
Unlike sleep inertia that only lasts up to 1.5 hours, sleep drunkenness takes its toll on your body for as long as four hours. In that sense, feeling as if you’re drunk on sleep extends far beyond the usual transitional state from sleep to wakefulness.
To complicate matters, sleep drunkenness has many culprits, from lifestyle to medical. We'll focus on the two common triggers that the average person likely encounters: sleep insufficiency and circadian misalignment.
Remember when we mentioned sleep debt earlier? That is the amount of sleep loss you've accrued in the short term (i.e., over 14 days). When you're continually sleep deprived over many months, years, or even decades, you're now parked firmly in the territory of chronic sleep deprivation. (Take note that if you're chronically sleep deprived, you most certainly have acute sleep debt hanging over your head, too.)
A new study in the Journal of Clocks and Sleep confirms that acute and chronic sleep deprivation instigate arousal parasomnias, including episodes of confusional arousal. Even in medical conditions like idiopathic hypersomnia, chronic sleep deprivation leads to sleep drunkenness that manifests as microsleeps (you doze off in an uncontrollable, random manner).
Here's how it works: When you don't get enough hours of sleep per your sleep need, your brain doesn't have sufficient time to burn off the accumulated adenosine. Consequently, your system is infused with a higher concentration of adenosine when morning comes, aggravating your wake-up grogginess to new heights.
For context, the “recycle rate” of the human brain is 16 hours. When you stay awake longer than that, scientists liken the resulting sleep loss as low-level brain damage.
In fact, going 18 hours without sleep is akin to having a blood alcohol concentration (BAC) of 0.05%. And, staying awake for 24 hours straight means your cognitive impairment is that of someone with a BAC of 0.10%, higher than every state’s legal limit. But you don’t need to pull an all-nighter to experience this same result.
If you’ve only slept seven hours for 10 consecutive nights (read: one hour less than the eight that most people need), your brain is now as impaired as if you’ve pulled an all-nighter.
But sleep debt in the short and long term isn't the only trigger you need to worry about.
Your circadian rhythm governs every biological process, including your sleep-wake cycle. When your sleep schedule conflicts with your internal clock, you become circadianally misaligned.
Circadian misalignment affects certain individuals more than others — for example, adolescents who are night owls on an early-bird school timetable and the shift work population on an alternating work roster.
Zeroing in on the latter example, a 1999 study shines a light on how shift workers in the United Kingdom show a significant association with confusional arousal, in which hypersomnia is a risk factor. Another 2015 study uncovered the prevalence of arousal parasomnias concerning different shift work schedules. The study findings are as follows:
On top of that, rotational shift workers reportedly sleep less, which racks up sleep debt, feeding into the first trigger of sleep drunkenness.
To make matters worse, scientific evidence demonstrates the vicious cycle of sleep loss and circadian misalignment. Not meeting your sleep need dysregulates the expression of genes associated with your biological clock. This throws your circadian rhythm off-kilter and exacerbates acute sleep debt.
From a medical perspective, sleep drunkenness is a key characteristic in several health conditions.
According to a population sample of 13,057 individuals, sleep drunkenness is strongly associated with mental health disorders such as bipolar disorder and anxiety disorders (like panic disorder and post-traumatic stress disorder). Various sleep problems and sleep disorders like obstructive sleep apnea, insomnia, hypersomnia, restless legs syndrome, and type 1 narcolepsy also contribute to confusional arousal.
Contrary to popular misconception, sleep drunkenness is often a byproduct (and sometimes, a trigger) of a mix of health issues rather than a sole condition.
Based on a 2018 study in the Journal of Sleep Medicine Reviews, confusional arousal is:
So, what does it all mean? Individuals with DSPS are more likely to experience sleep drunkenness due to their later-than-normal sleep and wake times. If you identify as such, you're more likely to awaken in the middle of your deep sleep cycle (aka slow-wave sleep), a time at which your core body temperature is likely at its lowest to keep you asleep. Both factors escalate sleep inertia to the degree of sleep drunkenness. Not to mention, DSPS-affected individuals are almost always chronically sleep deprived, making their profile a perfect fit for confusional arousal.
Your chronotype may also play a role in the issue of sleep drunkenness. While there isn’t any scientific evidence on the direct link between chronotype and sleep drunkenness yet, studies on chronotype and sleep-wake disruption in mental disorders may help shed some light on the former's relationship. For example, a 2017 systematic review on bipolar disorder and another on anxiety and insomnia highlights a prevalence of evening chronotype, another possible risk factor for this sleep disorder.
Last but not least, certain drugs may trigger or worsen confusional arousal. According to a 2014 study in the Journal of Neurology, 31.3% of confusional arousals were linked to psychotropic medications. The study author, Maurice Ohayon, highlighted that only a minority of the affected individuals use medications, of which "antidepressants were the most common."
Currently, there is no one-size-fits-all treatment option for sleep drunkenness. Most pharmaceutical interventions that tackle confusional arousal are based on individual cases. While more research is needed, existing studies recommend:
Take note that the drugs mentioned earlier only offer small-scale success that may not guarantee effectiveness for the general population. As such, good sleep hygiene is still a more sustainable measure in bolstering your defenses against sleep drunkenness. After all, healthy sleep-promoting habits tackle the two root causes of confusional arousal — sleep debt and circadian misalignment.
Here are some sleep hygiene tips you can put into practice to minimize sleep debt and keep your circadian rhythm aligned to ward off sleep drunkenness:
Of course, these recommendations are just the tip of the iceberg when it comes to sleep hygiene. For the full story on how healthy sleep hygiene counteracts sleep drunkenness, check out our in-depth Sleep Guide.
So, how can you stay "sober" in the face of sleep drunkenness? The RISE app can help. It's designed to help you alleviate high sleep debt and avoid circadian misalignment via a two-pronged approach.
Firstly, the Sleep screen of the app shows your running sleep debt in reference to your unique sleep need. This tells you whether you're in the red zone for sleep deprivation, so you can take steps to bring down your sleep debt before it overwhelms you.
Meanwhile, the Energy Schedule of the app mimics your circadian rhythm. It tells you the exact timing of your daily energy peaks and dips, and comes with 16 science-based habits paired to your unique chronobiology to help you hone your sleep hygiene to reduce your debt.
With the RISE app, you can use optimal sleep hygiene to manage the intensity of sleep drunkenness. The end result? You feel and function at your best to live life to the fullest.
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